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Hepatitis E

8 July 2019

Key facts

  • Hepatitis E is a liver disease caused by infection with a virus known as hepatitis E virus (HEV).
  • Every year, there are an estimated 20 million HEV infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E (1).
  • WHO estimates that hepatitis E caused approximately 44 000 deaths in 2015 (accounting for 3.3% of the mortality due to viral hepatitis).
  • The virus is transmitted via the fecal-oral route, principally via contaminated water.
  • Hepatitis E is found worldwide, but the disease is most common in East and South Asia.
  • A vaccine to prevent hepatitis E virus infection has been developed and is licensed in China, but is not yet available elsewhere.
  • A systematic review on hepatitis E virus globally 
  • WHO also released a position paper based on the SAGE review:

    Recommendations from the position paper are summarized in the WHO response section below.

    Guidelines for epidemic measures

    WHO has published a manual on recognition, investigation and control of waterborne outbreaks of hepatitis E.

    In brief, the following steps are recommended during a suspected outbreak of hepatitis E:

    • verification of the diagnosis and confirmation of existence of an outbreak;
    • determination of the mode of transmission, and identification of the population at increased risk of infection;
    • improvement of sanitary and hygienic practices to eliminate faecal contamination of food and water; and
    • elimination of the source of infection.

    WHO response

    WHO has issued a technical report “Waterborne Outbreaks of Hepatitis E: recognition, investigation and control”. The manual gives information about the epidemiology, clinical manifestations, and diagnosis of hepatitis E. It also provides guidance for public-health authorities on how to respond to outbreaks of hepatitis E infection.

    In 2015, the WHO SAGE on Immunization issued a position paper on hepatitis E which reviewed existing evidence on the burden of hepatitis E, and on the safety, immunogenicity, efficacy, and cost-effectiveness of the licensed hepatitis E vaccine. Regarding the use of the hepatitis E vaccine, it made the following recommendations:

    • WHO recognizes the importance of hepatitis E as a public health problem in many developing countries, particularly among special populations such as pregnant women and individuals living in camps for displaced persons and in outbreak situations.
    • WHO does not make a recommendation on the introduction of the vaccine for routine use in national programmes in populations where epidemic and sporadic hepatitis E disease is common. However, national authorities may decide to use the vaccine based on the local epidemiology.
    • Due to the lack of sufficient information on safety, immunogenicity, and efficacy in the following population subgroups, WHO does not recommend routine use of the vaccine in children aged under 16 years, pregnant women, people with chronic liver disease, people on organ transplant waiting lists, and travellers.
    • There may be special situations such as outbreaks where the risk of hepatitis E or its complications or mortality is particularly high. The current WHO position concerning routine programmes should not preclude the use of the vaccine in these specific situations. In particular, the use of the vaccine to mitigate or prevent outbreaks of hepatitis E should be considered as well as the use of the vaccine to mitigate consequences in high risk groups such as pregnant women.
    • As further data become available, WHO's position on hepatitis E vaccine will be reviewed and updated as necessary on the basis of new information.

    WHO is currently working with experts and global partners to develop a generic protocol for use of the hepatitis E vaccine as an outbreak response intervention. There is also ongoing work with similar groups to create a simplified algorithm for the diagnosis, triage and management of hepatitis E during an outbreak.

    In May 2016, the World Health Assembly adopted the first “Global health sector strategy on viral hepatitis, 2016-2021”. The strategy highlights the critical role of universal health coverage and sets targets that align with those of the Sustainable Development Goals.

    The strategy has a vision to eliminate viral hepatitis as a public health problem. This is encapsulated in the global targets to reduce new viral hepatitis infections by 90% and reduce deaths due to viral hepatitis by 65% by 2030. Actions to be taken by countries and the WHO Secretariat to reach these targets are outlined in the strategy.

    To support countries in achieving the global hepatitis elimination targets under the Sustainable Development Agenda 2030, WHO is working to:

    • raise awareness, promote partnerships and mobilize resources;
    • formulate evidence-based policy and data for action;
    • prevent transmission; and
    • scale up screening, care and treatment services.

    WHO recently published the “Progress report on HIV, viral hepatitis and sexually transmitted infections, 2019”, outlining its progress towards elimination. The report sets out global statistics on viral hepatitis B and C, the rates of new infections, the prevalence of chronic infections and mortality caused by these 2 high-burden viruses, and coverage of key interventions, all current as at the end of 2016 and 2017.

    Since 2011, together with national governments, civil society and partners, WHO has organized annual World Hepatitis Day campaigns (as 1 of its 9 flagship annual health campaigns) to increase awareness and understanding of viral hepatitis. The date of 28 July was chosen because it is the birthday of Nobel-prize winning scientist Dr Baruch Bloomberg, who discovered the hepatitis B virus and developed a diagnostic test and vaccine for it.

    66顺彩票appFor World Hepatitis Day 2019, WHO is focusing on the theme “Invest in eliminating hepatitis” to highlight the need for increased domestic and international funding to scale up hepatitis prevention, testing and treatment services, in order to achieve the 2030 elimination targets.


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