Hepatitis E

What is hepatitis E?

Hepatitis E is a viral infection of your liver that the hepatitis E virus (HEV) causes. It can cause digestive symptoms like vomiting, belly (abdominal) pain and diarrhea.

For most people, hepatitis E isn’t serious and goes away without treatment in a few weeks. But if you’re pregnant, hepatitis E can put you at high risk for liver failure and pregnancy complications. Let your pregnancy care provider know right away if you’re pregnant and think you could have hepatitis E.

What are the symptoms of hepatitis E?

The first symptoms of hepatitis E include:

• Fever
• Nausea and vomiting
• Loss of appetite
• Belly (abdominal) pain

After a few days, you might develop additional symptoms, including:

• Itching
• Rash
• Joint pain
• Dark pee (urine)
• Pale or clay-colored poop (stool)
• Diarrhea
• Yellow tinge to your skin or eyes (jaundice)

Some people don’t have any symptoms.

What causes hepatitis E?

Hepatitis E virus (HEV) causes hepatitis E. You can get HEV through:

• Drinking water contaminated with infected poop. This is the most common way to get hepatitis E.
• Eating undercooked meat. In areas where hepatitis E is uncommon, like the U.S., people occasionally get infected with HEV from eating undercooked pork, deer or boar meat, or shellfish.
• Vertical transmission. This is when an infection passes from your body to the fetus through the placenta during pregnancy.

Is hepatitis E contagious?

No, hepatitis E is rarely contagious (spread from person to person).

Who’s most at risk for hepatitis E?

Hepatitis E is most common in South and East Asia, Africa and Central America. People at most risk of infection are those without access to sanitized water, toilet facilities or health services.

Outbreaks can happen in areas experiencing crises or when large numbers of people are displaced, like during war. But there are also sporadic (individual) cases all over the world that don’t affect large numbers of people.

What are the complications of hepatitis E?

Pregnant women with hepatitis E — especially in the third trimester — are at the highest risk of complications, including:

• Liver failure.
• Miscarriage.
• Stillbirth.

Rarely, hepatitis E can cause liver failure in women who aren’t pregnant. If you have a compromised immune system, you might be at a higher risk for a chronic (long-lasting) hepatitis E infection.

How is hepatitis E diagnosed?

Healthcare providers diagnose hepatitis E with blood tests or a stool (poop) test. A lab looks for signs of the virus (its genetic material or antigens) or antibodies to the virus in the sample of blood or poop.

Is hepatitis E curable?

There’s no specific treatment for hepatitis E. If you have a compromised immune system and chronic hepatitis E, your provider might treat you with antiviral medications, like ribavirin, or treatments that boost your immune system, like interferon. These treatments aren’t considered safe if you're pregnant.

What can I expect if I have hepatitis E?

Hepatitis E infections usually last one to six weeks, though it may take longer for your liver to fully heal. Most hepatitis E infections don’t cause any complications.

If you’re pregnant, especially in your third trimester, healthcare providers will need to closely monitor you and the fetus. You may need to stay in the hospital.

If you have a compromised immune system, you may not be able to fight off the virus as easily and your infection may become chronic (lasting several months or more). You may need medications to help your body fight it off.

What’s the mortality rate of hepatitis E?

Hepatitis E is rarely fatal in women who aren’t pregnant. The mortality (death) rate from hepatitis E in pregnant women can be as high as 30%. Some studies suggest that infants born to someone who had hepatitis E during pregnancy can have a mortality rate around 6%.

Can hepatitis E be prevented?

If you live in or travel to an area where hepatitis E is common or there’s an outbreak, you can reduce your risk by:

• Drinking only bottled or treated water.
• Not using ice (unless you know it’s made from water that’s safe to drink).
• Cooking and preparing food (like washing fruits and vegetables) with bottled or treated water.
• Only eating fruits and vegetables that have been peeled or washed thoroughly with bottled or treated water.
• Washing your hands frequently, especially before eating and after going to the bathroom.

Is there a hep E vaccine?

Yes, a vaccine for hepatitis E, HEV p239 (Hecolin^®), is available in China and a few other places in the world. It’s not available in the U.S.

How do I take care of myself?

You can take care of yourself with hepatitis E by:

• Staying hydrated. Drink plenty of clear liquids or broth, especially if you’re throwing up or have diarrhea.
• Avoiding alcohol. Alcohol can put more stress on your liver and can also make you dehydrated.
• Checking in with your healthcare provider. They may want to monitor your liver function or make sure your symptoms are improving. You should also ask if it’s okay for you to return to work or school.

When should I see my healthcare provider?

Talk to your provider if you have symptoms of hepatitis E and you live in or have traveled to an area where it’s common, especially if you’re pregnant.

When should I go to the ER?

Go to the emergency room if you have signs of severe illness, including:

• Severe abdominal pain.
• Severe vomiting or being unable to keep anything down.
• Vomiting blood or vomit that looks like coffee grounds.
• Jaundice.
• Confusion or altered mental state (hepatic encephalopathy).
• Dark-colored pee or peeing very little.
• Pale or clay-colored poop.

What questions should I ask my doctor?

It might be helpful to ask your healthcare provider:

• How do I take care of myself at home?
• When can I go back to work/school?
• What serious symptoms should I look out for?
• When should I follow up with you?

What’s the difference between hepatitis E and other forms of hepatitis?

Hepatitis E — along with A, B, C and D — are all viral infections in your liver. But different viruses cause them. Each virus spreads in slightly different ways, some have vaccines and some don’t, and some require treatment while others don’t. Hepatitis E is different from most other forms of viral hepatitis because it doesn’t usually spread from person to person.