Hepatitis E

What is hepatitis E?
Hepatitis E infection is a disease of the liver caused by hepatitis E virus (HEV), a virus which can infect both animals and humans.

What are the symptoms of hepatitis E?
Symptoms of hepatitis E are similar to those of other types of acute viral hepatitis and include:

  • yellowing of the skin and eyes (jaundice)
  • darkening of the urine
  • pale stools
  • tiredness
  • fever
  • nausea
  • vomiting
  • abdominal pain
  • loss of appetite

Hepatitis E infection often has no symptoms or else causes a mild disease. However, it may result in liver failure in those who already have liver disease and in women infected during the third trimester of pregnancy.

Hepatitis E infection is usually self-limiting and resolves in 4-6 weeks without any treatment. Rarely, chronic hepatitis E infection may develop in people who have a suppressed immune system, for example after a solid organ transplant.

What is the incubation period for hepatitis E?
The incubation period (the time from exposure to the infection before developing symptoms) for hepatitis E is 15 to 60 days, the average being 40 days.

How is hepatitis E spread?
In developed countries, the virus may spread from animals to humans through the consumption of undercooked or raw pig and game meat, processed pork and shellfish. It has also been shown to spread directly by handling animals, particularly pigs.

In regions of the world where sanitation may be poor (Asia, Africa and Central America) the virus spreads by drinking contaminated water.

Direct spread of hepatitis E from one person to another is very rare though the virus has passed between people through blood transfusion.

Where is hepatitis E a problem?
Hepatitis E infection occurs worldwide, but the risk of infection is higher in countries or in situations where the levels of sanitation and hygiene are poor.

In developed countries hepatitis E was traditionally considered to be an infection associated with travel to areas with poor sanitation. However, it is increasingly being recognised as a disease that can be acquired within developed countries.

How is an infection diagnosed?
Hepatitis E is diagnosed by testing the patient's blood for the presence of specific anti-viral antibodies or the viral RNA.

Can hepatitis E be treated?
There is no specific treatment for hepatitis E and the infection usually resolves on its own without treatment. Therapy should be supportive and is aimed at maintaining comfort, hydration and adequate nutrition. Hospitalisation is sometimes required in severe cases and should be considered for pregnant women.

How can hepatitis E infection be prevented?

  • Cook meat and meat products thoroughly
  • Avoid raw or undercooked meat and shellfish
  • Good personal hygiene, with special emphasis on careful hand-washing after using the toilet and before preparing and eating food.

When travelling to countries with poor sanitation:

  • Avoid drinking unpurified water
  • Boil all drinking water, including water for brushing teeth
  • Avoid raw or undercooked meat and shellfish
  • Good personal hygiene, with special emphasis on careful hand-washing after using the toilet and before preparing and eating food.

Is hepatitis E a notifiable disease?
Hepatitis E is a notifiable disease under the Infectious Diseases Regulations. Cases should be notified to the Medical Officer of Health.

Is there a vaccine available?
Currently there is no vaccine available in Europe against HEV.

Further information is available from:
• Food Safety Authority of Ireland: https://www.fsai.ie/faq/hepatitis_e.html 
• Public Health England: https://www.gov.uk/government/collections/hepatitis-e
• Centers for Disease Control and Prevention: http://www.cdc.gov/hepatitis/hev/
• World Health Organization: http://www.who.int/mediacentre/factsheets/fs280/en/

Created: 7 December 2015

Updated: 17 December 2015