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World Hepatitis Day 2022 – Hepatitis E: Deserving of More Attention

15 / 2022

  • Every year, 1.1 million people worldwide die due to infection with the hepatitis B or hepatitis C viruses.
  • Little attention has been paid in the past to the hepatitis E virus, which is also found in Germany. The hepatitis E virus is mainly transmitted through inadequately cooked pork and game. However, transmission via blood products is also possible.
  • Unlike hepatitis A and B viruses, there is no hepatitis E vaccine available in Europe.

Quote Prof Cichutek

Press Release

July 28th is World Hepatitis Day! On this day each year, attention is drawn to a disease that affects many people around the world and restricts their health: viral hepatitis, which causes liver inflammation. Viral hepatitis infections are among the most common infectious diseases worldwide. The Paul-Ehrlich-Institut, the Federal Institute for Vaccines and Biomedicines, performs a variety of tasks connected to the development and provision of effective vaccines and safe blood products to protect against hepatitis infections. The less well-known Hepatitis E viruses and their relevance for public health are also becoming an expanding focus of research and regulation.

Hepatitis E Virus Modell (Source: K. Kon / Shutterstock)

Viral hepatitis, the viral inflammation of the liver, is a major global health problem. Even before SARS-CoV-2, the fact that several hundred million people worldwide are affected by viral hepatitis was often forgotten. Most cases of viral hepatitis are caused by five viruses that are completely different biologically: the hepatitis viruses A, B, C, D and E (HAV–HEV). Of these viruses, chronic HBV and HCV infections in particular can lead to severe disease courses and death. Around 296 million people worldwide currently suffer from a chronic HBV infection and around 58 million suffer from a chronic HCV infection. HDV uses HBV surface proteins and therefore only occurs together with HBV. This can lead to the most severe forms of chronic viral hepatitis with rapid development towards liver cancer. In chronic cases, HBV and HCV infections as well as HDV/HBV infections are among the major causes of liver cirrhosis and liver cell cancer. Approximately 1.1 million people die each year due to infection with HBV or HCV. HAV is not chronic and patients usually recover completely. In very rare cases, acute liver failure may occur.

Preventative vaccines against HAV and HBV are available in Europe.

Long Neglected – the Hepatitis E Virus

The hepatitis E virus (HEV) still does not receive much attention from the public. Hepatitis E genotypes 1 to 4 are pathogenic to humans. HEV genotype 3 is endemic in Germany, meaning it is relatively widespread. Like genotype 4, it is primarily transmitted zoonotically, i.e. from animals to humans. An HEV-3 infection is often associated with only mild symptoms and cases can even remain asymptomatic. However, severe and fatal disease courses are also possible. Genotypes 1 and 2 are transmitted mainly in developing countries via contaminated drinking water. These genotypes are neglected forms of the disease that are associated with poverty. The Paul-Ehrlich-Institut researches genotypes 1 and 2 as part of the DRUID (Novel Drug Targets against Poverty-related and Neglected Tropical Infectious Disease) research consortium.

The number of recorded HEV infections increased in Germany from 109 cases in 2009 to 3,728 cases in 2019. According to the Robert Koch-Institut (RKI), the reason for this increase lies primarily in the increased attention of doctors on this disease and in the availability of better diagnostic tests. Approximately one in six adults carries antibodies against HEV.

Transmission of Hepatitis E Viruses in Germany Occur Mainly through Food

Infections with HEV-3 viruses in Germany are predominantly caused by the consumption of inadequately cooked pork or game meat and by-products. Filtering organisms, such as bivalve mollusks, can concentrate HEV from the water and thus also serve as a source of infection.

Since the virus can also be transmitted via blood products, the Paul-Ehrlich-Institut stipulated in 2020 that blood donations must be tested for HEV. The success of this stipulation is shown by the fact that in 2020, in eight suspected cases, there was only one HEV transmission through a blood product that was assessed as probable. In contrast, out of a total of 30 reported suspected cases between 2013 and 2018, a causal link was confirmed in 13 cases and assessed as possible in four cases.

Unlike hepatitis A and hepatitis B, there is no authorised vaccine against hepatitis E in the EU. The best protection therefore remains good food hygiene, which includes ensuring that pork and game is sufficiently cooked through.

Research at the Paul-Ehrlich-Institut on Viral Hepatitis A to E

The Paul-Ehrlich-Institut is unique in that it conducts research in all the areas in which it is active as a regulator. This also applies to hepatitis viruses. The Virology Division of the Paul-Ehrlich-Institut, under the direction of Prof Eberhard Hildt, conducts intensive research on HBV, HCV and HEV. The focus of this work is on findings on virus-associated pathogenesis, i.e. on the processes involved in the development of the disease, as well as on analysing the mechanisms of virus replication and laying the foundations for a novel vaccine platform. This new vaccine platform targets HBV and aims to provide a therapeutic vaccination for chronically HBV-infected patients, in addition to the preventive vaccination.

Further Information

Infographic – Viral Hepatitis - from A to E
Vaccines
Haemovigilance Reports
Bekanntmachung über die Zulassung von Arzneimitteln – Abwehr von Arzneimittelrisiken – Anordnung der Testung von Blutspendern zur Verhinderung einer Übertragung von Hepatitis-E-Virus durch Blutkomponenten zur Transfusion und Stammzellzubereitungen zur hämatopoetischen Rekonstitution - Vom 5. Februar 2019 (German only)
Download - Audio file quote Professor Klaus Cichutek (mp3)

  • Hildt E (2022) Viral hepatitis – a hidden killer – Bundesgesundheitsblatt 2022; 65 (German only)
  • Glitscher M, Martín DH, Woytinek K, Schmidt B, Tabari D, Scholl C, Stingl JC, Seelow E, Choi M, Hildt E (2021): Targeting cholesterol metabolism as efficient antiviral strategy against the Hepatitis E virus.
    Cell Mol Gastroenterol Hepatol 12: 159-180.
  • Baylis SA, O´Flaherty N, Burke I, Hogema B, Corman VM (2022): Identification of rabbit hepatitis E virus (HEV) and novel HEV clade in Irish blood donors. J Hepatol. 2022 Apr 26;S0168-8278(22)00250-1. doi: 10.1016/j.jhep.2022.04.015
  • Peiffer KH, Spengler C, Basic M, Jiang B, Kuhnhenn L, Obermann W, Zahn T, Glitscher M, Loglio A, Facchetti F, Carra G, Kubesch A, Vermehren J, Knop V, Graf C, Dietz J, Finkelmeier F, Herrmann E, Trebicka J, Grünweller A, Zeuzem S, Sarrazin C, Lampertico P, Hildt E (2020): Quadruple mutation GCAC1809-1812TTCT acts as a biomarker in healthy

Updated: 28.07.2022