Hepatitis E FAQs for Health Professionals

Index of Questions

Overview and Statistics

What is Hepatitis E?

Hepatitis E is a liver disease caused by the Hepatitis E virus (HEV). HEV infection usually results in a self-limited, acute illness. It is widespread in the developing world.

How common is Hepatitis E in the United States?

Hepatitis E is believed to be uncommon in the United States. When HEV infection does occur, it is usually the result of travel to a developing country where Hepatitis E is endemic. However, rare cases have been reported among persons with no history of travel to HEV-hyperendemic countries. Furthermore, some recent studies have found a high prevalence of antibodies to HEV in the general population.

Where is Hepatitis E most common?

Hepatitis E is most common in developing countries with inadequate environmental sanitation. Hepatitis E epidemics have been reported in Asia, the Middle East, Africa, and Central America. Some epidemics of Hepatitis E have involved tens of thousand of persons affected over a short period of time. People living in refugee camps or overcrowded temporary housing after natural disasters can be at particular risk. Increasingly, sporadic Hepatitis E cases not associated with travel have been identified in developed countries

 

Transmission and Exposure

How is the Hepatitis E virus spread?

Hepatitis E virus is usually spread by the fecal-oral route. The most common source of infection is fecally contaminated drinking water.

Can the Hepatitis E virus be spread by animals?

There is a possibility of zoonotic spread of the virus, since pigs and non-human primates are susceptible to infection.

 

Symptoms

What are the signs and symptoms of Hepatitis E?

When they occur, the signs and symptoms of Hepatitis E are similar to those of other types of acute viral hepatitis and can include:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Jaundice
• Dark urine
• Clay-colored stool
• Joint pain

The ratio of symptomatic to asymptomatic infection is reported to range from 1:2 to 1:13.

Who is most likely to have symptomatic HEV infection?

For infection acquired in developing countries, symptoms of HEV infection are most common among older adolescents and young adults (aged 15–44 years). Children infected with HEV usually have mild or no symptoms. Pregnant women are more likely to experience severe illness, such as fulminant hepatitis, and death. For infection acquired in developed countries, symptoms are more common among older people (>45 years), particularly men.

How soon after exposure will symptoms appear?

When symptoms occur, they usually develop 15 to 60 days (mean: 40 days) after exposure.

How long does an HEV-infected person remain infectious?

The period of communicability has not been determined, but virus excretion in stool has been demonstrated up to 14 days after the onset of jaundice.

How serious is Hepatitis E?

Most people with Hepatitis E recover completely. The overall case-fatality rate is ≤4%. However, for pregnant women, Hepatitis E is more serious and the disease is fatal in 10%–30% of pregnant women, particularly those in their third trimester.

Can Hepatitis E become chronic?

Yes, but this appears very rare, and are so far reported only in organ transplantation patients.

 

Diagnosis and Treatment

How is Hepatitis E diagnosed?

Because cases of Hepatitis E are not clinically distinguishable from other types of acute viral hepatitis, diagnosis can be confirmed only by testing for the presence of antibody to Hepatitis E or HEV RNA. No serologic tests to diagnose HEV infection have been approved for commercial use in the United States. Several tests are available for research purposes.

HEV infection should be considered in any person with symptoms of hepatitis who has traveled to Hepatitis E endemic regions and who is negative for serologic markers of Hepatitis A, B, and C. A detailed history regarding sources of drinking water, uncooked food, and contact with jaundiced persons should be obtained to aid in diagnosis.

How is Hepatitis E treated?

Hepatitis E usually resolves on its own without treatment. There is no specific antiviral therapy for Hepatitis E. Physicians should offer supportive therapy. Patients are typically advised to rest, get adequate nutrition and fluids, and avoid alcohol. Hospitalization is sometimes required in severe cases and should be considered for pregnant women.

 

Prevention

How is Hepatitis E prevented?

Prevention of Hepatitis E relies primarily on good sanitation and the availability of clean drinking water. Travelers to developing countries can reduce their risk for Hepatitis E by not drinking unpurified water. Boiling and chlorination of water will inactivate HEV. Immune globulin is not effective in preventing Hepatitis E.

Is there a vaccine for Hepatitis E?

No FDA-approved vaccine for Hepatitis E is currently available in the United States.