Ans. d. (Hepatitis E) (Ref. Ananthanarayan-6th ed., 519)# A unique feature of Hepatitis E virus is the clinical severity and high case fatality rate of 2(M0% in pregnant women, especially in the last trimester of pregnancy.eHEPATITIS E# A distinct type of waterborne "non-A, non-B" hepatitis has been identified in India, Asia, Africa, and Central America (previously labelled epidemic or enterically transmitted non-A, non-B hepatitis), classified as hepatitis E virus (HEV).# Hepatitis E is enterically transmitted non-A non-B Hepatitis.# Hepatitis E is a 32- to 34-nm, nonenveloped, HAV-like virus with a 7600-nucleotide, single-stranded RNA genome.# The infection caused by hepatitis E is essentially water-borne disease- Water or Food supplies, contaminated with feces in which the virus is excreted, have been implicated in all major outbreak. Hepatitis AHepatitis BHepatitis CHepatitis DHepatitis ENucleic acidRNA (picornavirus)DNA (Hepadna)RNA (Flavivirus)RNARNA (Calcivirus)Characteristics# 50% seroposi- tivity in people >50# Worldwide carrier rate 300 million# 1,50,000 new cases/year in U.S.# Replication defectiveFulminant hepatits 0.3-3%; 20% in pregnant women# Clinical disease: mild or asympto- matic; rare after childhood# 300,000 new infections/year in U.S.# Most important cause of transfusion related hepatitis# Dependent on HBV coinfection for multiplicationTransmission:# Fecal-oral raw shellfish (concen- trate virus)# Parental, close personal contact# Transfusion# Parenteral, close personal contactParenteral, close personal contactWaterborneYoung adults # Not shed in semen, aliva, urine# Shed in stool 2 weeks before onset of jaundice and 1 week after# Dialysis# Needle-sticks# IV-drug use# Male homosexual activity# Route of transmission undetermined in 40-50% of cases Incubation2-6 weeks4-6 weeks2-26 weeks4-7 weeks in superinfection2-8 weeksCarrier stateNone1% blood donors1%1-10% in drug addictsUnknownProgression to chronic hepatitisNone5-10% acute infections>50%<5% in coinfection* 80% superinfectionNoneIncreased risk of Hepatocellular CaNoYesYesYes, same as for BUnknown although not likelyViral antigen # HBsAg indicates current infection# HBsAg indicates infectiviity Also Know:* Most common cause of sporadic cases in adults is - Hepatitis E.* Most common cause of sporadic cases in children is - Hepatitis A.* Most common virus associated with transfusion-associated hepatitis is HCV.