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Hepatitis E


Hepatitis E is an infection of the liver caused by the hepatitis E virus (HEV).HEV is found in an infected person's feces (stools). It is spread when someone accidentally ingests the virus, even in minute amounts. People in underdeveloped countries are most likely to contract hepatitis E via drinking water contaminated with the virus.   People have contracted hepatitis E after eating raw or undercooked pork, venison, wild boar meat, or shellfish in the United States and other developed nations where hepatitis E is not common. Most cases in developed countries in the past included people who had recently gone to places where hepatitis E was prevalent. Except for a few cases of chronic hepatitis E in patients with weakened immune systems, most people recover completely and without complications. Hepatitis E vaccination is not yet available in the United States.


There are at least four different types of the virus: genotypes 1, 2, 3, and 4. In humans, genotypes 1 and 2 only have been found. Genotypes 3 and 4 are found in various species, including pigs, wild boars, and deer, and can occasionally infect humans.


Hepatitis is caused by the hepatitis E virus (HEV). Infection with hepatitis E occurs when a person consumes food or drinks contaminated by an infected person's feces (stool), which is common in areas with inadequate sanitation. Natural disasters have contributed to the spread of hepatitis E in some cases. Heavy rains can cause sewers to overflow, contaminating drinking water as it mixes with it.

Transmission: The fecal-oral route is the most common way HEV can spread. The most common source of HEV infection in developing nations, where HEV genotypes 1 and 2 predominate, is contaminated drinking water or a lack of clean water and sanitation. Also, people living in overcrowded camps or temporary dwellings, such as refugees and homeless people. 

In developed countries, rare cases of HEV genotype 3 have been reported after eating raw or undercooked pig or venison. Shellfish consumption was found to be a risk factor in a recent outbreak among cruise ship passengers. Foodborne transmission has also been linked to HEV genotype 4, which has been found in China, Taiwan, and Japan.

Signs And Symptoms

Hepatitis E signs and symptoms are similar to those of other kinds of acute viral hepatitis and liver injury when they develop. They are as follows:

  • Yellow discoloration of eyes and skin (Jaundice)
  • Fatigue
  • Weakness
  • Joint pain
  • Abdominal pain
  • Clay-colored stools
  • Dark urine
  • Nausea
  • Vomiting
  • Loss of appetite
  • Fever 

Risk Factors

The following are risk factors for hepatitis E virus infection:

  • Lack of sanitation.
  • Contamination of drinking water supplies.
  • Meat and shellfish that are consumed uncooked or undercooked.
  • People who live in areas where community outbreaks have been going on for a long time.
  • International travels to HEV-endemic areas around the world
  • Refugees living in overcrowded temporary settlements as a result of natural disasters.
  • Those who suffer from chronic liver disease.
  • People who work with animals such as pigs, cows, sheep, or goats.


Hepatitis E cases cannot be distinguished clinically from other types of acute viral hepatitis. However, in appropriate epidemiologic settings, such as when multiple cases occur in known disease-endemic areas, in settings with a risk of water contamination when the disease is more severe in pregnant women, or if hepatitis A has been ruled out, a diagnosis can often be strongly suspected.

In places where the disease is common, identifying specific anti-HEV immunoglobulin M (IgM) antibodies to the virus in a person's blood is usually enough to make a definitive diagnosis of hepatitis E infection.

RT-PCR (Reverse transcriptase-polymerase chain reaction) is another test that detects hepatitis E virus RNA in blood and stool.   In locations where hepatitis E is rare and in rare cases of persistent HEV infection, this test is especially important.


There is no specific treatment for acute hepatitis E that can change the course of the disease. Hospitalization is rarely necessary because the disease is usually self-limiting. Doctors often recommend supportive therapy. Patients are often advised to rest, drink plenty of water, avoid alcohol, and consult their doctor before taking any medications that can harm the liver. The most important thing is to avoid taking medications that aren't necessary. Hospitalization is required for people with fulminant hepatitis and symptomatic pregnant women. People with chronic hepatitis E who are immunocompromised benefit from ribavirin, an antiviral medication. Interferon has also been used successfully in a few specific situations.


The most efficient way to fight infection is to prevent it. Transmission of HEV and hepatitis E infection can be reduced at the population and individual level by:

  • Maintaining water supply quality standards
  • Establishing proper human feces disposal systems
  • Avoiding the consumption of contaminated water and ice
  • Maintaining hygienic practices 
  • Travelers to underdeveloped countries should avoid drinking unpurified water to lower their risk of infection.
  • HEV is inactivated by boiling and chlorinating water.
  • HEV can be prevented by avoiding raw uncooked food (raw pork and venison). 

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 20, 2023. 


Hepatitis E - FAQs, Resources, and Testing Requests | CDC


Hepatitis E (who.int)


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