Dirty Hands Disease: Hepatitis E. Symptoms and Treatment of Hepatitis E Viral Hepatitis E

Good day, dear readers!

In today's article, we will continue to consider hepatitis in all its aspects, and next in line is hepatitis E, or, as it is also called, viral hepatitis E, as well as its causes, symptoms, diagnosis, treatment and prevention. So…

What is hepatitis E?

Hepatitis E- an inflammatory infectious disease of the liver, the cause of which is infection of the body with the hepatitis E virus (HEV). In severe cases, the infection can also affect the kidneys. The main mechanism of infection is the fecal-oral route.

The main danger of infection with the hepatitis E virus is the acute course of the disease in pregnant women with frequent adverse pregnancy outcomes in the last trimester, leading both mother and fetus to death. In other cases, this disease usually proceeds benignly, often a person even heals on his own, usually 2-6 weeks after the disease.

Diagnosis of hepatitis E includes the following tests and examination methods:

• History taking and visual examination of the patient;
• PCR method (polymerase chain reaction) with reverse transcriptase (RT-PCR);
• Blood test for markers of viral hepatitis A, B and E - IgM (anti-HEV IgM) and IgG;
• Biochemical analysis of feces;
• bodies abdominal cavity.

Additionally, a liver biopsy may be ordered.

Hepatitis E treatment begins with a visit to an infectious disease specialist and a thorough examination of the body. This is a mandatory step in effective treatment hepatitis E, thanks to which it will be possible to exclude possible secondary infections and diseases, especially other, more serious types of hepatitis (A, B and C).

If no complications of hepatitis E are detected, the patient is not a pregnant woman, and a transient process of the development of the disease is not detected, hospitalization and antiviral treatment are not applied, because. The human immune system is strong enough to deal with the infection on its own. In these cases, symptomatic treatment is prescribed - to eliminate nausea and vomiting, drugs to restore liver cells.

Otherwise, therapy for hepatitis E usually consists of the following:

1. Hospitalization and bed rest (if necessary);
2. Drug therapy:
2.1. antiviral therapy;
2.2. Therapy aimed at maintaining liver health;
2.3. Detoxification therapy;
2.4. Support for the patient's immune system;
2.5. Relief of symptoms of viral hepatitis E.
3. Diet.
4. Good rest.

Treatment for viral hepatitis E includes:

2. Drug therapy (drugs for hepatitis E)

Important! Before use medicines Be sure to consult with your doctor!

2.1. Antiviral therapy

To stop the infection in the body - the HEV virus, the use of the following antiviral drugs is indicated, sometimes in combination with each other:

• Group of alpha interferons - "Alfaferon", "Interferon";
• Nucleoside analogues - Adefovir, Lamivudine;
• "Ribavirin" (categorically contraindicated in pregnancy!)

The course of admission is prescribed by the attending physician.

2.2. Liver health therapies

Due to the fact that hepatitis viruses settle and affect primarily the liver, it must be supported. To strengthen the liver cells, as well as their recovery, hepatoprotectors are prescribed.

Among the hepatoprotectors, one can distinguish: "Hepatosan", "", "Legalon", "Ursonan", "".

To speed up the recovery of hepatocytes, ursodeoxycholic acid (UDCA) is sometimes additionally prescribed: "Ursodex", "Ursor".

2.3. Detox Therapy

When it enters the body, the infection poisons it with its waste products (toxins), which can cause such unpleasant symptoms as nausea, vomiting, and fever. To prevent this from happening, detoxification therapy is used, aimed at adsorbing toxins and removing them from the body.

Among the detoxification drugs, the following agents can be distinguished: "Atoxil", "Albumin", glucose solution (5%), "Enterosgel".

2.4. Support for the patient's immune system

The immune system, the main role of which is to protect the body from infection and other adverse factors for the normal functioning of the body, in case of illness, needs to be reinforced. In a healthy state, the immune system will additionally or in the main role destroy the infection.

As immunostimulants, one can note: Vilozen, Zadaksin, Timogen, especially (ascorbic acid), (tocopherol) and.

Among the natural sources of vitamin C, scientists note - cranberries and other natural products.

2.5. Relief of symptoms of viral hepatitis E:

To alleviate the course of hepatitis E, symptomatic drugs are usually prescribed.

For nausea and vomiting:"", "Pipolfen", "".

Against insomnia, anxiety- sedatives: Valerian, Tenoten.

3. Diet for hepatitis E

In hepatitis E, a therapeutic nutrition system developed by M.I. Pevzner - which is also prescribed in the treatment of cirrhosis of the liver and.

The basis of the diet is:

• drinking plenty of water (2-3 liters of liquid / day), fresh juices have an especially beneficial effect on the body (be careful during pregnancy!);
• sparing soups;
• steamed porridge;
• fresh vegetable salads.

For any hepatitis, it is strictly forbidden to drink alcohol, as well as spicy, salty, fried, fatty, canned and smoked foods, fast food, chips, crackers and other unhealthy and. You should also stop smoking and using drugs.

3. Complete rest

A proper rest for any disease is also necessary, like a breath of air, because. it contributes to the accumulation of forces to fight infection, as well as the removal of neurological disorders, for example,.

Treatment prognosis

The prognosis for the treatment of hepatitis E is very favorable, and in many cases, even without the intervention of doctors, and with the strengthening of the immune system, recovery comes on its own.

Even during pregnancy, with a timely visit to the attending physician, the positive result for the recovery of both the mother and the unborn child is quite high.

But even if the doctors do not promise anything good, remember, you can always turn to God in prayer, because the Lord is much stronger and wiser than any person, and His love for His creation is very great, like mercy!

Important! Before use folk methods treatment, be sure to consult your doctor!

Folk remedies against hepatitis E are aimed only at maintaining the liver during drug therapy of hepatitis, as well as at restoring liver cells during the recovery period.

An infectious lesion of the liver includes a disease such as hepatitis E. Infection occurs by the fecal-oral route and is characterized by an acute form of the course. Hepatitis of this group is especially dangerous for women in position. The duration of the incubation period is from several weeks to 2 months. The symptomatology of the disease is similar to hepatitis A. Hepatitis can be detected using differential diagnosis, instrumental and laboratory studies. In the treatment of group E diseases, the body is detoxified and special nutrition is prescribed.

general information

The hepatitis E virus infects the liver and kidneys.

Viral hepatitis E is most similar to hepatitis A in terms of signs and course of the disease. The first disease is distinguished by a more acute course and quickly causes complications. For hepatitis E, it is common to affect not only the liver, but also the kidneys. With untimely detection and treatment, the disease is fatal for pregnant women. This is due to the fact that the disease causes acute encephalopathy, which in half of the cases ends in the death of the fetus and woman. Diagnostic procedures for hepatitis E often provoke spontaneous miscarriage or fetal death.

How is it transmitted?

The causative agent of this type of hepatitis is a virus of the genus Calicivirus, which is less resistant to the influence of the external environment. The causative agents of this group are able to survive long time in the body, if comfortable thermal conditions are created (about 20 degrees). Often, the microorganisms of the virus live in patients and people who have an infectious disease. The incubation period of hepatitis E lasts from 14 days to several months.

The most common route of transmission is contaminated water.

Ways of transmission of infection occur in the alimentary way, in most cases through water. Sometimes the infection is transmitted to a person through unwashed dishes or household items. Often, a viral infection penetrates through the oral cavity, through the use of raw shellfish. An epidemic of hepatitis E has been seen in regions where there are problems with water treatment and people often consume contaminated liquid.

Doctors have noticed cases of infection through the blood, when a transfusion was made from a sick donor with asymptomatic hepatitis E. In most cases, the disease occurs in men and people aged 15 to 45 years. You need to be careful when you are pregnant at 30 weeks, because during this period the likelihood of infection increases significantly.

Features of the flow

In its course, the pathology resembles hepatitis A. After a person consumes contaminated water and food, after a certain period, damage to the cells of the hepatic parenchyma occurs. This leads to impaired liver function and intoxication of the body. The disease is noted from all hepatitis by the complexity and severity of the course. There are many symptoms that are often fatal.

Main symptoms

In the first stages of the disease, a person feels a constant weakness of the whole organism.

The hepatitis E virus may not appear for a long time and develop in a latent form. The incubation period lasts an average of one month. Gradually, a person begins to be disturbed by various minor symptoms, to which the patient does not attach much importance. The first sign of deviation is pain in the right hypochondrium. The following symptoms are observed:

• general weakness and fatigue;
• loss of appetite;
• aches in the joints;
• high body temperature;
• darkening of urine;
• discoloration of feces.

A week later, the patient experiences yellowing of the sclera of the eyes, skin and mucous membranes of the oral cavity.

Unlike hepatitis A, group E disease is manifested by an increase in symptoms after jaundice. As the disease progresses, itching of the skin is added to the main symptoms due to an increased concentration of bile acids in the blood. Over time, the liver enlarges and its function is disrupted. Often a few weeks after the onset of symptoms, regression of the disease occurs, which lasts up to 2 months. And sometimes the pathology is actively progressing and causes a number of complications. Patients often develop hemolytic syndrome and acute liver failure. With hemorrhage, bleeding occurs in the stomach, intestines, or uterus. Often this type of hepatitis causes cirrhosis of the liver.

Diagnosis of hepatitis E

One of the most common methods of instrumental diagnostics is ultrasound.

In diagnostic procedures, it is important to identify the antigens of a viral disease by means of a PCR reaction. In the process of diagnosis, IgM and IgG to pathology antigens are detected. To find out? whether liver function is impaired, instrumental and laboratory tests should be performed:

• ultrasound examination of the liver;
• coagulogram, which determines blood clotting;
• liver tests;
• magnetic resonance imaging;
• donating blood for viral markers of hepatitis.

Often, differential diagnostic methods are used, which take into account the anamnesis of the patient's region of residence. For pregnant women, a study with markers of a viral disease is used. This is due to the fact that hepatitis E is often manifested during pregnancy and is extremely dangerous. With untimely diagnosis and lack of therapy, a fatal outcome threatens.

Complex treatment

To eliminate the hepatitis E virus, you should undergo special treatment, which consists in a special diet and medication. All treatment takes place in a hospital under the supervision of a doctor. To eliminate the symptoms, drugs of various spectrums of action are prescribed. They are aimed at preventing the development of liver or kidney failure.

Medical treatment

Most medications are given intravenously.

In most cases, the disease shows detoxification drugs that are injected into the vein. Doctors prescribe "Hemodez" intravenously and a glucose solution. Drug therapy includes isotonic sodium chloride solution and agents containing potassium and magnesium. As preventive measures and elimination of hemorrhagic syndrome shows the reception of "Trental" and "Ditsinon".

Viral hepatitis- this is a group of common and dangerous infectious diseases for humans, which differ quite significantly from each other, are caused by different viruses, but still have one thing in common - this is a disease that primarily affects the human liver and causes inflammation. Therefore, viral hepatitis different types often grouped together under the name "jaundice" - one of the most common symptoms of hepatitis.

Epidemics of jaundice have been described as early as the 5th century BC. Hippocrates, but the causative agents of hepatitis were discovered only in the middle of the last century. In addition, it should be noted that the concept of hepatitis B modern medicine can denote not only independent diseases, but also one of the components of a generalized, that is, affecting the body as a whole, pathological process.

Hepatitis (a, b, c, d), i.e. inflammatory liver disease, is possible as a symptom of yellow fever, rubella, herpes, AIDS and some other diseases. There is also toxic hepatitis, which includes, for example, liver damage due to alcoholism.

We will talk about independent infections - viral hepatitis. They differ in origin (etiology) and course, however, some symptoms various kinds of this disease are somewhat similar to each other.

Classification of viral hepatitis

Classification of viral hepatitis is possible on many grounds:

The danger of viral hepatitis

Especially dangerous for human health hepatitis viruses B and C. The ability to exist in the body for a long time without noticeable manifestations leads to severe complications due to the gradual destruction of liver cells.

Another one salient feature viral hepatitis is what anyone can get infected. Of course, in the presence of factors such as blood transfusion or work with it, drug addiction, promiscuity, the risk of contracting not only hepatitis, but also HIV increases. Therefore, for example, healthcare workers should regularly donate blood for markers of hepatitis.

But you can also become infected after a blood transfusion, an injection with a non-sterile syringe, after an operation, a visit to the dentist, in a beauty parlor or for a manicure. Therefore, a blood test for viral hepatitis is recommended for anyone exposed to any of these risk factors.

Hepatitis C can also cause extrahepatic manifestations such as autoimmune diseases. The constant fight against the virus can lead to a perverted immune response to the body's own tissues, resulting in glomerulonephritis, skin lesions, etc.

Important: in no case should the disease be left untreated, since in this case the risk of its transition to a chronic form or rapid damage to the liver is higher.

Therefore, the only available way to protect yourself from the consequences of hepatitis infection is to rely on early diagnosis with the help of tests and subsequent visits to a doctor.

Forms of hepatitis

Acute hepatitis

The acute form of the disease is the most typical for all viral hepatitis. Patients have:

• deterioration of well-being;
• severe intoxication of the body;
• liver dysfunction;
• development of jaundice;
• an increase in the amount of bilirubin and transaminase in the blood.

With adequate and timely treatment, acute hepatitis ends complete recovery of the patient.

chronic hepatitis

If the disease lasts more than 6 months, then the patient is diagnosed with chronic hepatitis. This form is accompanied by severe symptoms (asthenovegetative disorders, enlargement of the liver and spleen, metabolic disorders) and often leads to cirrhosis of the liver, the development of malignant tumors.

Human life is in danger when chronic hepatitis, the symptoms of which indicate damage to vital organs, is aggravated by improper treatment, reduced immunity, and alcohol addiction.

General symptoms of hepatitis

jaundice appears with hepatitis as a result of bilirubin, which is not processed in the liver, enters the bloodstream. But it is not uncommon for the absence of this symptom in hepatitis.

Usually hepatitis in the initial period of the disease manifests flu symptoms. It notes:

• temperature increase;
• body aches;
• headache;
• general malaise.

As a result of the inflammatory process, the patient's liver increases and its membrane stretches; at the same time, a pathological process may occur in the gallbladder and pancreas. All this is accompanied pain in the right hypochondrium. Pain often have a long course, aching or dull character. But they can be sharp, intense, paroxysmal and give to the right shoulder blade or shoulder.

Descriptions of symptoms of viral hepatitis

Hepatitis A

Hepatitis A or Botkin's disease is the most common form of viral hepatitis. Its incubation period (from the moment of infection to the appearance of the first signs of the disease) is from 7 to 50 days.

Causes of Hepatitis A

Hepatitis A is most widespread in the countries of the "third world" with their low sanitary and hygienic standard of living, however, isolated cases or outbreaks of hepatitis A are possible even in the most developed countries of Europe and America.

The most common mode of transmission of the virus is through close household contact between people and ingestion of food or water contaminated with faecal material. Hepatitis A is also transmitted through dirty hands, so children most often fall ill with it.

Symptoms of Hepatitis A

The duration of hepatitis A disease can vary from 1 week to 1.5-2 months, and the recovery period following the disease sometimes stretches up to six months.

The diagnosis of viral hepatitis A is made taking into account the symptoms of the disease, anamnesis (that is, the possibility of the onset of the disease due to contact with patients with hepatitis A is taken into account), as well as diagnostic data.

Hepatitis A treatment

Of all forms, viral hepatitis A is considered the most favorable in terms of prognosis, it does not cause severe consequences and often ends spontaneously, without requiring active treatment.

If necessary, hepatitis A is treated successfully, usually in a hospital setting. During illness, bed rest is recommended for patients, a special diet and hepatoprotectors are prescribed - drugs that protect the liver.

Prevention of hepatitis A

The main measure for the prevention of hepatitis A is the observance of hygiene standards. In addition, children are recommended to be vaccinated against this type of viral hepatitis.

Hepatitis B

Hepatitis B or serum hepatitis is a much more dangerous disease characterized by severe liver damage. The causative agent of hepatitis B is a virus containing DNA. The outer shell of the virus contains a surface antigen - HbsAg, which causes the formation of antibodies to it in the body. Diagnosis of viral hepatitis B is based on the detection of specific antibodies in the blood serum.

Viral hepatitis b remains infective in the blood serum at 30-32 degrees Celsius for 6 months, at minus 20 degrees Celsius - 15 years, after warming up to plus 60 degrees Celsius - for an hour, and only with a 20-minute boil she disappears completely. That is why viral hepatitis B is so common in nature.

How is hepatitis B transmitted?

Infection with hepatitis B can occur through the blood, as well as through sexual contact and vertically - from mother to fetus.

Symptoms of Hepatitis B

In typical cases, hepatitis B, like Botkin's disease, begins with the following symptoms:

• temperature increase;
• weaknesses;
• pain in the joints;
• nausea and vomiting.

Symptoms such as dark urine and discoloration of feces are also possible.

Other symptoms of viral hepatitis B may also appear:

• rashes;
• enlargement of the liver and spleen.

Jaundice for hepatitis B is uncharacteristic. Liver damage can be extremely severe and, in severe cases, lead to cirrhosis and liver cancer.

Hepatitis B treatment

Treatment of hepatitis B requires an integrated approach and depends on the stage and severity of the disease. In the treatment, immune preparations, hormones, hepatoprotectors, antibiotics are used.

To prevent the disease, vaccination is used, which is carried out, as a rule, in the first year of life. It is believed that the duration of post-vaccination immunity to hepatitis B is at least 7 years.

Hepatitis C

The most severe form of viral hepatitis is hepatitis C or post-transfusion hepatitis. Hepatitis C virus infection can affect anyone and is more common in younger people. The incidence is on the rise.

This disease is called post-transfusion hepatitis due to the fact that infection with viral hepatitis C most often occurs through the blood - during blood transfusion or through non-sterile syringes. Currently, all donated blood must be tested for the hepatitis C virus. Sexual transmission of the virus or vertical transmission from mother to fetus is less common.

How is hepatitis C transmitted?

There are two ways of transmission of the virus (as with viral hepatitis B): hematogenous (i.e. through the blood) and sexual. The most common route is hematogenous.

How infection occurs

At blood transfusion and its components. This used to be the main mode of infection. However, with the advent of the method laboratory diagnostics viral hepatitis C and with its introduction into the mandatory list of donor screenings, this path has faded into the background.

The most common way at present is infection with tattooing and piercing. The use of poorly sterilized, and sometimes not treated instruments at all, has led to a sharp surge in the incidence.

Often, infection occurs when visiting dentist, manicure rooms.

Using common needles for intravenous drug use. Hepatitis C is extremely common among drug addicts.

Using general with a sick person of toothbrushes, razors, nail scissors.

The virus can be transmitted from mother to child at the time of birth.

At sexual contact: this route is not so relevant for hepatitis C. Only 3-5% of cases of unprotected sex can become infected.

Injection with infected needles: this mode of infection is not uncommon among medical workers.

In about 10% of patients with hepatitis C, the source remains unexplained.

Hepatitis C Symptoms

There are two forms of the course of viral hepatitis C - acute (relatively short period, severe) and chronic (prolonged course of the disease). Most people, even in the acute phase, do not notice any symptoms, however, in 25-35% of cases, signs similar to other acute hepatitis appear.

Symptoms of hepatitis usually appear after 4-12 weeks after infection (however, this period can be within 2-24 weeks).

Symptoms of acute hepatitis C

• Loss of appetite.
• Abdominal pain.
• Dark urine.
• Light chair.

Symptoms of chronic hepatitis C

As with the acute form, people with chronic hepatitis C often do not experience any symptoms in the early or even late stages of the disease. Therefore, it is not uncommon for a person to be surprised to learn that he is sick after a random blood test, for example, when going to the doctor in connection with a common cold.

Important: you can be infected for years and not know it, which is why hepatitis C is sometimes called the "silent killer".

If the symptoms still appear, then they are likely to be as follows:

• Pain, swelling, discomfort in the area of ​​the liver (in the right side).
• Fever.
• Muscle pain, joint pain.
• Decreased appetite.
• Weight loss.
• Depression.
• Jaundice (yellow tint to the skin and sclera of the eyes).
• Chronic fatigue, rapid fatigue.
• Vascular "asterisks" on the skin.

In some cases, as a result of the immune response of the body, damage can develop not only to the liver, but also to other organs. For example, kidney damage called cryoglobulinemia may develop.

In this condition, there are abnormal proteins in the blood that become solid when the temperature drops. Cryoglobulinemia can lead to consequences ranging from skin rashes to severe kidney failure.

Diagnosis of viral hepatitis C

Differential diagnosis is similar to that for hepatitis A and B. It should be borne in mind that the icteric form of hepatitis C, as a rule, occurs with mild intoxication. The only reliable confirmation of hepatitis C is the results of marker diagnostics.

Given the large number of anicteric forms of hepatitis C, it is necessary to carry out marker diagnostics of persons who systematically receive a large number of injections (primarily intravenous drug users).

Laboratory diagnosis of the acute phase of hepatitis C is based on the detection of viral RNA in PCR and specific IgM by various serological methods. If hepatitis C virus RNA is detected, genotyping is desirable.

The detection of serum IgG to antigens of viral hepatitis C indicates either a previous illness or the ongoing persistence of the virus.

Treatment of viral hepatitis C

Despite all the terrible complications that hepatitis C can lead to, in most cases the course of hepatitis C is favorable - for many years, the hepatitis C virus may not show up.

At this time, hepatitis C does not require special treatment - only careful medical monitoring. It is necessary to regularly check liver function, at the first signs of activation of the disease should be carried out antiviral therapy.

Currently, 2 antiviral drugs are used, which are most often combined:

• interferon-alpha;
• ribavirin.

Interferon-alpha is a protein that the body synthesizes on its own in response to a viral infection, i.e. it is actually a component of natural antiviral protection. In addition, interferon-alpha has antitumor activity.

Interferon-alpha has many side effects, especially when administered parenterally, ie. in the form of injections, as it is usually used in the treatment of hepatitis C. Therefore, treatment should be carried out under mandatory medical supervision with the regular determination of a number of laboratory parameters and the appropriate dosage adjustment of the drug.

Ribavirin as an independent treatment has low efficiency, but when combined with interferon, it significantly increases its effectiveness.

Traditional treatment quite often leads to a complete recovery from chronic and acute forms of hepatitis C, or to a significant slowdown in the progression of the disease.

Approximately 70-80% of people with hepatitis C develop the chronic form of the disease, which is the greatest danger, as this disease can lead to the formation of a malignant tumor of the liver (that is, cancer) or cirrhosis of the liver.

When hepatitis C is combined with other forms of viral hepatitis, the patient's condition can deteriorate sharply, the course of the disease can become more complicated and lead to death.

The danger of viral hepatitis C is also that an effective vaccine that can protect healthy person from infection, currently does not exist, although scientists are making a lot of efforts in this direction of preventing viral hepatitis.

How long do people live with hepatitis C

Based on medical experience and research in this field, life with hepatitis C is possible and even long enough. A common disease, in other matters, like many others, has two stages of development: remission and exacerbation. Often hepatitis C does not progress, that is, does not lead to cirrhosis of the liver.

It must be said right away that lethal cases, as a rule, are not associated with the manifestation of the virus, but with the consequences of its effects on the body and general disturbances in the functioning of various organs. It is difficult to specify a specific period during which pathological changes incompatible with life.

Various factors influence the rate of progression of hepatitis C:

According to the statistics of the World Health Organization, there are more than 500 million people in whose blood a virus or pathogenic antibodies are found. These data will only go up every year. The number of cases of cirrhosis of the liver has increased by 12 percent worldwide over the past decade. The average age category is 50 years.

It should be noted that in 30% of cases the progression of the disease is very slow and lasts about 50 years. In some cases, fibrotic changes in the liver are quite insignificant or absent even if the infection lasts for several decades, so you can live with hepatitis C for quite a long time. So, with complex treatment, patients live 65-70 years.

Important: if appropriate therapy is not carried out, then life expectancy is reduced to an average of 15 years after infection.

Hepatitis D

Hepatitis D or delta hepatitis differs from all other forms of viral hepatitis in that its virus cannot multiply in the human body separately. To do this, he needs a "helper virus", which becomes the hepatitis B virus.

Therefore, delta hepatitis can be considered rather than as an independent disease, but as a complicating course of hepatitis B, a companion disease. When these two viruses coexist in the patient's body, a severe form of the disease occurs, which doctors call superinfection. The course of this disease resembles that of hepatitis B, but the complications characteristic of viral hepatitis B are more common and more severe.

Hepatitis E

Hepatitis E in its characteristics, it is similar to hepatitis A. However, unlike other types of viral hepatitis, in severe hepatitis E, there is a pronounced lesion not only of the liver, but also of the kidneys.

Hepatitis E, like hepatitis A, has a fecal-oral infection mechanism, is common in countries with a hot climate and poor water supply to the population, and the prognosis for recovery is favorable in most cases.

Important: the only group of patients for whom infection with hepatitis E can be fatal is women in the last trimester of pregnancy. In such cases, mortality can reach 9-40% of cases, and the fetus dies in almost all cases of hepatitis E in a pregnant woman.

Prevention of viral hepatitis in this group is similar to the prevention of hepatitis A.

Hepatitis G

Hepatitis G- the last representative of the family of viral hepatitis - in its symptoms and signs resembles viral hepatitis C. However, it is less dangerous, since the progression of the infectious process inherent in hepatitis C with the development of liver cirrhosis and liver cancer is not typical for hepatitis G. However, the combination of hepatitis C and G can lead to cirrhosis.

Medicines for hepatitis

Which doctors to contact with hepatitis

Tests for hepatitis

To confirm the diagnosis of hepatitis A, a biochemical blood test is sufficient to determine the concentration of liver enzymes, protein and bilirubin in the plasma. The concentration of all these fractions will be increased due to the destruction of liver cells.

Biochemical blood tests also help determine the activity of the course of hepatitis. It is by biochemical parameters that one can get an impression of how aggressively the virus behaves in relation to liver cells and how its activity changes over time and after treatment.

To determine infection with the other two types of virus, a blood test is carried out for antigens and antibodies to hepatitis C and B. Blood tests for hepatitis can be taken quickly, without spending much time, but their results will allow the doctor to obtain detailed information.

By assessing the number and ratio of antigens and antibodies to the hepatitis virus, you can find out about the presence of infection, exacerbation or remission, as well as how the disease responds to treatment.

Based on the data of blood tests in dynamics, the doctor can adjust his appointments and make a forecast for the further development of the disease.

diet for hepatitis

The diet for hepatitis is as sparing as possible, since the liver, which is directly involved in digestion, is damaged. For hepatitis, frequent small meals.

Of course, one diet for the treatment of hepatitis is not enough, drug therapy is also needed, but proper nutrition plays a very important role and favorably affects the well-being of patients.

Diet reduces pain and improves general state. During an exacerbation of the disease, the diet becomes more strict, during periods of remission - more free.

In any case, it is impossible to neglect the diet, because it is the reduction in the load on the liver that can slow down and alleviate the course of the disease.

What can you eat with hepatitis

Foods that can be included in the diet with this diet:

• lean meats and fish;
• low-fat dairy products;
• inedible flour products, lingering cookies, yesterday's bread;
• eggs (only protein);
• cereals;
• boiled vegetables.

What not to eat with hepatitis

The following foods should be excluded from your diet:

• fatty meats, duck, goose, liver, smoked meats, sausages, canned food;
• cream, fermented baked milk, salty and fatty cheeses;
• fresh bread, puff and pastry, fried pies;
• fried and hard-boiled eggs;
• pickled vegetables;
• fresh onions, garlic, radishes, sorrel, tomatoes, cauliflower;
• butter, lard, cooking fats;
• strong tea and coffee, chocolate;
• alcoholic and carbonated drinks.

Prevention of hepatitis

Hepatitis A and hepatitis E, which are transmitted by the fecal-oral route, are quite easy to prevent if basic hygiene rules are followed:

• wash hands before eating and after going to the toilet;
• do not eat unwashed vegetables and fruits;
• do not drink raw water from unknown sources.

For children and adults at risk, there is hepatitis A vaccination, but it is not included in the mandatory vaccination calendar. Vaccination is carried out in case of an epidemic situation in terms of the prevalence of hepatitis A, before traveling to areas unfavorable for hepatitis. Hepatitis A vaccination recommended for workers preschool institutions and physicians.

As for hepatitis B, D, C and G, transmitted through the infected blood of a patient, their prevention is somewhat different from the prevention of hepatitis A. First of all, it is necessary to avoid contact with the blood of an infected person, and since hepatitis is enough to transmit the hepatitis virus the minimum amount of blood, then infection can occur when using one razor, nail scissors, etc. All these devices must be individual.

As for the sexual transmission of the virus, it is less likely, but still possible, so sexual contact with unverified partners should take place only using a condom. Increases the risk of contracting hepatitis intercourse during menstruation, defloration, or other situations in which sexual contact is associated with the release of blood.

The most effective protection against hepatitis B infection today is considered to be vaccination. In 1997, hepatitis B vaccination was included in the mandatory vaccination schedule. Three vaccinations against hepatitis B are carried out in the first year of a child's life, and the first vaccination is given in the maternity hospital, a few hours after the birth of the baby.

Adolescents and adults are vaccinated against hepatitis B on a voluntary basis, and experts strongly recommend such a vaccination to representatives of the risk group.

Recall that the risk group includes the following categories of citizens:

• employees of medical institutions;
• patients who received blood transfusions;
• drug addicts.

In addition, people who live or travel in areas with a high prevalence of hepatitis B virus, or who have family contact with people with hepatitis B or carriers of the hepatitis B virus.

Unfortunately, vaccines to prevent hepatitis C are currently does not exist. Therefore, its prevention is reduced to the prevention of drug addiction, mandatory testing of donor blood, explanatory work among adolescents and young people, etc.

Questions and answers on the topic "Viral hepatitis"

Question:Hello, what is a healthy carrier of hepatitis C?

Answer: A hepatitis C carrier is a person who has the virus in their blood and does not show any symptoms. This condition can last for years while the immune system keeps the disease at bay. Carriers, being a source of infection, must constantly take care of the safety of their loved ones and, if they wish to become parents, carefully approach the issue of family planning.

Question:How do I know if I have hepatitis?

Answer: Get a blood test for hepatitis.

Question:Hello! I am 18 years old, hepatitis B and C negative, what does this mean?

Answer: The analysis showed the absence of hepatitis B and C.

Question:Hello! My husband has hepatitis B. I recently had my last hepatitis B vaccine. A week ago, my husband's lip cracked, now it doesn't bleed, but the crack hasn't healed yet. Is it better to stop kissing until it heals completely?

Answer: Hello! It is better to cancel, and you to pass anti-hbs, hbcorab total, PCR quality for him.

Question:Hello! I did a trimmed manicure in the salon, my skin was injured, now I’m worried, after what time should I be tested for all infections?

Answer: Hello! Contact an infectious disease specialist to decide on an emergency vaccination. After 14 days, you can take a blood test for RNA and DNA of hepatitis C and B viruses.

Question:Hello, please help: I ​​was recently diagnosed with chronic hepatitis b with low activity (hbsag +; dna pcr +; dna 1.8 * 10 in 3 tbsp. IU / ml; alt and ast are normal, other indicators in the biochemical analysis are normal ; hbeag - ; anti-hbeag +). The doctor said that no treatment is required, no diet is needed, however, I have repeatedly come across information on various sites that all chronic hepatitis is treated, and there is even a small percentage of complete recovery. So maybe you should start treatment? Also, I've been using it for over a year now. hormonal drug prescribed by the doctor. This drug adversely affects the liver. But it is impossible to cancel it, what to do in this case?

Answer: Hello! Observe regularly, follow a diet, exclude alcohol, it is possible to prescribe hepatoprotectors. HTP is currently not required.

Question:Hello, I am 23 years old. Recently, I had to take tests for a medical examination, and this is what was found out: the analysis for hepatitis B is deviating from the norm. Do I have a chance to pass a medical examination for contract service with such results? I was vaccinated against hepatitis B in 2007. I have never observed any symptoms related to the liver. Jaundice did not hurt. Nothing bothered. Last year, for six months I took SOTRET 20 mg per day (there were problems with the skin of the face), nothing more special.

Answer: Hello! Probably transferred viral hepatitis B with recovery. The chance depends on the diagnosis made by the hepatological commission.

Question:Maybe the question is in the wrong place, tell me who to contact. The child is 1 year and 3 months old. We want to vaccinate him against infectious hepatitis. How can this be done and are there any contraindications.

Answer:

Question:What should other family members do if the father has hepatitis C?

Answer: Viral hepatitis C refers to the "blood infections" of a person with a parenteral mechanism of infection - during medical manipulations, blood transfusions, during sexual intercourse. Therefore, at the household level in family foci for other family members, there is no danger of infection.

Question:Maybe the question is in the wrong place, tell me who to contact. baby is 1 year and 3 months old. We want to vaccinate him against infectious hepatitis. How can this be done and are there any contraindications.

Answer: Today it is possible to vaccinate a child (as well as an adult) against viral hepatitis A (infectious), against viral hepatitis B (parenteral or "blood") or by a combined vaccination (hepatitis A + hepatitis B). Vaccination against hepatitis A is single, against hepatitis B - three times at intervals of 1 and 5 months. Contraindications are standard.

Question:I have a son (25 years old) and a daughter-in-law (22 years old) with hepatitis G, they live with me. In addition to the eldest son, I have two more sons of 16 years old. Is hepatitis ji contagious to others? Can they have children and how this infection will affect the health of the child.

Answer: Viral hepatitis G is not transmitted by contact and is not dangerous for your younger sons. A woman infected with hepatitis G can give birth to a healthy child in 70-75% of cases. Since this is generally a fairly rare type of hepatitis, and even more so in two spouses at the same time, to exclude a laboratory error, I recommend repeating this analysis again, but in a different laboratory.

Question:How effective is the hepatitis B vaccine? What are the side effects of this vaccine? What should be the vaccination plan if a woman is going to become pregnant in a year? What are the contraindications?

Answer: Vaccination against viral hepatitis B (performed three times - 0, 1 and 6 months) is highly effective, cannot lead to jaundice on its own and has no side effects. There are practically no contraindications. Women who are planning a pregnancy and have not had rubella and chickenpox, in addition to hepatitis B, must also be vaccinated against rubella and chickenpox, but no later than 3 months before pregnancy.

Question:What to do about hepatitis C? To treat or not to treat?

Answer: Viral hepatitis C should be treated in the presence of three main indicators: 1) the presence of cytolysis syndrome - elevated levels of ALT in whole and diluted 1:10 blood serum; 2) a positive test result for antibodies of the immunoglobulin M class to the core antigen of the hepatitis C virus (anti-HCVcor-Ig M) and 3) detection of hepatitis C virus RNA in the blood by polymerase chain reaction (PCR). Although the final decision should still be made by the attending physician.

Question:Hepatitis A (jaundice) was diagnosed in our office. What should we do? 1. Should the office be disinfected? 2. When does it make sense for us to get tested for jaundice? 3. Should we limit contact with families now?

Answer: Disinfection in the office should be done. Analyzes can be taken immediately (blood for ALT, antibodies to HAV - hepatitis A virus classes of immunoglobulins M and G). It is desirable to limit contacts with children (before testing or up to 45 days after the discovery of a case of the disease). After clarifying the situation of healthy non-immune employees (negative test results for IgG antibodies to HAV), it is advisable to vaccinate against viral hepatitis A, as well as hepatitis B - in order to prevent similar crises in the future.

Question:How is the hepatitis virus transmitted? And how not to get sick.

Answer: Hepatitis A and E viruses are transmitted with food and drink (the so-called fecal-oral route of transmission). Hepatitis B, C, D, G, TTV are transmitted through medical manipulations, injections (for example, among injecting drug users using one syringe, one needle and a common “shirk”), blood transfusions, during surgical operations with reusable instruments, as well as during sexual contacts (the so-called parenteral, blood transfusion and sexual transmission). Knowing the ways of transmission of viral hepatitis, a person can control the situation to a certain extent and reduce the risk of the disease. From hepatitis A and B in Ukraine, there have long been vaccines, vaccinations with which give a 100% guarantee against the onset of the disease.

Question:I have hepatitis C, genotype 1B. He was treated with reaferon + ursosan - without result. What drugs to take to prevent cirrhosis of the liver.

Answer: In hepatitis C, combined antiviral therapy is most effective: recombinant alpha 2-interferon (3 million per day) + ribavirin (or in combination with other drugs - nucleoside analogues). The treatment process is long, sometimes more than 12 months under the control of ELISA, PCR and indicators of cytolysis syndrome (AlT in whole and diluted 1:10 blood serum), as well as at the final stage - puncture liver biopsy. Therefore, it is desirable to be observed and undergo a laboratory examination by one attending physician - it is necessary to understand the definition of “no result” (dosages, duration of the first course, laboratory results in the dynamics of the use of drugs, etc.).

Question:Hepatitis C! A 9-year-old child has had a fever for all 9 years. How to treat? What's new in this area? Will the right way be found soon? Thank you in advance.

Answer: Temperature is not the main sign of chronic hepatitis C. Therefore: 1) it is necessary to exclude other causes of fever; 2) determine the activity of viral hepatitis C according to three main criteria: a) ALT activity in whole and diluted 1:10 blood serum; b) serological profile - Ig G antibodies to HCV proteins of classes NS4, NS5 and Ig M to the HCV nuclear antigen; 3) test the presence or absence of HCV RNA in the blood by polymerase chain reaction (PCR), and determine the genotype of the detected virus. Only after that it will be possible to talk about the need to treat hepatitis C. There are quite advanced drugs in this area today.

Question:Is it possible to breastfeed a child if the mother has hepatitis C?

Answer: It is necessary to test the mother's milk and blood for hepatitis C virus RNA. If the result is negative, you can breastfeed the baby.

Question:My brother is 20 years old. Hepatitis B was diagnosed in 1999. He is now diagnosed with hepatitis C. I have a question. Does one virus pass into another? Can it be cured? Is it possible to have sex and have children? He also has 2 lymph nodes on the back of his head, can he be tested for HIV? Didn't take drugs. Please, please answer me. Thank you. Tanya

Answer: You know Tanya big share The likelihood of infection with two viruses (HBV and HCV) occurs precisely when injecting drug use. Therefore, first of all, it is necessary to clarify this situation with the brother and, if necessary, recover from drug addiction. Drugs are a cofactor that accelerates the adverse course of hepatitis. It is advisable to be tested for HIV. One virus does not pass into another. Chronic viral hepatitis B and C are treated today and sometimes quite successfully. Sex life - with a condom. You can have children after treatment.

Question:How is the hepatitis A virus transmitted?

Answer: The hepatitis A virus is transmitted from person to person by the fecal-oral route. This means that a person with hepatitis A is shedding viruses in their stool that, if not properly hygienic, can get into food or water and infect another person. Hepatitis A is often referred to as "dirty hand disease".

Question:What are the symptoms of viral hepatitis A?

Answer: Often, viral hepatitis A is asymptomatic, or under the guise of another disease (for example, gastroenteritis, flu, colds), but, as a rule, some of the following symptoms may indicate the presence of hepatitis: weakness, fatigue, drowsiness, tearfulness and irritability in children; decreased or lack of appetite, nausea, vomiting, bitter belching; discolored feces; fever up to 39°C, chills, sweating; pain, feeling of heaviness, discomfort in the right hypochondrium; darkening of urine - occurs a few days after the first signs of hepatitis appear; jaundice (the appearance of yellow coloration of the sclera of the eyes, body skin, oral mucosa), as a rule, appears a week after the onset of the disease, bringing some relief to the patient's condition. Often there are no signs of jaundice in hepatitis A at all.

• Hepatitis E is a viral liver disease caused by the hepatitis E virus (HEV).
• It is estimated that 20 million HEV infections occur each year worldwide, causing 3.3 million symptomatic cases of hepatitis E (1).
• WHO estimates that approximately 44,000 people died from hepatitis E in 2015 (representing 3.3% of viral hepatitis deaths).
• Transmission of the virus occurs via the fecal-oral route, mainly through contaminated water.
• Hepatitis E occurs throughout the world, but is most common in East and South Asia.
• To prevent infection with the hepatitis E virus, a vaccine has been developed that is licensed in China but not yet available in other countries.

Hepatitis E is a liver disease caused by the hepatitis E virus (HEV). The virus has at least four various types: genotypes 1, 2, 3 and 4. Genotypes 1 and 2 have only been found in humans. Genotypes 3 and 4 circulate in several animals (including pigs, wild boars and deer) without causing any disease and sometimes infect humans.

The virus is excreted in environment through the faeces of infected people and enters the human body enterally. The virus is transmitted mainly through contaminated drinking water. The infection is usually self-limiting and resolves within 2-6 weeks. Rarely develops serious illness, known as fulminant hepatitis (acute liver failure), in which a fatal outcome is possible.

Epidemiological situation

Hepatitis E infection is common throughout the world. Two different backgrounds are observed at hepatitis E sites:

• areas with limited resources and frequent water pollution; And
• areas with safe drinking water.

The disease is predominantly prevalent in low- and middle-income countries with limited access to water, sanitation, hygiene and health services. In these areas, the disease occurs both in the form of outbreaks and in the form of sporadic cases. Outbreaks usually follow periods of faecal contamination of sources drinking water and can affect from a few hundred to several thousand people. Some of these outbreaks occur in areas of conflict and humanitarian emergencies, such as war zones, and in refugee or internally displaced persons camps, where sanitation and safe water supplies are particularly serious problems.

Sporadic cases are also believed to be associated with water pollution, albeit on a smaller scale. Cases in these areas are caused mainly by genotype 1 virus infection and much less frequently by genotype 2 virus.

In areas with better sanitation and water supplies, hepatitis E is uncommon and occurs only in sporadic cases. Most of these cases are caused by genotype 3 virus of animal origin, which usually occurs as a result of ingestion of undercooked animal meat (including animal liver, especially pork), and is not associated with contamination of water or other food products.

Serological evidence of prior exposure to the virus was found in most areas, with higher seroprevalence (proportion of people with a positive result for antibodies to HEV) is observed in Asia and Africa. However, the presence of these antibodies does not mean the presence or increased risk of the disease. The usefulness of such data for epidemiological purposes may also be limited by the varying and possibly suboptimal performance of available serological assays and the possible (over time) loss of antibodies in exposed individuals.

Virus transmission

The hepatitis E virus is transmitted through the fecal-oral mechanism as a result of contamination of drinking water. This route of spread accounts for a very significant proportion of clinical cases of this disease. Risk factors for hepatitis E are associated with poor sanitation, which allows the virus shed in the feces of infected individuals to enter the drinking water supply.

Other routes of transmission of the virus have been identified, but they appear to explain a much smaller number of clinical cases. These transmission routes include:

• eating insufficiently cooked meat or meat products obtained from infected animals (for example, pork liver);
• transfusion of contaminated blood products; And
• vertical transmission from a pregnant woman to her fetus.

Symptoms

The incubation period after HEV exposure is 2 to 10 weeks, with an average of 5 to 6 weeks. Infected individuals shed the virus from a few days before the onset of illness to 3-4 weeks after it.

In areas of high endemicity of the disease, symptomatic infection is most common among young people aged 15-40 years. In these areas, despite the occurrence of infection in children, they often either have no symptoms or develop only mild illness without jaundice, which is not diagnosed.

Typical signs and symptoms of hepatitis include:

• initial phase of mild fever, loss of appetite (anorexia), nausea and vomiting for several days; some patients may also experience abdominal pain, itching (without skin lesions), skin rash, or joint pain;
• jaundice (yellowing of the skin and whites of the eyes), dark urine and colorless stools; And
• slightly enlarged, tender liver (hepatomegaly).

These symptoms are often indistinguishable from those experienced during any acute stage of liver disease and usually last one to six weeks.

Rarely, acute hepatitis E can lead to fulminant hepatitis (acute liver failure) and death. Fulminant hepatitis most often develops during pregnancy. Pregnant women with hepatitis E, especially in the second and third trimesters, are at increased risk of acute liver failure, fetal loss, and death. Mortality of hepatitis E among pregnant women can reach 20-25% in the third trimester.

Cases of chronic hepatitis E infection have been reported in immunosuppressed individuals, especially in recipients of immunosuppressive organ transplants infected with HEV genotype 3 or 4. They remain rare.

Diagnostics

Clinically, cases of hepatitis E do not differ from other cases of acute viral hepatitis. However, under appropriate epidemiological conditions, reasonable assumptions about the diagnosis often arise, for example, if several cases of the disease occur in communities in known endemic areas or in areas with a risk of water contamination, if the disease is more severe in pregnant women, or if hepatitis A was excluded.

The definitive diagnosis of hepatitis E infection is usually based on the detection of specific IgM antibodies to the virus in the person's blood; this is generally sufficient in areas where the disease is prevalent. For use in field conditions there are rapid tests.

Additional tests include reverse transcription polymerase chain reaction (RT-PCR) to detect hepatitis E virus RNA in blood and/or stool; this analysis is carried out in specialized laboratories. Such testing is especially needed in areas where hepatitis E is rare and in cases of chronic HEV infection.

Treatment

Treatment that can change the course of acute hepatitis E has not been developed. The disease is usually self-limiting and hospitalization is usually not required. The main thing is to avoid unjustified prescribing of drugs. Acetaminophen/paracetamol and antiemetic drugs should not be given.

However, hospitalization is necessary if the disease is fulminant, and may also be required for pregnant women with severe symptoms.

Immunosuppressive patients are treated with ribavirin (an antiviral drug) to improve their condition. Interferon has also been used successfully in certain cases.

Prevention

Most effective method the fight against this disease is prevention. At the population level, the risk of HEV transmission and hepatitis B disease can be reduced by:

• maintaining high standards of public water supply; And
• establishing proper systems for the disposal of human faeces.

At the individual level, the risk of infection can be reduced by:

• compliance with hygiene rules;
• abstaining from drinking water and ice of unknown purity.

A recombinant subunit vaccine for the prevention of hepatitis E was registered in China in 2011. It has not yet received approval in other countries.

In 2015, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization reviewed the available data on the burden of hepatitis E and the safety, immunogenicity, efficacy and cost-effectiveness of the licensed hepatitis E vaccine:

• Global prevalence and susceptibility to hepatitis E virus infection: a systematic review
• Systematic review of hepatitis E in the world

Based on the SAGE review, a WHO position paper was issued:

• WHO position paper on hepatitis E

Guidelines for Sanitary and Epidemiological Measures

• Outbreaks of waterborne hepatitis E: detection, investigation and control

IN summary If a hepatitis E outbreak is suspected, the following actions are recommended:

• verifying the diagnosis and confirming the existence of an outbreak;
• determining the mode of transmission and identifying populations at increased risk of infection;
• improving the efficiency of sanitary and hygienic measures to eliminate fecal contamination of food and water; And
• elimination of the source of infection.

WHO activities

WHO has released a technical report Waterborne Hepatitis E Outbreaks: Recognition, Investigation and Control. It provides information on the epidemiology, clinical manifestations, and diagnosis of hepatitis E. The report also provides guidance to public health authorities on how to respond to outbreaks of hepatitis E virus infection.

In 2015, the WHO Strategic Advisory Group of Experts on Immunization released a position paper on hepatitis E in 2015, which provides an overview of the available evidence on disease burden, safety, immunogenicity, efficacy and cost-effectiveness of the licensed hepatitis E vaccine E. With regard to the use of the hepatitis E vaccine, SAGE made the following recommendations:

• WHO recognizes the importance of hepatitis E as a public health problem, especially for special populations such as pregnant women and those living in displaced camps and in outbreak settings.
• WHO does not recommend the introduction of the vaccine into national routine immunization programs in countries with epidemic and sporadic cases of hepatitis E. However, national authorities in these countries may decide to use the vaccine based on local epidemiological conditions.
• Due to the lack of sufficient information on the safety, immunogenicity and efficacy of the vaccine in the subpopulations listed below, WHO does not recommend the routine use of the vaccine in children under 16 years of age, pregnant women, patients with chronic liver disease and patients awaiting organ transplantation, and travelers persons.
• There may be special situations, such as outbreaks, when the risk of contracting hepatitis E or developing complications from the disease or death is particularly high. At present, WHO's position on routine immunization programs should not preclude the use of the vaccine in these specific situations. In particular, consideration should be given to the use of the vaccine to reduce the risk or prevention of outbreaks of hepatitis E, and the use of the vaccine to reduce the consequences among high-risk groups such as pregnant women.
• As more data become available, the WHO position on hepatitis E vaccine will be reviewed and updated as necessary.

WHO is currently working with experts and global partners to develop a model protocol for the use of hepatitis E vaccine in outbreak response. As part of similar groups, work is also ongoing on the creation of a simplified algorithm for diagnosing, triaging and managing patients during outbreaks.

In May 2016, the World Health Assembly adopted the first Global Health Sector Strategy on Viral Hepatitis 2016-2021. It highlights the critical role of universal health coverage and sets out targets that are aligned with the Sustainable Development Goals.

The strategy contains the concept of elimination of viral hepatitis as a public health problem. This is reflected in the global targets to reduce new viral hepatitis infections by 90% and viral hepatitis deaths by 65% ​​by 2030. The strategy outlines the steps that countries and the WHO Secretariat must take to achieve these targets.

To support countries in achieving the global goals to eliminate hepatitis as part of the 2030 Agenda for Sustainable Development, WHO is working in the following areas:

• raise awareness, promote partnerships and mobilize resources;
• formulating evidence-based policy and generating evidence for action;
• prevention of transmission of infection; And
• expanding coverage of screening, care and treatment services.

WHO recently published the 2019 Progress Report on HIV, Viral Hepatitis and Sexually Transmitted Infections, which outlines the progress made towards their elimination. The report provides global statistics on viral hepatitis B and C, rates of new infections, prevalence of chronic infections and deaths caused by these two widespread viruses, as well as information on the main actions taken at the end of 2016 and 2017.

Since 2011, WHO, together with national governments, civil society and partners, has been organizing annual events to mark the world day hepatitis (as one of the nine major annual public health campaigns) to raise awareness and better understanding of viral hepatitis. The date July 28 was chosen to commemorate the birthday of Nobel Prize-winning scientist Dr. Baruch Blumberg, who discovered the hepatitis B virus and developed a diagnostic test and vaccine against the virus.

For World Hepatitis Day 2019, WHO is focusing on Investing in Ending Hepatitis to highlight the need for increased funding at national and international levels to scale up hepatitis prevention, testing and treatment services to meet hepatitis targets. elimination by 2030

Hepatitis E is a rather severe pathology characterized by viral damage to the liver. A distinctive feature from other varieties of the disease is that it quite often proceeds favorably and ends with recovery. However, at the same time, it poses a danger to female representatives in position.

An RNA-containing virus acts as the causative agent of the disease, which can enter the body of a healthy person in several ways - through unwashed hands, the use of incompletely cooked foods, direct contact with the patient's feces. It is worth noting that the provocateur of the disease can be transmitted from mother to child.

The symptomatic picture of this type of hepatitis is nonspecific and is expressed in signs characteristic of other variants of the course of viral liver damage. The main symptoms are considered to be pain in the area under the right ribs, a change in skin tone, urine and feces.

A gastroenterologist or hepatologist can make the correct diagnosis, based on information obtained during a physical examination and a wide range of laboratory and instrumental examinations.

Viral hepatitis E is eliminated by conservative methods, including medication and diet therapy.

Etiology

The main provocateur of the disease is the hepatitis E virus, which is HEV, which has the following characteristics:

• performance degradation occurs when temperature conditions above 20 degrees;
• death is noted during freezing followed by thawing;
• practically unstable to the influence of the external environment;
• neutralized by disinfectants, which contain chlorine and iodine.

A sick person always serves as a source and carrier of a provocateur of pathology. It should be borne in mind that the variant of the course of hepatitis E does not matter, both a patient with pronounced symptoms and an asymptomatic carrier will be dangerous.

The main ways hepatitis E is transmitted are:

• contact - when a healthy person interacts with the feces of a patient;
• non-observance of hygiene rules, namely the habit of not washing hands after the street;
• drinking infected liquid;
• ingestion of meat and seafood that have undergone insufficient heat treatment;
• blood transfusion procedure;
• visits to dental offices in which dubious instruments are used;
• vertical, i.e. from mother to child - this happens in the process of the birth of the baby. This is observed extremely rarely, because often the expectant mother knows about her diagnosis, which is why labor activity takes place by caesarean section.

In addition to the main methods of infection, it should be noted those mechanisms in which it is almost impossible to become infected with the HEV virus:

• protected sexual contact;
• airborne - the virus is not transmitted through saliva or mucus;
• the process of eating with an infected person;
• handshakes and hugs.

Nevertheless, a contact-household mechanism for the transmission of a pathological agent can be implemented. From this, it follows that the highest risk of infection have:

• health workers;
• relatives of a sick person;
• women during pregnancy, in particular after 30 weeks;
• persons visiting manicure and dental offices;
• patients in need of a blood transfusion;
• babies born to mothers diagnosed with hepatitis E.

The pathogenesis of such a pathology lies in the fact that when a virus enters the human body, it primarily affects the intestines - under the conditions of its microflora, it begins to actively increase its numbers. With the bloodstream, the pathogen reaches the liver, where it multiplies even more, which negatively affects this organ. Against this background, the immune system takes the liver as a foreign object and tries to get rid of it by secreting antibodies.

Symptoms

Since hepatitis E is viral in nature, we should mention the incubation period, which varies from 14 days to 2 months, but in the vast majority of situations it is 40 days.

The first clinical manifestations are rather non-specific and are often mistaken for a banal malaise or physical overwork. This means that by ignoring such symptoms, a person independently provokes the progression of a dangerous disease.

The negative impact of the causative agent of hepatitis E leads to the appearance of:

• rapid fatigue and weakness of the body;
• nasal congestion;
• a slight increase in temperature indicators;
• loss of appetite;
• distraction of attention;
• memory loss;
• discomfort in the area where the liver is located, namely under the right ribs;
• distribution of pain in the shoulder girdle and shoulder blades.

A similar variant of the course of viral liver disease almost completely corresponds to the symptomatic picture - this means that the main symptoms of hepatitis E are:

• decrease in pressure against the background of normal temperature;
• sleep disorders;
• constant nausea;
• increased severity of pain;
• aversion to food;
• muscle and joint pain.

On average, after 9 days from the beginning of the development of the pathological process, the disease passes into the icteric stage, the duration of which ranges from 1 week to 20 days. After that, the symptoms gradually subside and complete recovery occurs. However, in some cases, this period ends with the development of life-threatening complications.

Thus, the icteric stage of the infection has the following symptoms:

• bitter taste in the mouth;
• the acquisition of visible mucous membranes and sclera of a yellowish tint;
• spread of jaundice over the entire skin:
• skin itching of varying severity;
• discoloration of faeces;
• an increase in the level of bilirubin in the urine, which is expressed in its darkening.

If one or more of the above symptoms occur, you should immediately seek professional help from a gastroenterologist, especially for children and women during pregnancy. This is due to the fact that it is in these categories of patients that the appearance of complications is most often noted.

Diagnostics

Against the background of the fact that hepatitis E does not have characteristic external signs, a wide range of laboratory and instrumental diagnostic measures is aimed not only at establishing the correct diagnosis, but also at differentiating this type of pathology from other types of viral liver damage.

Diagnosis of the disease consists of several stages, the first of which is aimed at the direct work of the clinician with the patient, namely, it includes:

• familiarization with the medical history;
• collection and study of life history - to establish the etiology, which in this case reflects the transmission of the HEV virus;
• the implementation of a physical examination, with mandatory palpation of the abdomen - to establish the fact of an increase in the volume of the liver and spleen, as well as the study of the state of the sclera, mucous membranes and skin. This also includes the measurement of blood pressure and temperature indicators;
• conducting a detailed survey - to compile a complete symptomatic picture.

The second stage is laboratory research, the most valuable of which are:

• general clinical analysis of urine and blood;
• coprogram;
• blood biochemistry;
• PCR diagnostics;
• liver tests;
• coagulogram;
• serological tests - to detect antibodies to the pathogen.

The last stage in the diagnosis of hepatitis E is instrumental procedures, namely:

• Ultrasound of the affected organ and abdominal cavity;
• endoscopic liver biopsy;
• MRI and CT.

Treatment

It is customary to treat viral hepatitis E with conservative methods that practically do not differ from the tactics of eliminating other types of the disease.

At severe course disease, as well as its development in children and pregnant women, the placement of the patient in a hospital is indicated; in other cases, therapy can be carried out at home - in any case, it includes:

• strict adherence to bed rest;
• diet therapy - all patients are prescribed diet table №5;
• detoxification treatment, in particular a plentiful drinking regimen, intravenous administration of glucose and saline solutions;
• oral use of hepatoprotectors, choleretic and analgesic substances. This should also include taking medications aimed at combating symptoms, as well as the use of vitamin complexes and immunomodulators.

In especially severe cases, the above treatment of hepatitis E requires transfusion of blood plasma and platelet masses.

As for the elimination of the disease in women during the period of bearing a child, conservative methods are used only after the baby is born. Sometimes an emergency termination of pregnancy or a premature birth is necessary.

Possible Complications

Despite the fact that viral hepatitis E often ends in complete recovery, the disease also often leads to dangerous consequences, including:

• or ;
• or ;
• formation of hepatocellular carcinoma;
• coma;

As mentioned above, this type of disease is most dangerous for female representatives in a position, since it causes:

• intrauterine fetal death;
• spontaneous miscarriage;
• the birth of a child before the due date;
• rapid development of general complications.

It also increases the likelihood of death for mother and baby.

Prevention and prognosis

Currently, there is no specific vaccine for hepatitis E, however, its development can be prevented by observing the following general preventive measures:

• rejection bad habits;
• good nutrition;
• maintaining an active lifestyle;
• avoiding the consumption of unrefined liquids and products that have undergone incomplete heat treatment;
• visits to proven dental and manicure rooms;
• piercing and tattooing only with sterilized instruments;
• regular visits to a gastroenterologist and other specialists - for a complete preventive examination.

In the vast majority of situations, hepatitis E has a favorable prognosis, and mortality among the total number of patients does not exceed 5%.

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