Neurologic Disorders in Hepatitis E Virus Infection

The provided content discusses various studies and research papers related to Hepatitis E virus. The articles focus on the neurologic disorders in immunocompetent patients with acute hepatitis, detection of HEV RNA in blood donors, impaired monocyte-macrophage functions in pregnant women, pathogenicity of HEV genotype 3 variants, vaccination strategies for established cancer and more.

The Sustainability Around Vaccine

EXECUTIVE SUMMARY
The World Health Organization (WHO) stated that the prevalence of Hepatitis E is
increasing at the global level. Although, various efforts and interventions have taken to control
over the spreading of the infection. The prevalence of Hepatitis E is generally highest in
underdeveloped and developed countries where more than 20 millions people have found
infected from infection. Along with this, over 3 million symptomatic cases related virus has
recorded in all over the world. More than 56600 people have died from this disease. Hepatitis E
has posed a serious threat to the health of people at international level specially in those
locations where sanitation facilities are improper and poor, people have consumed contaminated
water and uncooked meat.
It has found that Hepatitis E is a self-limiting infection which has resolved within 4 to 6
week in a good immunity people. But the persons who has poor immune system, the changes of
failure of liver has increased. The most infected geographical locations are Asia, Africa and
Central America. In the developed nation, the virus may be spread from animal to humans via
consuming undercooked pig and shellfish meat. Transmission of virus via person to person is
very less and this can be happen through blood transfusion and transplantation of solid organ in
the human body. From the last few years, the rate of outbreak of Hepatitis E at international level
has increased. It has created a big health issue for the health care professionals. Along with this,
it has raised the extra burden for the hospitals to ensure the proper care to the patients who are
infecting from the virus.
The virus partials of Hepatitis E had been recognized in 1980 in the form of Hepevirus. It
virus can be classified into 4 genotypes where genotype 1 and genotype 2 has most widely
outbreak in different nations. Genotype 1 has been seen in those countries where people have
limited access to water, poor sanitation facilities, under develop healthcare services etc. The
outbreak of this infection can be seen in Asia and Africa which are developing geographical
locations. But genotype 2 has found in developing nations. From the research, it has found that,
Hepatitis E first outbreak in India in 1955 to 1956. Along with this, the same care was reporting
in Asia and Africa. So, it is a major public health problems at international level.
To stop the outbreak rate of Hepatitis E has needed some preventions and interventions.
The preventions from this is sanitation. It is a most important measure in prevention of infection
which can only be possible to proper treatment and disposal of human waste on the right place.

Along with this, by developing various higher standards to treat public water supplies and
improve personal hygiene process, it has easy to reduce the rate of infected people from Hepatitis
E. With the help of sanitary food preparation, the chances of transmission of virus from one
person to another can be reduced. Therefore, with the help of above stated prevention strategies,
Hepatitis diseases transmission and its impact on community health at international level has
minimized at significant level. On the other hand, with the help of vaccination process, the
infection of virus of Hepatitis E has treated. It has more effective and safe from other clinical
treatments. In the 2012, the Chinese scientists have developed HEV 239 for treating infected
virus. Along with this, there are some treatments available for Hepatitis E in which the people
have to keep distance from infected patients and try to avoid undercooked or raw meet. In this
context, before preparing and eating food, hand has washed. For washing the hands, an
antibacterial soap or liquid has to be used.

But, there are some issues which may created a barrier in the direction of adopting the
prevention and intervention from Hepatitis E. In this regards, socio-economic beliefs, economic
conditions of the nations, psychology of the people regarding accepting the treatments and other
preventions etc. Along with this, unstable government in the developed, developing and
underdeveloped nations. Sometime, the government has not taken the actions at the starting stage
of outbreak of infection. It has lead to increased the transmission of the disease and people have
continuously faced health issues. Beside this, environmental factor of the countries have also
responsible for increase rate of the infection. Natural disasters have the contaminated the water.
To decrease the rate of infection via Hepatitis E, it has important to communicate disease
and the treatments to the public with the aim of aware them about the infection. For this, various
methods of communicating has take so that essential information can be deliver to the target
audience. There are several types of techniques for communicating such as mass media, social
networking cites, heath promotional programs, activities, health educational campaigns,
advertisements, poster presentations, leaflets, role plays and government initiatives.

Table of Contents
EXECUTIVE SUMMARY.............................................................................................................2
INTRODUCTION...........................................................................................................................5
History of Hepatitis E.............................................................................................................6
Reasons for an intervention being required............................................................................9
Issues around sustainability and resilience...........................................................................11
The science behind the hepatitis E vaccines.........................................................................13
Delivering the information for the chosen audience ...........................................................15
CONCLUSION .............................................................................................................................17
REFERENCES................................................................................................................................2

INTRODUCTION
There is a world acceptance that health and social well-being determine by various
elements such as socio-economic conditions, learning environment, demographics patterns,
patterns of consumption of food, culture and social factors etc (Sehgal and et.al., 2015). In this
context, health issues can be effectively address and empowering individuals as well as
communities to take action for being healthy. Generally, health promotion address public health
problems in more effective manner. In the globalization aspects, the increase impacts on
diversity of living of the people in the community, it is important to understand how factors are
influencing the determinants of health and its outcomes (Perrin and et.al., 2015). At the
international level, health promotion increases with the time. The aim of global health promotion
is to enable people to increase control over and improve the life of the people. It moves the focus
from individual behaviour to the wide range of social and environmental interventions. The aim
of this is to prevent the human from disease as well as risk factors that affects the health of the
person. The following study is relating to global health promotion regarding the sustainability
around vaccine. To understand this, a global health problem Hepatitis E is taking into the
consideration. it is a disease which causes infections in the liver (Martinelli and et.al., 2015). It is
caused by hepatitis E virus (HEV) which gets transmitted when a person drinks contaminated
water. It can damage the liver and may result in the death of a person. Hepatitis E is found
around the world and mostly in South Asia and Eastern countries. Those countries which have
low standards of sanitation, hygiene, limited access to water and health services are more prone
to this disease. The proper vaccination help the society from the prevention of disease. The
objectives that will cover under the present study will be history of chosen health problem,
reasons for an intervention behind required, issues around sustainability and resilience, science
behind chosen intervention etc.
History of Hepatitis E
Hepatitis E was suspected firstly in India during the year 1980. The water borne disease
was not related to hepatitis A or hepatitis B. In the year 1956, in New Delhi a large outbreak
occurred which was also related to hepatitis A or B (Gerbi and et.al., 2015). The same situation
arise in Afghanistan in 1983 where it was confirmed that it was a new type of infection. Hepatitis
only affects humans and is found in areas which has limited supply of water and improper
sanitation. During the year 1990, few cases of HEV were found in developed countries. It has

been a major health problem in many countries. The first outbreak of HEV in India reported
29,300 cases. Similarly, in China more than 119,000 cases of HEV were found. It has been
divided into four types. Genotypes 1 and 2 are found in humans while genotype 3 and 4 are
found in animals (Kuniholm and et.al., 2015). The HEV in developing countries has been
genotype 1, in Mexico and western Africa has genotype 2 and in Asia it is genotype 4. It has
been the most common cause during the pregnancy. It has accounted for about 37% of acute
viral hepatitis cases. It is still unknown why it causes severe problem in women at the time of
pregnancy. Genotype 1 is considered as a water-borne disease. In India the water bodies are
contaminated by sheep, swine, buffalo and goats. It has given rise to genotype 1 infection in
India. In Uganda, it was found that hepatitis E has transfer from person to person (Debing and
et.al., 2016). There is high risk of genotype 1 infection to those people who live in areas which
are prone to outbreaks, those who travel to HEV endemicity and in refugee camps. It has been
found that person to person transmission has been constantly increasing in many areas. People
are advised to wash their hands and maintain good hygiene in their houses (Holm and et.al.,
2015). China has been developing a vaccine to cure this disease but still it has not been approved
by FDA. Furthermore, two sub units vaccines have also been developed and they have been
successful in preventing HEV. Some of the measures which can be taken to prevent HEV are
educating people about personal hygiene, proper human feces, drinking boiled water, properly
cooking pig and deer meat (Boni and et.al., 2015).
Table 1: Origination of HEV
Years Location No. of persons
infected
Mode of transmission
1955-56 India 29,300 Water-borne
1978-79 India More than 270 Water-borne
1986 Mexico More than 200 Contaminated well
water
1988-89 Ethiopia More than 750 After monsoon rains
1991 India 79,000 Contaminated river

water
1991 China 119,000 Water-borne
1994 Vietnam More than 300 After monsoon rains
2004 Sudan More than 2600 Insufficient safe water
2008 Uganda More than 10,000 Person to person
It can be seen from the table that initially the infection was water borne and the main
resin for the development of disease was contamination of water. But in the year 2008, Uganda
experienced person to person disease which transmitted through humans.
Genotype 1,2 and 4 are found in developing nations while genotype 3 is found in
developed nations (Sauleda and et.al., 2015). There has been only 5 cases of HEV in US which
have been domestically acquired. All of them have been genotype 3 and the patients were above
40 years of age. There has been no evidence about how this disease developed in the country. It
is believed that this disease developed in people because of domestic or wild swine and raw meat
consumption. In Japan, HEV was developed due to consumption of raw and uncooked pig liver.
It has been found that the infected animals can also contaminate the agricultural products. Apart
from this, 11% of packaged commercial pig livers have been detected with HEV in US groceries.
It has been found that the immunity of people against HEV decreases with age (Nakano and
et.al., 2016). National Institutes of Health has also found the similar result in Denmark.
Developed countries have lack of data to investigate the real reason behind the growth of the
disease. There has been many cases of people developing the infection when they travel to
Mexico or other developing countries. But domestically acquired infection is mostly genotype 3
or 4. The affected people have been adults and have other illness too. Furthermore, organ
transplant recipients, chronic liver injury, liver cirrhosis have been vulnerable to this infection.
HEV was detected around 20th century but it has originated between 500 and 1300 years ago
(Monne and et.al., 2015).
Table 2: Geographical distribution pattern
Characteristics Areas with high endemicity Ares with low endemicity
Human disease Large outbreaks and many
cases
Small number of cases

Characteristics of a diseased
person
Young
More males than females
Mostly old people with other
diseases.
Prevalent causative Viral
genotypes
Genotype 1 and 2 and some
cases of Genotype 4 in China
Genotype 3 and 4.
Reservoir of infection Human Mostly animals like pigs, deer,
wild boars.
Route of transmission Fecal and oral
Mostly form contamination of
water
Intake of raw and uncooked
food
Close contact with infected
animals
Relationship with pregnancy High risk from pregnant
women.
No reports have been found for
women with severe HEV
Chronic infection No reports of Chronic
infection of hepatitis E.
Chronic infection of hepatitis
E have been reported among
people who had organ
transplant and are receiving
immunosuppresive drugs.
The epidemiologic has been seen primarily in Indian subcontinent, Central and South-
east Asia, Middle East and northern parts of Africa (Zhang and et.al., 2015). Large outbreaks
have been reported in China in the year 1980 and 1990. On the other hand, no reports have been
found in America. In the year 1986-87 two small outbreaks were reported in Mexico. HEV has
higher mortality rate among pregnant women and it increases with semester.
Reasons for an intervention being required
Hepatitis E is a major public health concerns in international level. The high prevalence
of this disease worldwide and the significance of its complications, impact of economic and
social raised concern related to global interventions (Lei and et.al., 2016). Hepatitis E is liver
disease which cause by the Hepatitis E virus. The structure of this virus is a non-enveloped and
single stranded ribonucleic acid (RNA) virus. It is transmitted via drinking of contaminated

water. Usually, it is a self confining infection and resolves within 4 to 6 weeks. But, if the virus
develop in the from of hepatitis that create failure of liver. In the recent years, Hepatitis E still
place a major issue for healthcare organization where individual looking for the treatment as well
as care in both normal and complication cases (Rendon and et.al., 2016). So, it is require to plan
for appropriate intervention and arrange proper resources and it will leads to easily quantified the
number of patients and their level of seriousness of diseases (Smith and et.al., 2015).
Outbreak of Hepatitis E occur around the world and these are quickly happening in under
developed nations or limited resources countries. In such places, the people have limited access
water, poor facilities of sanitation, unhygienic places and lack health services. These all reasons
have affected the health of the people. From the past evidence (Di Bartolo and et.al., 2015), it has
found that in recent years, some outbreak of Hepatitis E has occurred in areas such as
humanitarian emergencies in war zones, in the camp of refugees, internally displaced
populations etc. Along with this, it has also determined that in these locations, 20 million people
infected and 3.3 million cases occur related to this disease in the world and 56000 people died
from Hepatitis E (Koning. and et.al., 2015).
There are various genotype of Hepatitis E virus because of differences in epidemiology.
Genotype 1 is mainly seen in developing nations and occur outbreaks at community level. But
genotype 3 of Hepatitis E can be seen in the developed countries but does not create any kind of
outbreaks. Seroprevalence rates high in those geographical locations where standards of
sanitation is low and it causes a risk of transmission of Hepatitis E virus. South and East Asia are
come under the most infected locations because of this disease (Deng, Cho,Fiers and Saelens,
2015). The frequent outbreak can be seen in both the countries at the time of rainy season when
sources of water become contaminated by faecal materials. So, by drinking faecal contaminated
water, the virus of Hepatitis E transmitted into the human body. On the other hand, there are
many other ways by which the disease can be transmitted into the person.
Sometimes, Hepatitis E creates other diseases like diabetes, prior liver diseases and
cardiovascular issue (Becattini and et.al., 2015). In this context, from the research, it has found
that in UK, the following disease on peaks in spring and summer seasons. Along with this, it has
appeared in coastal and estuarine areas. Seropidemiological data shows that in 1988-1994, the
rate of Hepatitis E in US was 21% and it was increasing with the time. In 1955-156, the number
of infected persons form virus was 29300 and in 1991, these number was increasing and reach at

79000. To prevent both high-endemicity and low-endemicity areas, an intervention has taken
into the consideration (Sridhar, Brokstad and Cox, 2015). In this regards, vaccines have been
developed against Hepatitis E infections. This intervention has proved highly protected against
clinical treatments.
Most of the people have not required any kind of intervention because it has treated in
body automatically. But in older people and pregnant women, they have needed more care and
treatments because their immune systems weakened (van der Burg and et.al., 2016). Along with
this, chronic liver disease can raise more severe infections because of infection from Hepatitis E.
Such type of patients have required closer observation. Therefore, these are the some reasons
which shows that intervention i.e. vaccination has required to reduce the rate of infections as
well as stop in the transmission of the disease (Barouch and et.al., 2015).
On the other hand, some other interventions beside vaccination for Hepatitis E can be
take to minimize the outbreak of the infection in high and low epidemiology areas. In this
context,first is properly cooking meat and other meat products in right manner, it can be easy to
prevent community at international level from virus of Hepatitis E (Wilson, Xiang and
Plebanski, 2015). The patients and other normal people try to avoid eating undercooked or raw
shellfish and meet. Along with this, before preparing and eating food, it has required to wash
hand from antibacterial soap. Beside this, at the time of travelling to those countries where has
poor sanitation facilities, the travellers needs to boil drinking water and use it for all kind of
purpose (Ye and et.al., 2015). In addition to this, the people have tried to avoid to came in the
contact with Hepatitis E infected patients.
Issues around sustainability and resilience
In order to understand about the issues linked with sustainability and resilience model of
sustainable development is quite effective which relies on large number of factors such as
economic prosperity, environmental protection and social justice. All these elements are most
crucial for this framework and in health care sector they play most important role. Apart from
this, corrective measures taken by healthcare providers to control Hepatitis E a most crucial issue
(Johnson, 2016). Moreover, it is the moral responsibility and duty of local authority with the
motive to accomplish aim of sustainable development. Further, in order to maintain sustainable
development various corrective measures have been taken which takes into consideration social
justice, environmental protection and economic prosperity. Various acts have been introduced by

government which highlights the initiatives taken in order to develop awareness regarding the
issue of Hepatitis E and in turn it has produced favorable results for the entire society (Yuen and
et.al., 2016). Issue of sustainability along with resilience can be easily tackled if corrective
measures are taken by healthcare sector to develop effective policies so as to deal with this health
issue. Apart from this, in underdeveloped areas awareness is necessary and on the basis of same
this problem can be tackled easily.
Social factors
This factor is linked with distribution of resources in the society which has directly acted as
hurdle in implementation of programs which are linked with Hepatitis E at global level. The
overall inequality is influenced by gender, location, ethnicity etc (Le and et.al., 2015). Health
inequalities are considered to be not equitable as it take into consideration undertaking different
framework that can be addressed for an effective outcome. Further, media has played most
significant role to deal with the health issue of Hepatitis E and main focus is on developing
awareness in the market. Each and every area is required to be covered through appropriate
media sources and through this large number of people can know about the health issue of
Hepatitis E (Hepatitis E Vaccine, 2015). Apart from this youngsters are facing this health issue
and it is necessary to understand its symptoms along with causes so that disease can be prevented
easily. Generally Hepatitis E is a virus which does not lead to long term virus or serious liver
damage. Further, this disease is generally spread by drinking water or eating food that is being
contaminated by feces from someone infected. On the other hand, people also suffers from
hepatitis E if they come in contact with animal such as consumption of undercooked meat etc
(Hepatitis E, 2013).
Apart from this, corruption also acts as main challenge to sustainable intervention in preventing
Hepatitis E. Different type of policies and laws have been developed with the motive to reduce
the impact on this disease but due to corruption effectiveness of such laws have been declined
(Vaccine for Hepatitis E, 2015). Apart from this, various medicines along with devices have
been introduced to tackle issue of Hepatitis E but they are also somehow ineffective due to
presence of corruption. Therefore, in this way social factors are also playing crucial role in health
issue such as Hepatitis E.
Environmental factors

This factor is also crucial and with the help of sustainable environment it is possible to ensure
that people living in the society are living healthy life, well being and better life that have impact
on actions of individuals. This type of environment can surely enhance resilience of individuals
easily and they can easily deal with the health related challenges (Deng, Cho,Fiers and Saelens,
2015). To develop awareness in the environment regarding issue of Hepatitis E is necessary
where its symptoms along with causes have to be known. Moreover, it is well known fact that
behavioral issues also act as significant barrier in attaining sustainable intervention. The main
causes of Hepatitis E involve touching inefected pig, eating undercooked meat etc (Zhang and
et.al., 2015). So, this type of infections has to be reduced in environment so as to deal with
Hepatitis E. On the other hand, in developing nations large number of challenges are present
where poverty leads to rise in health issue such as Hepatitis E. No proper transportation systems
along with other modes are present through which this issue can be avoided easily (Debing and
et.al., 2016). Proper health care facilities along with medical treatment is needed so that people
can live healthy life.
Ignorance is also regarded as one of the most crucial factor where majority of the individual
ignore issue of Hepatitis E such as lack of education, poverty and other unfavorable factors
which prevents them from knowing about this health issue (Kuniholm and et.al., 2015).
Moreover, in underdeveloped nation this issue is rising at faster pace and due to this reason
proper sharing of knowledge and information is must. Further, it is well known fact that some
factors are beyond control which can play significant role in controlling Hepatitis E.
Economical factors
Sharing wrong message with people living in society has direct impact on economy and
can adversely affect resource distribution. Further, in areas where funds are limited then to work
in favor of dealing with issue of hepatitis E is difficult. Moreover, government provides funds on
continuous basis for development of healthcare sector and through this individuals can easily
deal with the health issues being faced by them (Rendon and et.al., 2016). Apart from this, in the
entire society awareness is required to be developed where people needs to be educated so that
they can deal with Hepatitis E as a crucial health issue. Moreover, with the rise in economical
development more superior services can be offered to people living in society and they can live
healthy life. On the other hand, more developments are required to be take place in the field of
healthcare sector and through this better solution can be identified for the problem of Hepatitis E

(Di Bartolo and et.al., 2015). With the development of economy more advanced tools and
healthcare equipments can be employed for identifying the best possible solution of health issue
Hepatitis E. This can surely bring favorable results for the entire society and can lead to long
term sustainability along with the other kind of issues being faced which are linked with health.
The science behind the hepatitis E vaccines
Hepatitis E vaccine helps in preventing the infection of HEV. Basic hygiene and
sanitation has been the first defence against the disease. It was important to develop a safe
vaccine which could prevent the disease. The development of vaccine considers that all the main
genotypes of hepatitis E in human are from same serotype (Sauleda and et.al., 2015). Two
vaccines have been developed from genotype 1 by Xiamen Innovax Biotech Co.Ltd. and
GlaxoSmithKlein. These vaccines have short term efficacy in the trials. China has produced the
world's fist vaccine for hepatitis E whci is known as Hecolin. It has been approved by (SFDA)
State Food and Drug Administration of China in 2011. The researchers in Xiamen University has
produces a protein which can be injected into humans. It will help the immune system to fight
against HEV (Holm and et.al., 2015). It began in the year 2000, when a company invested USD
$1.8 million to set-up bio tech laboratory. This lab was given national status in 2006 by Chinese
Ministry. This vaccine has been used in China but still the long term efficacy of the vaccine in
not determined till now. Many countries have been working towards this issue and huge
investments have been made to develop a vaccine which can treat HEV infections (Vaccine for
Hepatitis E, 2015). It is essential to develop a medicine which has long term efficacy and gives
benefits for lifelong. It has to be commercial available and within the reach of common people.
The major problem has been in the developing nations which have lack of resources. These
vaccinations have to be provided to them. Moreover, awareness has to be created to encourage
people to diagnose themselves at regular intervals and maintain healthy environment.
Vaccine history
In 1990, HEV vaccination phase 1 trial started on 88 adults. In 2001-04, phase 2 trial was
conducted by US army and GlaxoSmithKlein on 1794 military conscripts. but it had many
controversies related to it and it has to be terminated as a result of political opposition. The
vaccines was unaffordable to the common public (Hepatitis E Vaccine, 2015). It showed efficacy
of about 88 % which improved to 95 % after 3 doses. This data was published in 2007, after 3
years of end of the trial. GlaxoSmithKlein did not pursue this vaccine. In 2005, researchers in

Xiamen University, China started working on new HEV vaccine. HEV 239 was tested on
112,604 people of Jiangsu Province which had genotype 3 and 4 patients. The vaccine showed
more than 99 % efficacy after 3 doses of the vaccine (Le and et.al., 2015). This drug was
licensed in 2012 and its production has been started. It is produced and sold by State Food and
Drug Administration of China. It will be initially used by the people of China who have high risk
with HEV. But the manufacturer, Xiamen Innovax Biotech Co.Ltd. has showed his interest in
selling the vaccine to other regions as well (Wilson, Xiang and Plebanski, 2015). This vaccine
has not been tested on genotype 1 patients which are more in number. But the manufacturer
claimed that the protein has been derived from Burma reference strain genotype 1 and it will be
effective on the genotype 1 patients as well. The pregnant women in China have been excluded
from the trial so there is no data available in this respect (Deng, Cho,Fiers and Saelens, 2015). It
has been tested on 68 pregnant women and it was successful. but still efficacy, safety and
immunogenicity in pregnant women are still warranted. It is believed that this vaccine will be
commercially available in countries which have high endemic HEV. According to a research in
Bangladesh, hepatitis E was associated 9.8% pregnancy deaths while 9.6% in non pregnancy
related deaths. This rate is even higher in slum areas. In Bangladesh the major reason behind
acute liver failure has been HEV (Zhang and et.al., 2015). HEV has been three decades old now
and it has high mortality rate.
Laboratory tests of vaccines
Commercial enzymes which are linked to immunosorbent assay (ELISA) have been used.
The specimens were tested for IgG and Igm antibodies. All hospital records and death records
were taken into consideration during the tests. The efficacy was divided into three levels for the
analysis and it included collection of data after 1 month (Boni and et.al., 2015). 54 people were
observed who received the vaccine of hepatitis E. The total efficacy which was observed in the
test was 95% which had the control group and patients with the vaccine. In order to test the
immunosorbent only those people were included who had taken at least one dosage of the
vaccine. It was found from the analysis that the efficacy improved significantly after 54 months
and it did not decrease in the follow up study. The total efficacy of the vaccine was 86.8% which
increased to 95 % after 3 doses (Boni and et.al., 2015). It was found that the vaccine can provide
sustained protection against the disease. It can prevent this disease up-to 4.5 years after the first
vaccination. Furthermore, the efficacy has not dropped after the follow up as well.

Delivering the information for the chosen audience
In present time, Hepatitis E virus is spreading in fast manner which affects the health
conditions of people. In respect to this, this virus generally spread by the route of fecal oral
(Martinelli and et.al., 2015). The virus directly attacks on the liver of individual and in infection
tie period it affects the daily life routines of people. The many research describes that Hepatitis E
is present across the entire world. This is severe issue in front of entire world in order to prevent
and minimize its impacts. The research in science explored that this type of virus is transmitted
from he microscopic amount of fecal matter. In may countries it is also observe that due to poor
sanitation and contaminated water supply, this types of disease is spreading in fast manner
among people (Sehgal and et.al., 2015). Many people usually eat the foods or drink the water
which already contaminated by the feces form someone infected form the cited disease. Along
with this, it is also explored hat people can also get affected form the virus of Hepatitis E while
making contract with animal such as infected pig or eating the under cooked meat related food
items. In respect to this disease, it is very uncommon to get its virus directly from other person.
In respect to this, who research that every year near about 20 million people are found infectious
from this disease and 56,600 people faces the death due to this. This is considered as a
waterborne disease (Sauleda and et.al., 2015). In present time there is no specific treatments or
medical therapies are present to reduce its harmful impacts along with this, it is also explored by
researcher that it commonly occur among the young adults between the age group of 5 to 44
years and older adolescents. The pregnant women are also present on the high level of risk elated
to Hepatitis E. For this reason, the affected people form hepatitis E are suggested to drink plenty
of fluids, get adequate rest, avoid alcohol consumption and take nutrients in essential manner.
With the presence of all these reasons, it is essentially requires to increase the awareness of
people in order to prevent the risk chances of Hepatitis E (Nakano and et.al., 2016). In order to
deliver the information for chosen audience in effective manner, there are several types of
methods are present such as mass media, social networking cites, heath promotional programs,
activities, health educational campaigns, advertisements, poster presentations, leaflets, role plays
and government initiatives. With the help of all these methods, awareness of people can be
increase by conveying the information related to medical care services and tips to prevent the
risk chances (Rendon and et.al., 2016). It is essentially requires to stop cases related to Hepatitis
E in future because with the presence of more suffered cases with progression to chronic liver

disease and chronic hepatitis. With the help of all above described methods, the awareness
among people can be increase in effective manner. In this context, to deliver information related
to symptoms and prevention methods among people, few methods are preset which are described
below such as:
 Social Networking sites- In present time, many people are actively present and uses the
social networking sites on regular basis such as Twitter, Facebook, Instagram, Pinterest
and podcasts etc (Smith and et.al., 2015). By using this famous social sites, information
related to Hepatitis E can be deliver to large number of people. This will help to increase
the awarenesses among people.
 Heath promotional programs- This type of programs are very effective and by conducting
the health promotional programs, informations related to Hepatitis E can effectively
deliver to large number of people.
 Activities- With the help of doing activities like video related to live example, infection
cycle and impact of Hepatitis on health related awareness among people can be increase
(Di Bartolo and et.al., 2015). By watching the videos, people will get the information and
take the precautions at the time of eating foods and drinking water.
 Health educational campaigns- With the help of this method, people will be aware about
the sanitation and vaccines which are available to prevent the risk factors of Hepatitis E.
 Advertisements- The advertisement related to Hepatitis E on television, radio, games,
web portals and you tube, more people will be able to get the information (Koning. and
et.al., 2015). The reason of selecting these mediums for advertisements is that in present
time most of the people spend their time on these.
 Poster presentations and Leaflets- By making the poster and pasting them to hoarding
which present in crowded area, more people can be attracted. The poster may holds the
information related to symptoms and treatment tips and medical methods (Lei and et.al.,
2016).
 Role plays- In the public area and malls, role plays can be conducted which represent the
impact of Hepatitis and prevention methods (Sauleda and et.al., 2015).
 Global initiatives- World Health Organisation deliver the information related to
epidemiology, prevention tips and clinical manifestations of Hepatitis E and its diagnosis

n he technical report which is “ Waterborne Outbreaks of Hepatitis E: recognition,
investigation and control” (Gerbi and et.al., 2015).
With the help of all the above described methods, awareness among people will be
increases because it is very important to stop the cases with the Hepatitis E. People will be more
aware at the time of drinking water and eating the food items. In case, if unconsciously they
made contact with The virus of Hepatitis E, people will be aware about the symptoms and
medical treatments in order to diagnose it in effective manner. In respect to this, several agencies
are present at international level such as World Health Organisation (WHO), UNDP (United
Nation Development Program) and UNICEF (United Nation Children Fund) etc (Perrin and
et.al., 2015). The main motive al these agencies is to maintain the health and well being of entire
population in effective manner. In present time, people are more aware about their health and in
addition to the awareness related to Hepatitis E, people will take the precautions at the time of
eating food and drinking water.
CONCLUSION
It can be concluded from the above report that Hepatitis E is caused by Hepatitis E virus
(HEV). It is caused by consumption of contaminated food and water. Water borne HEV is
regarded as genotype 1 and 2. It is mostly found in poor countries where there is no proper
sanitation system. Genotype 3 and 4 are found in developed countries due to the consumption of
raw or uncooked meat. Hepatitis E has been growing around the world and many researchers
have been working towards development of vaccines. There have been many trials and China has
been ale to develop the first vaccines which protects against HEV. Xiamen Innovax Biotech
Co.Ltd. and GlaxoSmithKlein have been the major contributor in the research and development
of the vaccine. HEV causes liver problems and even death so it is important to prevent this
disease from growing. Furthermore, all the issues relating to sustainability and resilience has to
be considered. It is essential to transmit the information to the people so that they can take
precautions against it. Proper sanitation system, washing of hands and eating properly cooked
food can help in eradicating this disease. Sustainability of the vaccines and efficacy has to be
ensured for a long period of time.

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