Hepatitis E is inflammation of the liver caused by the hepatitis E virus.
Hepatitis E is usually spread when people ingest something that has been contaminated by the stool of an infected person.
Hepatitis E causes typical symptoms of viral hepatitis, including loss of appetite, a general feeling of illness, and jaundice.
Doctors diagnose hepatitis E based on blood tests.
There is no specific treatment for acute hepatitis E, but most people recover completely.
(See also Overview of Hepatitis, Overview of Acute Viral Hepatitis, and Overview of Chronic Hepatitis.)
Hepatitis E does not usually become chronic, but it may become chronic in people with a weakened immune system, such as people with HIV infection or people who are taking medications to suppress the immune symptoms, such as cancer chemotherapy drugs.
Transmission of hepatitis E
Hepatitis E is spread primarily when something contaminated with the stool of an infected person is ingested by another person (called the fecal-oral route).
Hepatitis E occasionally causes epidemics, which are often linked to water contaminated by stool. Epidemics have occurred only in China, India, Mexico, Peru, Russia, Pakistan, and central and northern Africa, not in the United States or Western Europe. In countries that have effective, routine sanitation methods, most cases occur in travelers returning home after visiting a country where sanitation is poor and access to safe water is limited.
Symptoms of Hepatitis E
People with hepatitis E have typical symptoms of acute hepatitis. These symptoms include
Loss of appetite
A general feeling of illness (malaise)
Nausea and vomiting
Fever
Abdominal pain
Jaundice (yellowing of the skin and whites of the eyes)
Itching
Jaundice develops because the damaged liver cannot remove bilirubin from the blood as it normally does. Bilirubin then builds up in the blood and is deposited in the skin, causing itchiness. Bilirubin is a yellow pigment produced as a waste product during the normal breakdown of red blood cells.
Although rare, hepatitis E may cause severe symptoms, especially in pregnant women. In pregnant women, the risk of severe hepatitis with signs of liver failure (fulminant hepatitis) and death is increased.
Diagnosis of Hepatitis E
Blood tests
Doctors suspect hepatitis based on typical symptoms, such as jaundice.
Testing for hepatitis usually begins with blood tests to determine how well the liver is functioning and whether it is damaged (liver tests). Liver tests involve measuring the levels of liver enzymes and other substances produced by the liver. These tests may help determine the severity of liver damage.
If tests suggest hepatitis, doctors do other blood tests to check for hepatitis viruses. These blood tests can identify parts of specific viruses (antigens), specific antibodies produced by the body to fight the virus, and sometimes genetic material (RNA or DNA) of the virus.
Doctors do not routinely test people for hepatitis E. However, a blood test to detect antibodies produced by the person's immune system in response to the hepatitis E virus, if available, is done when both of the following are present:
Tests do not detect hepatitis A, B, or C, but the person has typical manifestations of viral hepatitis.
The person has recently traveled to an area where hepatitis E is common.
Treatment of Hepatitis E
General measures
People with hepatitis E should not drink alcohol because it can damage the liver further. There is no need to avoid certain foods or limit activity.
There is no specific treatment for acute hepatitis E.
Most people can safely return to work after jaundice resolves.
Prevention of Hepatitis E
Good sanitation and personal hygiene can help prevent hepatitis E. Travelers to countries where sanitation is not optimal can reduce their risk of infection by not drinking unpurified water. Boiling and chlorination of water inactivate the hepatitis E virus.
A vaccine is available in China, where hepatitis E is more common. The vaccine is not available in the United States.
