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Hepatitis E, vaccine protection lasts a long time

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Hepatitis E, vaccine protection lasts a long time

There is a viral infection of the liver that in our area is little known and probably very under-diagnosed. Yet, according to the World Health Organization (WHO), every year there are 20 million infections with HEV (the virus responsible) and 3.3 million symptomatic cases of hepatitis E in the world, especially in southern and eastern Asia. A vaccine exists (although for the moment it is only approved in China and Pakistan) and today, thanks to new data presented on Lancet, we know that not only is it very effective, but that the protection it gives lasts a long time. An important premise so that in the future this instrument can also be proposed in high-income countries.

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What is hepatitis E

Hepatitis E is not the best-known liver disease in our area. The incidence in Italy and Europe suffers from a good deal of uncertainty, due to the failure to identify cases: either due to lack of knowledge or because specific diagnostic tests are not prescribed. The virus responsible for hepatitis E (HEV) is transmitted via the fecal-oral route and infections are more common in those low-middle income areas of the world where contamination of water and food with human faeces is easier. In Europe, however, beyond the cases “imported” from endemic areas, the cases detected are more linked to the consumption of raw or insufficiently cooked pork.

HEV infection in healthy people can manifest as acute hepatitis. The symptoms are tiredness, jaundice, alteration of liver values, inability to carry out normal daily activities. “Tendively, the infection resolves spontaneously without serious consequences – explains a Salute Vincenza CalvarusoNational Secretary of the Italian Association for the Study of the Liver (Aisf) – But there are exceptions: the virus in fragile patients, such as immunocompromised people and those with previous liver disease, and in pregnant women can cause a liver failure, even with a fatal outcome, or become chronic”.

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The vaccine

In the most serious cases of hepatitis E, it is possible to resort to antiviral therapies (generally based on ribavirin, a molecule which before the advent of direct-acting antiviral drugs was used for hepatitis C), but a turning point has occurred several years ago now with the development – and then approval in China (2011) and Pakistan (2020) – of a vaccine that has proven to be very effective in preventing infection in healthy populations. Today the same vaccine, produced by are maintained at high levels.

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The study involved more than 100 thousand healthy people – both vaccinated and unvaccinated – monitored from 2007 to 2017. In this period of time, researchers recorded 90 cases of acute hepatitis E: 13 in the group of vaccinated people and 77 in the group of unvaccinated people. vaccinated. “This is a study like you don’t often see. Its value lies in the large sample of population involved, followed over 10 years” – comments Calvaruso. According to the expert, similar results undoubtedly confirm the importance of the vaccine for public health where hepatitis E is endemic, but they are also a crucial premise because in the future, after appropriate trials to this, can also find application in other areas of the world, such as Europe. “In high-income countries – concludes Calvaruso – a vaccine of this type could be offered to pregnant women and to some categories of fragile patients, those who risk very serious consequences following infection and to whom we already recommend vaccinations against other liver viruses , such as that of hepatitis A”.

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