Hepatitis E is an illness of the liver caused by hepatitis E virus (HEV), a virus which can infect both animals and humans. HEV infection usually causes no symptoms but if it does, it produces only a mild disease, hepatitis E. In rare cases, however, it can prove fatal, particularly in pregnant women but seems not to do so in thie UK. Normally the virus infection will clear by itself. However, it has been shown that in individuals whose immune system is suppressed the virus can result in a persistent infection which may lead to chronic inflammation of the liver.
Symptoms of hepatitis E include yellowing of the skin and eyes (jaundice), darkening of the urine and pale stools, which may or may not be accompanied by tiredness, fever, nausea, vomiting, abdominal pain and loss of appetite. The illness usually resolves within one to four weeks. A test for HEV antibodies and RNA can be undertaken to confirm HEV infection on either blood or oral fluid samples.
Hepatitis E occurs world-wide, particularly in regions of the world where sanitation may be poor including Asia, Africa and Central America. However, hepatitis E can be indigenously acquired in developed countries, including the UK. This was first recognised in 2003 and the numbers of confirmed hepatitis E cases and infections have increased significantly over the past few years.
In the developing world, the virus is transmitted by the consumption of sewage-contaminated food and water. The source of contamination is faeces shed from other infected people (or infected animals). In the developed world the virus is believed to tranmit from animals to humans through the consumption of undercooked or raw pig and game meat, processed pork and shellfish. The transmission routes in the UK remain unknown. Person to person transmission of the virus is very rare though the virus has been transmitted through blood transfudion and transplantation.
The average incubation period, i.e. the period of time you can have the infection before developing symptoms, for hepatitis E is 40 days (range 15-60 days).
There is normally no need for any treatment as most people will clear their infections naturally. It is best for those infected to avoid alcohol during the course of their illness.
Pregnant and older people, those with weakened immune systems, and people with chronic liver disease might need closer observation for deterioration in liver function as they may experience more severe infection. Pregnant women should seek advice from their antenatal carer.
It is important to cook meat and meat products throughly and to practice good hygiene - always wash hands thoroughly before preparing or serving food; or before eating meals.
Currently, there is no licensed vaccine for hepatitis E. When travelling to countries with poor sanitation, it is advisable to boil all drinking water, including water used for brushing teeth. Avoid the consumption of raw or undercooked meat and shellfish.
During the first two weeks of illness, infected people should not prepare meals for others and, if possible, should limit contact with others, especially those who are pregnant or have pre-existing chronic liver disease.
Hands should be washed thoroughly with soap and warm water and then dried properly after contact with an infected person or their soiled articles. It is also important to wash hands after going to the toilet; before preparing or serving food; or before eating meals.
Further information and advice is available from: