Hepatitis E frequently asked questions
What is hepatitis E?
Hepatitis E infection is a disease that results in liver inflammation. It is caused by hepatitis E virus (HEV) which can infect both animals and humans. It is a notifiable disease in Ireland under the Infectious Diseases Regulations.
Where is Hepatitis E a problem?
Every year there are an estimated 20 million HEV infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E.
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. Because of this, it has traditionally been considered 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.
What are the symptoms of Hepatitis E?
Hepatitis E often has no symptoms or causes mild disease. Therefore, many cases often go undiagnosed.
If symptoms do occur, the incubation period (the time from exposure to the infection before developing symptoms) is 15 to 60 days, the average being 40 days. Symptoms are more common in older adolescents and young adults, and include:
- Fever
- Fatigue
- Abdominal pain
- Nausea and vomiting
- Loss of appetite
- Dark urine
- Clay-coloured stools
- Jaundice
In general, people who are infected with hepatitis E fully recover within 4-6 weeks without any treatment.
What are the complications of Hepatitis E?
Most people with hepatitis E recover completely. During outbreaks, overall case-fatality rate is around 1%. However, more severe disease and even death can occur in a small number of cases. This includes pregnant women infected with genotype 1 or 2 and those with pre-existing liver disease.
Persistent (chronic) infection is rare. It may develop in people with suppressed immune systems.
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 can be spread 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.
Who is most at risk of Hepatitis E infection?
Although anyone can get hepatitis E, there are certain groups of people who are more at risk of both getting infected. This includes:
- Consumption of undercooked meat and shellfish
- Poor sanitation / lack of safe water
- Those born in or travelling to countries with high hepatitis B prevalence
- Living in a household with an infected person
Those who are pregnant or have chronic liver disease are at increased risk for more severe disease if they get infected.
How is Hepatitis E 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 adequate hydration and nutrition.
Hospitalisation is sometimes required in severe cases and should be considered for pregnant women.
Immunosuppressed people with chronic hepatitis E can benefit from antiviral medications.
How can Hepatitis E infection be prevented?
Prevention is the most effective approach against the infection. Risk of infection can be reduced by:
- Cooking meat and meat products thoroughly
- Avoiding raw or undercooked meat and shellfish
- Using good personal hygiene, with emphasis on careful handwashing after using the toilet and before preparing and eating food
- Ensuring human faeces are disposed of appropriately.
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 emphasis on careful handwashing after using the toilet and before preparing and eating food.
Hepatitis E vaccination
Currently there is no vaccine available in Europe against HEV. However, a vaccine has been developed and is licensed in China.
Further information is available from:
HPSC: https://www.hpsc.ie/a-z/hepatitis/hepatitise/
WHO: https://www.who.int/en/news-room/fact-sheets/detail/hepatitis-e
CDC: https://www.cdc.gov/hepatitis/hev/
Public Health, UK: https://www.gov.uk/government/collections/hepatitis-e
Last updated: 20 October 2023