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SaBTO Hepatitis E virus and solid organ transplantation
The following information was circulation by the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) in relation to the Hep E virus.
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To: Patient Support Groups
13th August 2015
We are writing to let you know that we have circulated a letter to the Heads of Solid Organ and Stem Cell Transplant Units across the UK about Hepatitis E and the transplant recipient. We attach the letter and Patient Information Sheet for your information.
We would like to stress that we do not know the impact that the virus might have on the transplant recipient. At present, reports in the UK and the rest of the world suggest it is not a major issue but there are reported cases of patients developing fibrosis and cirrhosis.
Although the virus may be transmitted by blood, blood products and the transplanted organ, food is an important source. Pork products have been associated with illness due to HEV. Consumers should continue to follow FSA cooking advice which is that all whole cuts of pork, pork products and offal should be thoroughly cooked until steaming hot throughout, the meat is no longer pink and the juices run clear.
We thought it would be helpful to share this information with you so you could support any of your members who are concerned. Please circulate both this letter and Patient Information Sheet amongst your members to raise awareness of this issue.
Prof John Forsythe, Chair, SaBTO
Prof James Neuberger, Associate Medical Director, ODT
HEPATITIS E VIRUS PATIENT INFORMATION LEAFLET
What is hepatitis E?
Hepatitis E is an illness of the liver caused by the Hepatitis E Virus (HEV), a virus which can infect both animals and humans. There are four genetic types (G1-G4) of HEV. In most cases, HEV infection causes no symptoms but if it does, the resulting disease, hepatitis E, is usually mild. In rare cases of G1, G2 and G4 infections, however, it can prove fatal, particularly in pregnant women. The common hepatitis E virus in this country, G3, appears to follow a different pattern. While the G3 virus infection will usually clear by itself, in individuals whose immune system is suppressed - following transplantation, for example - the virus can result in an asymptomatic persistent infection which may lead to chronic inflammation of the liver.
How common is hepatitis E?
Hepatitis E due to G1, G2 and G4 occurs in regions of the world where sanitation may be poor including Asia, Africa and Central America. However HEV infection caught in the UK and Europe is usually caused by G3. First recognised in 2003, the numbers of confirmed G3 hepatitis E cases and infections have recently increased significantly and it is now likely that as many as 100,000 people in the UK may get infected each year.
How can I tell if I have been infected by Hepatitis E Virus?
Most people who get infected with Hepatitis E Virus will never know this and only a few, no more than 1%, will get any illness at the time. Symptoms of hepatitis E include yellowing of the skin and eyes (jaundice), darkening of the urine and pale stools, preceded by tiredness, fever, nausea, vomiting, abdominal pain and loss of appetite. Symptoms usually resolve within four weeks. However in individuals who are immunosuppressed symptoms may be less obvious or non-existent at the time of infection, including when the infection has become persistent. Blood tests can be undertaken to confirm HEV infection.
How is Hepatitis E Virus transmitted?
In the developing world, the G1 and G2 viruses are transmitted by the consumption of human sewage-contaminated food or water. In the developed world, G3 infection is through diet and the virus is acquired from animals through the consumption of undercooked processed pork and shellfish. Person to person transmission of the G3 virus is very rare although someone with hepatitis E should always wash their hands after using the toilet. There also have been cases of the virus being transmitted through blood transfusion and transplantation.
How is hepatitis E treated?
In most cases, Hepatitis E infection clears by itself, with no need for any treatment. However, where in immunosuppressed patients the Hepatitis E infection has become persistent and long term (chronic), minor changes in their immunosuppressive regimens can clear the infection. Where this is not the case antiviral treatment has been used successfully.
How can I avoid Hepatitis E Virus infection?
Currently, there is no licensed vaccine for hepatitis E. In all parts of the world, avoid the consumption of raw or undercooked pig meat and shellfish. In the UK and Europe, it is important to make sure that processed food containing pig meat is well cooked, especially sausages. When travelling to countries with poor sanitation, it is advisable to boil all drinking water, including water used for brushing teeth.
Where can I get further help?
Further information and advice is available from:
NHS Direct (Tel: 0845 46 47 or www.nhsdirect.nhs.uk/) or NHS Inform in Scotland
(www.nhsinform.co.uk or 0800 22 44 88) or your own GP
The British Liver Trust (Tel: 0800 652 7330 or www.britishlivertrust.org.uk/home.aspx).