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JAMA Patient Page
May 12, 2020

Hepatitis E

JAMA. 2020;323(18):1862. doi:10.1001/jama.2019.21495

Hepatitis E is an infectious disease associated with inflammation of the liver.

What Is Hepatitis E?

The hepatitis E virus (HEV) causes an infection of the liver, known as hepatitis E. The disease is more common in countries with inadequate sanitation and hygiene. Transmission usually occurs when people drink water contaminated with stool that contains HEV. Large outbreaks have occurred in refugee camps and other environments prone to overcrowding. Occasionally, hepatitis E occurs in high-income countries and is associated with contaminated pork and other meat products.

What Are the Symptoms of Hepatitis E?

Symptoms of HEV infection include fever, nausea, vomiting, abdominal pain, fatigue, joint pains, dark urine, and jaundice (yellow eyes or skin). Some people have very mild symptoms or none at all. Pregnant women may experience more severe symptoms, and having HEV infection can be fatal in this population. Symptoms usually appear within 15 to 60 days after being infected. It is unknown how long individuals stay infectious.

How Is Hepatitis E Diagnosed and Treated?

HEV infection can be diagnosed by a blood test; however, blood may need to be sent to a special laboratory, as not all local laboratories perform the test.

Most people who have hepatitis E will recover with plenty of rest, fluids, and avoiding alcohol and medication such as acetaminophen or dietary supplements that may damage the liver. Supportive care in the hospital may be provided if necessary. Pregnant women are at risk for more severe disease, and hospitalization may be required. There is no antiviral medication available to treat acute hepatitis E.

Who Is at Risk for Hepatitis E?

Pregnant women are at high risk for severe disease when infected with HEV. Although HEV is found around the world, travelers to countries where HEV is common, such as those in East and South Asia, Africa, Central America, and the Middle East, are especially at risk. People with preexisting liver disease may be at higher risk of severe infection. Although HEV infection resolves in most people, individuals with suppressed immune systems may experience chronic infection.

How Do I Prevent Hepatitis E?

Ensuring good hygiene and sanitation is important to prevent HEV infection. Boil or chlorinate water (or purchase bottled water), and avoid ice of unknown purity when traveling in areas that have poor access to clean drinking water. Wash hands frequently with soap and water for at least 20 seconds. Avoid raw meat. Pregnant women and immunocompromised individuals should take special care when traveling to or in an environment that poses a high risk for contracting HEV infection. There is a vaccine to prevent infection; however, it is not yet in widespread use and is not available in the US.

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Article Information

Conflict of Interest Disclosures: None reported.

Sources: Friedrich MJ. Global burden of hepatitis E virus. JAMA. 2012;307(19):2017. doi:10.1001/jama.2012.5081

Hepatitis E. Centers for Disease Control and Prevention. Updated March 3, 2020. Accessed April 6, 2020. https://www.cdc.gov/hepatitis/hev/index.htm

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