About Hepatitis E (Hepeviridae, Hep E virus)
Once known as non-A, non-B hepatitis, hepatitis E was first distinguished and isolated from hepatitis A in 1980. Hepatitis E is a non-enveloped, positive sense single stranded RNA virus.
Why it is Problematic
Hepatitis E is a self-limiting infection, meaning that it typically clears itself 4-6 weeks. Occasionally, fulminant forms of hepatitis E may develop. Fulminant hepatitis cases can lead to liver failure or death.
Causes and Risk Factors
Hepatitis E has a fecal-oral transmission route and is usually contracted via contaminated drinking water and/or inadequate environmental sanitation. Other ways to contract hepatitis E include eating food derived from infected animals, having a blood transfusion with infected blood products, or mother to child transmission.
Hepatitis E can be asymptomatic. When symptoms do present themselves, they take 3-8 weeks after infection to surface, with the average incubation period being 40 days. Symptoms are most common in young adults aged 15-40. Hepatitis E is common in children but is more likely to remain symptomless or with mild symptoms, such as a generalized feeling of illness without jaundice.
When symptoms are present they may include:
- Abdominal pain
- Enlarged liver
- Jaundice (the yellowing of the skin and whites of eyes)
- Loss of appetite
- Vague sense of feeling unwell
Hepatitis E is not clinically distinguishable from other types of acute viral hepatitis. Blood test may be used to check for specific antibodies to Hep E or HEV RNA. Diagnostic tests used in research studies- RT-PCR, immune electron microscopy may also assist in diagnosing hepatitis E.
Treatment and Prevention
There are no specific treatments for hepatitis E. Treatment is supportive, usually consisting of rest, adequate nutrients and fluids, and avoiding alcohol. Prevention of the virus is the focus. A hepatitis E vaccine exists, but it has only been approved for use in China.
Hospitalization is usually not required for hepatitis E except in fulminant cases. Hepatitis E is not common in the U.S.; it is most common in East Asia and South Asia.
When traveling to an endemic area, ways to prevent infection with the hepatitis E virus include:
- Drink clean, filtered water
- Maintain good hygiene, wash hands with clean water (especially before handling food)
- Avoid drinking water and ice of unknown purity
- Avoid eating uncooked shellfish and uncooked fruits and vegetables
Hepatitis E is uncommon in the US. When present it is usually the result of traveling to developing countries in Asia, the Middle East, Africa or Central America. It is estimated that approximately one in 1 million U.S. residents is infected with Hepatitis E each year. Globally, about 20 million people are infected with hepatitis E every year.