Hepatitis E: review.

Hepatitis E is endemic, often provoking epidemics in many developing countries. It resembles hepatitis A clinically and epidemiologically but show a higher mortality rate and less infectiousness. Several lines of evidence strongly support the assumption that humans become immunized once they contract hepatitis E. Because of the low infectiousness, most of the adult population of endemic areas are susceptible to hepatitis E until an epidemic occurs, although they are almost always infected with hepatitis A during infancy. Epidemics are caused by accidental contamination by the hepatitis E virus (HEV) in feces of water provided to these people. The liver change reveals necroinflammation related to the immune-mediated mechanism. The HEV is molecularly cloned and sequenced and has a single-stranded, positive-sense RNA genome, 7,194 nucleotides followed by a poly (A) tail. There are three open reading frames. The non-structural gene, approximately 5 kb is located at the 5' end, while the structural gene, approximately 2 kb is located at the 3' end of the genome. There is a low level of nucleotide variations among HEV strains isolated from Myanmar and China and a single serotype appears to exist. The HEV may be a new RNA virus or belong to Caliciviridae family. Further investigation include in vitro propagation, elucidation of the gene replication, global seroepidemiology and vaccination of the HEV.