Limits to the prevention of HEV infections

Hepatitis E represents a major health challenge worldwide and is still difficult to control. For example, prevention in disinfection is reaching its limits and vaccination is currently only available in China.

Most commercially-available disinfectants fail

Hepatitis E represents a major health challenge worldwide and is still difficult to control. For example, prevention in disinfection is reaching its limits and vaccination is currently only available in China.

Primary infection prevention also includes several approaches to hepatitis E. The most convenient way of virus control, namely a protective vaccination, currently exists only in China. The second pillar of prevention is hand hygiene, consisting of hand washing and the use of disposable gloves when preparing food, such as in the catering industries, canteen kitchens, or in the medical sector.

The hepatitis E virus (HEV) is very often transmitted via shellfish and raw or undercooked meat. Cooking the animals leads to heat inactivation of the virus particles. At present, however, the risk of infection from humans to humans is not well understood.

HEV resistance to alcohol

A particular problem in preventing HEV infections is that the virus is resistant to the majority of alcohols used in commercially-available hand disinfectants. 1-propanol, 2-propanol, or ethanol alone can kill the hepatitis-E virus. Studies have shown that alcohol resistance applies equally to extracellular and intracellular virus particles.

One recent study looked at the extent to which ready-to-use hand disinfectants from specialist retailers can inactivate HEV. The result was predictable: only one agent reduced the number of particles long enough to achieve adequate hand disinfection.

Ethanol at 99% failed as well as 2-propanol or 2-propanol (45 g) + 1-propanol (30 g) + Mecetronium Ethyl Sulphate (0.2 g). Only the combination of 1-propanol (10 g) + ethanol (57.6 g) (96%) was virucidal against HEV.

Source: 
Steinmann E. "Prevention and treatment of HEV infection"; In: Interactive Session "HEV - From virology to treatment", ILC 2020 (digital)

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