Hepatitis E Virus (HEV)

Characteristics

Morphology Hepatitis E virus (HEV) is a non-enveloped, positive-sense, single-stranded RNA virus in Hepeviridae family, genus Hepevirus, 27–34 nm diameter. There are four HEV genotypes: Genotype 1 in Africa and Asia, Genotype 2 in Mexico and West Africa, Genotype 3 as isolated cases in developed countries, and Genotype 4 in China and Taiwan.
Growth Conditions PLC/PRF/5 human hepatoma or A549 human lung adenocarcinoma cell lines

Health Hazards

Host Range Genotypes 1 and 2: human; Genotypes 3 and 4: human, pig, boar, deer. NHPs, non-inbred white mice and Wistar rats can be experimentally infected.
Modes of Transmission

Fecal-oral (feces-contaminated drinking water); food-borne (consumption of uncooked/ undercooked shellfish, pork or deer meat); blood-borne (blood transfusions); mother to baby immediately before and after birth; person-to-person (uncommon)

Signs and Symptoms HEV causes acute sporadic and epidemic viral hepatitis. The ratio of symptomatic to asymptomatic Hepatitis E (HE) ranges from 1:2 to 1:13. When symptoms occur, they last 1-2 weeks and include jaundice, anorexia, enlarged tender liver, abdominal pain, nausea and vomiting, and fever. Pregnant women are at greater risk of obstetrical complications and death, with 10-30% mortality rate among pregnant women in the third trimester. Sporadically, HEV Genotype 3 mainly affect older men (>40 years) and immunocompromised individuals.
Infectious Dose Unknown.
Incubation Period 15-60 day (average 40 day). HEV has been detected in stool from one week prior to symptom onset up to 30 days after onset of jaundice. Chronically infected persons (exclusively HEV Genotype 3 infections of immunocompromised) shed virus as long as infected.

Medical Precautions/Treatment

Prophylaxis None
Vaccines None
Diagnosis & Treatment

Infections of HEV are not clinically distinguishable from other types of acute viral hepatitis. No serologic tests have been approved by the FDA. Diagnosis of HEV infection is based on detection of IgM and IgG antibodies against the virus, or detection of HEV RNA in blood or stool.

Hepatitis E is self-limiting and usually resolves on its own without treatment. Patients are typically advised to rest and get adequate nutrition and fluids. Hospitalization is sometimes required in severe cases and should be considered for pregnant women.
Surveillance Monitor for symptoms of disease.
Emory Requirements Report all incidents using PeopleSoft

Laboratory Hazards

Laboratory Acquired Infections (LAIs) No cases of laboratory-acquired infections have been reported to date.
Sources Potential sources include feces and sera from infected NHPs or humans.

Supplemental References

Containment

BSL2/ABSL2

Follow biosafety level 2 practices and containment for activities utilizing HEV, or HEV-infected feces, blood, or other tissues.

Animal biosafety level 2 practices and containment are recommended for activities using naturally or experimentally infected NHPs or other animal models that may shed the virus.

Spill Procedures

Small Notify others working in the lab.  Allow aerosols to settle. Don appropriate PPE. An EPA-registered disinfectant should be used to remove contaminating matter from surfaces (e.g., of bench tops and equipment). All decontamination litter and other disposable materials should be autoclaved.
Large

For assistance, contact Emory’s Biosafety Officer (404-727-8863), or the EHSO Spill Team (404-727-2888).

Exposure Procedures

Mucous membrane Flush eyes, mouth or nose for 15 minutes at eyewash station.
Other Exposures Wash area with soap and water for 15 minutes.
Reporting Immediately report incident to supervisor, complete an employee incident report using PeopleSoft.
Medical Followup 

7am-4pm (OIM): EUH (404-686-7941) EUHM (404-686-7106) WW (404-728-6431)

After Hours: OIM NP On Call 404-686-5500 PIC# 50464

Needle Stick (OIM): EUH (404-686-8587) EUHM (404-686-2352)

Yerkes: Maureen Thompson Office (404-727-8012) Cell (404-275-0963)

Viability

Disinfection Susceptible to 1% sodium hypochlorite, 2% glutaraldehyde, formaldehyde
Inactivation Inactivated by heat (60°C for 30 minutes), UV and gamma irradiation.
Survival Outside Host Does survive outside the host

Personal Protective Equipment (PPE)

Minimum PPE Requirements At minimum, personnel are required to don gloves, closed toed shoes, lab coat, and appropriate face and eye protection prior to working with ­­­­­­­HEV-infected samples. Additional PPE may be required depending on lab specific SOPs.
Additional Precautions

All procedures that may produce aerosols, or involve high concentrations or large volumes should be done in a BSC.

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