Hepatitis E is a liver infection caused by the hepatitis E virus (HEV). HEV is found in the stool of an infected person. It is spread when someone unknowingly ingests the virus – even in microscopic amounts. In developing countries, people most often get hepatitis E from drinking water contaminated by feces from people who are infected with the virus. In the United States and other developed countries where hepatitis E is not common, people have gotten sick with hepatitis E after eating raw or undercooked pork, venison, wild boar meat, or shellfish. In the past, most cases in developed countries involved people who have recently traveled to countries where hepatitis E is common. Symptoms of hepatitis E can include fatigue, poor appetite, stomach pain, nausea, and jaundice. However, many people with hepatitis E, especially young children, have no symptoms. Except for the rare occurrence of chronic hepatitis E in people with compromised immune systems, most people recover fully from the disease without any complications. No vaccine for hepatitis E is currently available in the United States.

Hepatitis E is a viral infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs.

Viruses invade normal cells in your body. The hepatitis E virus has different types that spread in different ways.

• Some types are spread by drinking contaminated water. These types are more common in developing countries, including parts of Africa, Asia, Central America, and the Middle East.
• Other types are spread by eating undercooked pork or wild game, such as deer. These types are more common in developed countries, such as the United States, Australia, Japan, and parts of Europe and East Asia.

Hepatitis E typically causes acute, or short-term, infection.

Acute hepatitis E

Acute hepatitis E is a short-term infection. In most cases, people’s bodies are able to recover and fight off the infection and the virus goes away. People usually get better without treatment after several weeks.

Chronic hepatitis E

Chronic hepatitis E is a long-lasting infection that occurs when your body isn’t able to fight off the virus and the virus does not go away. Chronic hepatitis E is rare and only occurs in people with weakened immune systems. For example, hepatitis E may become chronic in people taking medicines that weaken their immune system after an organ transplant, or in people who have HIV or AIDS.

Hepatitis E is more common in developing countries, where sanitation is poor and access to clean water is limited.

Although experts used to think hepatitis E was rare in the United States, recent research suggests that about 20 percent of the population has had hepatitis E.

The types of hepatitis E that are common in developing countries are likely to cause severe infections, especially in pregnant women.

The types of hepatitis E that are common in developed countries are often mild and cause no symptoms. Many people don’t know they’ve had these types of hepatitis E.

Here’s a type of hepatitis you probably haven’t heard of before. Like all types of viral hepatitis, hepatitis E is a disease that affects the liver. It is spread by ingesting fecal matter contaminated with hepatitis E virus, even in tiny amounts, and is often associated with contaminated water in countries with poor sanitation. For this reason, hepatitis E is more common in developing parts of the world; it is rare in the United States and other developed countries. In the United States, most cases of hepatitis E occur among travelers to countries with a high burden of this disease, but rarely cases can also be traced to consumption of raw or undercooked food that is contaminated with the virus.

For most people, infection with the hepatitis E virus (HEV) results in short-term illness. The infection usually improves with rest, proper hydration, and nutrition. Although many people don’t have any symptoms, hepatitis E can lead to liver disease and death in certain people (pregnant women and people who have received solid organ transplants) No FDA-approved vaccine is available to prevent hepatitis E.

Key Facts

• Hepatitis E is a liver disease caused by the hepatitis E virus.
• People living in countries with poor sanitation and limited access to safe water are at highest risk for hepatitis E, along with travelers to these countries.
• Hepatitis E may occur in high-income countries as a result of the consumption of raw or undercooked food.
• Hepatitis E can cause serious liver disease and even lead to death in pregnant women and people with vulnerable immune systems.
• Not everyone infected with hepatitis E has symptoms, but symptoms can include fever, fatigue, nausea, and jaundice.
• Hepatitis E can only be diagnosed by your health-care provider with the assistance of laboratory tests.
• No vaccine is available to prevent hepatitis E.

Prevention Tips

• Avoid drinking untreated water when traveling to areas with poor sanitation; HEV is inactivated when water is boiled and chlorinated.
• Avoid eating raw or undercooked food, specifically pork and venison.
• Visit your health-care provider immediately if you have signs and symptoms consistent with viral hepatitis.

Different types of hepatitis E are more likely to affect different groups of people. The types of hepatitis E that are more common in developing countries are more likely to affect adolescents and young adults.

In contrast, the types of hepatitis E that are more common in developed countries most often affect older men.

The hepatitis E virus causes hepatitis E. In developing countries, hepatitis E typically spreads through drinking contaminated water. In developed countries, such as the United States, hepatitis E typically spreads from animals to people, when people eat undercooked pork or wild game, such as deer.

Research suggests that hepatitis E can also spread through blood transfusion, but this is very rare.

Many people infected with hepatitis E have no symptoms. Some people have symptoms 15 to 60 days after they become infected with the virus. These symptoms may include

• feeling tired
• nausea and vomiting
• poor appetite
• pain over the liver, in the upper part of the abdomen
• darkening of the color of urine
• lightening of color of stool
• yellowish tint to the whites of the eyes and skin, called jaundice

People with hepatitis E typically get better without treatment after several weeks.

Acute hepatitis E complications

Most people recover from acute hepatitis E without complications. In some cases, acute hepatitis E may cause acute liver failure, a condition in which the liver fails suddenly. Acute liver failure due to hepatitis E is more common in

• pregnant women
• people who have other liver diseases

In pregnant women, hepatitis E can cause other complications for the mother and baby, such as stillbirth, premature birth, or low birthweight.

Chronic hepatitis E complications

Chronic hepatitis E—which is rare and only occurs in people with weakened immune systems—may lead to complications such as cirrhosis or liver failure.

Doctors diagnose hepatitis E based on symptoms and blood tests. A health care professional will take a blood sample from you and send the sample to a lab. Blood tests can detect antibodies to the hepatitis E virus and show whether you have hepatitis E. The virus can also be detected in blood and in stool samples taken during acute hepatitis E infection.

Treatment for acute hepatitis E includes resting, drinking plenty of liquids, and eating healthy foods to help relieve symptoms.

Talk with your doctor before taking any prescription or over-the-counter medicines, vitamins or other dietary supplements, or complementary or alternative medicines—any of these could damage your liver. You should avoid alcohol until your doctor tells you that you have completely recovered from hepatitis E.

See your doctor regularly to make sure your body has fully recovered.

Doctors may treat chronic hepatitis E with ribavirin or peginterferon alfa-2a (Pegasys).

When traveling in a developing country, drink bottled water. Use bottled water to brush your teeth, make ice cubes, and wash fruits and vegetables.

Also, make sure any pork or deer you eat is thoroughly cooked, both in developing countries and in developed countries such as the United States.

No vaccine for hepatitis E is available in the United States. Vaccines have been developed and are used in China.

What is hepatitis E?

Hepatitis E is a virus that causes liver disease. Hepatitis E virus is found in places around the world where sanitation is poor and there is limited access to safe drinking water.

You can get infected with hepatitis E virus if you

• Eat food or drink beverages contaminated with hepatitis E
• Eat shellfish or uncooked or undercooked products made from deer, boar, and pig

Some people who get hepatitis E never feel sick. Others have symptoms that may include fever, tiredness, loss of appetite, nausea, vomiting, stomach pain, dark urine, clay-colored bowel movements, joint pain, and jaundice (yellow color in the skin or eyes). Symptoms usually last less than two months but can last for up to six months.

Most people infected with hepatitis E virus recover with no lasting liver damage. However, people with existing liver disease can get seriously ill. Infected pregnant women can get seriously ill and have pregnancy complications.

Who is at risk?

Hepatitis E is found worldwide. Hepatitis E is more widespread in low and middle income countries, specifically in Asia and Africa, that do not have adequate food and water safety standards. Travelers to these countries are more likely to get infected.

In addition, travelers working in health care settings or refugee camps may be more at risk of infection. Many large hepatitis E outbreaks have occurred among refugees and internally displaced people living in camps.

What can travelers do to prevent hepatitis E?

There is no vaccine to prevent hepatitis E. Travelers can help prevent hepatitis E by taking the following steps:

Choose food and drinks carefully

• Only drink beverages from factory-sealed containers
• Avoid ice because it may have been made from unclean water
• Only drink pasteurized milk
• Only eat foods that are cooked and served hot
• Avoid food that has been sitting on a buffet
• Only eat raw fruits and vegetables if you have washed them in clean water or peeled them

If you traveled and feel sick, particularly if you have a fever, talk to a healthcare provider, and tell them about your travel. Avoid contact with other people while you are sick.

What is hepatitis E?
Hepatitis E is a liver disease caused by the hepatitis E virus (HEV). Most people with hepatitis E fully recover and have no long-term liver problems as a result of their infection.

How is hepatitis E spread?
In developing countries, people most often get hepatitis E from drinking water contaminated by feces from people who are infected with the virus. In the United States and other developed countries, people have gotten sick with hepatitis E after eating raw or undercooked pork, venison, and wild boar meat.

How common is hepatitis E?
Hepatitis E is common in many parts of the developing world where sanitation is poor. It is not common in the United States, where people have access to clean drinking water. Most cases in the United States involve people who have recently traveled to countries where hepatitis E is common.

Who is at risk for hepatitis E?
Travelers to areas of the world with poor sanitation are at greatest risk for getting hepatitis E.

Does hepatitis E cause symptoms?
Many people with hepatitis E, especially young children, do not have any symptoms. Others may experience one or more of these symptoms:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored stool
• Joint pain
• Jaundice (a yellowing of the skin or eyes)

How soon after exposure to hepatitis E will symptoms appear?
If symptoms occur, they usually appear anywhere from 2 to 6 weeks after exposure to the virus that causes hepatitis E.

How serious is hepatitis E?
Pregnant women are at greater risk for liver failure and death from hepatitis E. People who have had solid-organ transplants and those with compromised immune systems can experience more severe, long-term liver problems if infected.

How would I know if I have hepatitis E?
Hepatitis E can only be diagnosed with laboratory tests ordered by your health-care provider. If you are having symptoms of hepatitis E, see your health-care provider.

How is hepatitis E treated?
There is no specific treatment for hepatitis E. Most people get better by treating their symptoms.

Can hepatitis E be prevented?
No vaccine is available to protect against hepatitis E. However, you can lower your risk for HEV infection by drinking only purified water when visiting countries where hepatitis E is common and by avoiding raw or undercooked pork, venison, and wild boar meat.