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Review
. 2014 Sep 1;111(35-36):577-83.
doi: 10.3238/arztebl.2014.0577.

Hepatitis E in Germany--an under-reported infectious disease

Sven Pischke  1 , Patrick Behrendt, Claus-Thomas Bock, Wolfgang Jilg, Michael P Manns, Heiner Wedemeyer
Affiliations
Review

Hepatitis E in Germany--an under-reported infectious disease

Sven Pischke et al. Dtsch Arztebl Int. .

Abstract

Background: At least 17% of the population in Germany has been infected with the hepatitis E virus (HEV); thus, HEV infections are more frequent than was previously assumed. However, fewer than 500 HEV infections were reported to the Robert Koch Institute in 2013.

Method: Review of pertinent literature retrieved by a selective search in PubMed.

Results: Persons living in Germany generally acquire hepatitis E infection within the country by consuming infected and undercooked pork; in rare cases, hepatitis E infections are imported from the tropics. HEV can be transmitted via blood products, blood transfusions, and organ transplantation. More than 99% of HEV infections are asymptomatic and self-limiting, but there are also severe cases with acute liver failure. Immunosuppressed persons can develop chronic HEV infection, potentially leading, within a few years, to liver cirrhosis with life-threatening sequelae. Moreover, HEV infection may be associated with extrahepatic manifestations such as Guillain-Barré syndrome. In two retrospectively evaluated case series, ribavirin was found to be active against HEV and can be used to treat either acute or chronic HEV infection.

Conclusion: Hepatitis E must be considered in the differential diagnosis of elevated hepatic enzyme levels and of systemic and neurological conditions of uncertain origin. The infection is usually self-limiting but can take a severe course in immunosuppressed persons. In such cases, ribavirin can be used as an antiviral treatment.

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Figures

Figure 1
Figure 1
Numbers of cases of hepatitis E reported in Germany (red; Robert Koch Institute) and numbers of publications on hepatitis E worldwide (blue; PubMed) in the period 2001 to 2013
Figure 2
Figure 2
Distribution of HEV genotypes
Figure 3
Figure 3
Prevalence of anti-HEV antibodies by age group in Germany (detected by blot procedure [10])
See this image and copyright information in PMC

Comment in

  • Current data.
    Panning M, Umhau M, Emmerich F. Panning M, et al. Dtsch Arztebl Int. 2015 Mar 27;112(13):220. doi: 10.3238/arztebl.2015.0220a. Dtsch Arztebl Int. 2015. PMID: 25869340 Free PMC article. No abstract available.
  • In reply.
    Wedemeyer H, Pischke S. Wedemeyer H, et al. Dtsch Arztebl Int. 2015 Mar 27;112(13):220. doi: 10.3238/arztebl.2015.0220b. Dtsch Arztebl Int. 2015. PMID: 25869341 Free PMC article. No abstract available.

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