Editor's note: Among the five common viral hepatitis types (A, B, C, D, and E), although Hepatitis E virus (HEV) is the latest discovered hepatotropic virus in humans, its incidence of acute viral hepatitis has risen to the top, posing a serious threat to public health. Especially vulnerable are those with chronic liver disease, women of childbearing age, the elderly, etc., who are more likely to develop severe cases after HEV infection. Therefore, "Hepatology Digest" invited Dr. Jian Wu from Suzhou Hospital affiliated to Nanjing Medical University, Chairman of the Chinese Consortium for the Study of Hepatitis E (CCSHE), to share the epidemiology and advances in the diagnosis and treatment of Hepatitis E, interpreting updates in consensus and adjustments in WHO strategies for the readers' learning and reference.
“Hepatology Digest”: First, could you talk about the current global and Chinese epidemiology and treatment of Hepatitis E? What are the main challenges in treatment? How has our understanding of Hepatitis E changed?
Dr. Jian Wu: Globally, there are approximately 20 million cases of Hepatitis E virus (HEV) infection each year, with about 3.3 million cases of Hepatitis E and 70,000 deaths related to HEV infection. According to the World Health Organization (WHO) statistics, in 2015, HEV infection caused about 44,000 deaths, accounting for 3.3% of viral hepatitis-related deaths. China is a high-prevalence country for Hepatitis E, and in recent years, Hepatitis E has become a common cause of acute viral hepatitis, with the number of cases surpassing Hepatitis A. In 2020, National Bureau of Statistics data showed that the incidence of Hepatitis E in China was 1.3558 per 100,000, with a mortality rate of 0.0009 per 100,000. With a large population base in China, the number of HEV infections is high, resulting in a significant disease burden.
Currently, there are several challenges in the diagnosis and treatment of Hepatitis E, including screening management, prediction of severity, prevention and treatment of extrahepatic manifestations, vaccine evaluation, and the establishment of animal models. Hepatitis E has four main genotypes, with genotypes 1 and 2 infecting only humans, mainly found in developing countries with poor environmental and water hygiene conditions. Genotypes 3 and 4 are zoonotic viruses shared between humans and animals, mainly prevalent in developed countries. Due to the significant improvement in domestic hygiene infrastructure, China has shifted from predominantly genotype 1 to predominantly genotype 4, and our team has found an increasing number of genotype 3 cases in the East China region in recent years. Therefore, special attention needs to be paid to genotype 3 and 4 Hepatitis E infections in China.
“Hepatology Digest”: In April of this year, the Chinese Consortium for the Study of Hepatitis E (CCSHE), in collaboration with the Chinese Physician Association for Infectious Disease (CPAID) and the National Clinical Center for Infectious Diseases, released the “Expert Consensus on the In-hospital Screening and Management Process of Chinese Hepatitis E Virus Infection (2023 Edition).” What is the background of the development of this consensus? How will it promote domestic screening and management of Hepatitis E?
Dr. Jian Wu: Hepatitis E is classified as a Class B notifiable infectious disease in China. Currently, China’s screening efforts for Hepatitis E are still limited, and there are no standardized reference criteria. The disease burden of Hepatitis E in China may be seriously underestimated, leading to severe consequences in clinical practice. For example, once pregnant women or the elderly are infected, they are more likely to develop severe cases. Early intervention could effectively reduce the mortality rate.
The development of this consensus, led by academician Lanjuan Li, aims to strengthen the attention of medical personnel in medical institutions to Hepatitis E, providing guidelines for the diagnosis, treatment, prevention, and health management of Hepatitis E. We hope that by formulating this consensus, the in-hospital screening and management process of Hepatitis E in China will be standardized, accurately assessed, and thus alleviate the disease burden of Hepatitis E in our country.
“Hepatology Digest”: Recently, the World Health Organization (WHO) has included Hepatitis E in the Essential Diagnostics List (EDL), adding one nucleic acid test and two immunoassays to help diagnose Hepatitis E infection. One immunoassay is for communities and medical institutions without laboratories, and the other two assays are for facilities with clinical laboratories. What is the background or evidence behind WHO’s decision? What significance does it have for reducing the global burden of Hepatitis E?
Dr. Jian Wu: Hepatitis E, as one of the common viral hepatitis, should not be overlooked, and eliminating Hepatitis E is crucial for the overall elimination of viral hepatitis. Currently, due to inadequate screening efforts, there is a problem of underreporting of Hepatitis E infections in various regions, leading to a severe underestimation of the global burden of Hepatitis E. International platforms for Hepatitis E, the Chinese Consortium for the Study of Hepatitis E (CCSHE), and other researchers have continuously called for strengthening Hepatitis E screening and management, attracting attention from countries worldwide and the WHO, making Hepatitis E screening and management a research hotspot.
For communities and medical institutions without laboratories, using immunoassays can provide rapid and relatively accurate results. Taking preventive measures and early treatment can help minimize the spread of Hepatitis E. For communities and institutions with clinical laboratories, providing different testing methods can improve diagnostic accuracy. Including Hepatitis E in the EDL will help strengthen Hepatitis E screening and prevention, reduce Hepatitis E transmission, and effectively alleviate the social and economic burden caused by Hepatitis E.
“Hepatology Digest”: CCSHE is dedicated to research and innovation in Hepatitis E, aiming to improve clinical practice related to Hepatitis E, raise public awareness, and provide a collaborative platform for researchers in the field of Hepatitis E. As the chairman, could you introduce the achievements CCSHE has made in over a year? What future work plans are there?
Dr. Jian Wu: In the past year, in addition to releasing the expert consensus on in-hospital screening and management, CCSHE members have conducted a special issue on Hepatitis E in the “Chinese Journal of Hepatology,” and a multidisciplinary team has published many high-quality papers in the fields of hepatology and virology. We have also applied for over 10 national and provincial research projects and conducted nationwide popular science education activities through channels such as official accounts on WeChat. Recently, CCSHE has joined forces with professional teams to write relevant monographs on basic and clinical aspects.
In the future, CCSHE will actively address the challenges in the field of Hepatitis E, overcome difficulties, further promote research progress in Hepatitis E in China, strengthen exchanges and cooperation with foreign platforms, and continue to strive for the goal of eliminating the public health threat of viral hepatitis by 2030, as advocated by the WHO.
TAG: Interview; Hepatitis E
