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Hepatitis E: Causes, Symptoms & Treatment

Hepatitis E is a liver inflammation caused by the hepatitis E virus (HEV). It is mainly transmitted through contaminated water or food and usually resolves on its own in healthy adults.

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Things worth knowing about "Hepatitis E"

Hepatitis E is a liver inflammation caused by the hepatitis E virus (HEV). It is mainly transmitted through contaminated water or food and usually resolves on its own in healthy adults.

What is Hepatitis E?

Hepatitis E is an acute inflammation of the liver caused by the hepatitis E virus (HEV), a member of the family Hepeviridae. The disease occurs worldwide and is one of the most common causes of acute viral hepatitis globally. In developing countries with limited access to clean water, hepatitis E is frequently transmitted through contaminated drinking water. In industrialized countries, infections are more commonly linked to the consumption of undercooked pork or game meat.

Causes and Transmission

The hepatitis E virus is primarily spread via the fecal-oral route, meaning the virus is ingested through water or food contaminated with infected fecal matter. The main transmission routes include:

Contaminated drinking water: The most common route in endemic regions (South Asia, Africa, Central America)
Food-borne transmission: Raw or undercooked animal products, especially pork, wild boar, and shellfish
Zoonotic transmission: Direct transmission from animals (mainly pigs) to humans, particularly with HEV genotypes 3 and 4
Blood transfusions: Possible in rare cases, particularly in immunocompromised individuals
Mother-to-child transmission: Vertical transmission during pregnancy has been documented

Symptoms

The incubation period is typically 2 to 10 weeks. Many infected individuals experience no symptoms or only mild illness. Common signs and symptoms include:

Fatigue and general malaise
Jaundice (icterus): Yellowing of the skin and whites of the eyes
Dark urine and pale stools
Abdominal pain, especially in the upper right quadrant
Nausea, vomiting, and loss of appetite
Low-grade fever
Joint pain

In most healthy adults, the infection resolves spontaneously within 4 to 6 weeks. Severe cases are uncommon but can occur in pregnant women, immunocompromised individuals, and those with pre-existing liver disease.

Diagnosis

Hepatitis E is diagnosed through laboratory testing:

Blood tests and liver enzymes: Elevated levels of ALT, AST, and bilirubin suggest liver inflammation
Antibody testing: Detection of IgM and IgG antibodies against HEV in the blood
PCR testing: Direct detection of the viral genome (HEV RNA) in blood or stool, particularly useful in immunocompromised patients where antibody responses may be impaired

Treatment

There is no specific antiviral therapy recommended for acute hepatitis E in immunocompetent individuals. Management is largely supportive:

Rest and adequate fluid intake
Avoidance of alcohol and hepatotoxic medications
In severe or chronic cases (especially in immunosuppressed patients): treatment with the antiviral drug ribavirin
In organ transplant recipients, reduction of immunosuppressive therapy may be considered

Chronic Hepatitis E

In immunocompromised individuals (e.g., organ transplant recipients, people living with HIV), hepatitis E can become chronic and may progress to liver cirrhosis if left untreated. Early diagnosis and antiviral treatment are therefore essential in these patient groups.

Prevention

Drinking safe, boiled, or bottled water when traveling in endemic regions
Thorough cooking of meat (especially pork) to an internal temperature of at least 70 °C (158 °F)
Good hand hygiene, particularly after using the toilet and before handling food
A licensed hepatitis E vaccine (Hecolin) is available in China but has not yet been approved in Europe or other Western countries

References

World Health Organization (WHO): Hepatitis E Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-e (2023)
Kamar N, Izopet J, Pavio N et al.: Hepatitis E virus infection. Nature Reviews Disease Primers, 3:17086 (2017)
European Centre for Disease Prevention and Control (ECDC): Hepatitis E. Available at: https://www.ecdc.europa.eu/en/hepatitis-e (2022)

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