HEPATITIS E

Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, May 2005)

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: An illness caused by the hepatitis E virus characterized by acute onset of jaundice, fever, malaise, anorexia, abdominal pain and fatigue, and arthralgia. The disease is more common in adults than children and has a high fatality rate among pregnant women, especially those in their third trimester of pregnancy.

B. REPORTING CRITERIA: Clinical diagnosis initially; laboratory confirmation required to meet case definition.

C. LABORATORY CRITERIA FOR CONFIRMATION:

• IgM anti-HEV positive serology.

D. WISCONSIN CASE DEFINITION: Laboratory confirmation.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.

B. EPIDEMIOLOGY REPORTS REQUESTED:

1. Acute and Communicable Diseases Report (DPH 4151).
2. Viral Hepatitis Case Report (CDC 53.1).

C. PUBLIC HEALTH INTERVENTIONS:

• Confirm that a separate assay for IgM antibody to HEV was performed and was positive.
• Conduct assessment of patient for high-risk activities (food worker, day care attendee/provider, health care provider).
• Source investigation by LHD. (Search for history of exposure to other cases, travel outside USA , etc.)

Note : Unlike Hepatitis A, immune globulin (Ig) is not effective in preventing Hepatitis E

III. CONTACTS FOR CONSULTATION

A. BCDP / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 267-7321.

B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

C. WSLH / HEPATITIS SEROLOGY: (608) 262-2302.

IV. RELATED REFERENCES

1. Heymann DL, ed. HEPATITIS VIRAL. In: Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:266-268.

2. Pickering LK, ed. Hepatitis E. In: Red Book: 2003 Report of the Committee on Infectious Diseases. 26 th ed. Elk Grove Village , IL : American Academy of Pediatrics, 2003:342-343.

3. Hepatitis E among U.S. Travelers, 1989-1992. MMWR 1993;42 (01):1-4.

DISEASE TRENDS

 Hepatitis E became a reportable disease in Wisconsin in April 2000. Since then there have been no reported cases of Hepatitis E.