Hepatitis E

Hepatitis E is a liver infection caused by the hepatitis E virus (HEV). It spreads mainly through contaminated food and water. The infection can make you feel sick to your stomach. It can cause symptoms like belly pain and vomiting.

Hepatitis E is common in areas around the world with poor sanitation. You might get it if you live or travel to an area where there isn’t access to clean water.

People with HEV usually get better within two to six weeks without treatment. But having hepatitis E during pregnancy can be dangerous. It can cause severe symptoms, leading to liver failure, pregnancy complications or death. If you’re pregnant and have hepatitis E, it’s vital to get immediate medical care.

Types of hepatitis E

The hepatitis E virus can cause acute or chronic infections:

• Acute hepatitis E: Acute hepatitis E only lasts for a short time. It typically goes away on its own within six weeks. Rarely, acute hepatitis E can lead to complications like liver failure.
• Chronic hepatitis E: Chronic hepatitis E can last for months or longer without treatment. With treatment, many people can clear the virus. Chronic hepatitis E is rare. It most often affects people with weakened immune systems.

Hepatitis E symptoms

Symptoms of hepatitis E can appear 15 to 60 days after you get the infection. But most people don’t have symptoms or only have mild symptoms.

If you do develop symptoms, they can include:

• Jaundice (yellowing of your skin and the whites of your eyes)
• Fatigue
• Loss of appetite
• Abdominal (belly) pain
• Nausea and vomiting
• Fever

Less common symptoms include:

• Diarrhea
• Itchy skin
• Joint pain
• Hives

Cause of hepatitis E

The hepatitis E virus (HEV) causes hepatitis E. HEV is found in the poop of infected people. It primarily spreads through contaminated food or water. Hepatitis E transmission can occur through:

• Drinking unclean water: This is the most common way you can get it. The water has tiny bits of poop that carry the virus.
• Eating undercooked food: In the U.S., you can get HEV from eating raw or undercooked pork, venison, boar or shellfish.
• During pregnancy: If you’re pregnant, you can pass the virus to the fetus (vertical transmission).
• Blood transfusion: Blood you get from a donor can contain HEV, but this is rare.

Hepatitis E rarely spreads from person to person.

Risk factors

People who travel to or live in areas with poor sanitation are at the greatest risk of hepatitis E. You’re also more likely to get it if you:

• Eat raw shellfish or undercooked meat
• Have a weakened immune system
• Have hepatitis C or chronic liver disease

Complications of hepatitis E

For most people with hepatitis E, the infection clears up quickly. But sometimes, it can cause life-threatening complications, including:

• Acute liver failure
• Cholestatic hepatitis
• Chronic liver disease

In some parts of the world, especially during late pregnancy, hepatitis E can be life-threatening. Up to 1 in 4 pregnant women die if they get hepatitis E during the third trimester. The risk is much lower in countries with advanced medical care. In addition to complications from the infection, they can develop pregnancy complications, including:

• Stillbirth
• Preterm labor
• Low birth weight

How doctors diagnose hepatitis E

Your healthcare provider can sometimes diagnose hepatitis E through a blood test. The test looks for the antibodies of HEV in your blood. Antibodies are proteins your immune system makes in response to viruses. You may need other blood tests or a test that checks for the virus in your poop.

Is there a cure for hepatitis E?

There’s no specific cure or treatment for hepatitis E. But most people with the virus get better on their own within two to six weeks. You can relieve the symptoms of acute hepatitis E by:

• Resting
• Drinking lots of fluids
• Avoiding alcohol
• Eating healthy foods

Check with your healthcare provider before taking any medications or supplements.

Chronic hepatitis E mostly affects people who have weakened immune systems. Treatment involves reducing your immunosuppressant and/or getting an antiviral, like ribavirin.

Hepatitis E treatment during pregnancy

If you’re pregnant, especially in the third trimester, your healthcare provider will need to closely watch over you and the fetus. They may recommend that you stay in the hospital. If not, you’ll need to check in often.

Don’t take any medication without speaking to your provider. Certain medicines can be unsafe for you and the fetus. Antiviral medicines like ribavirin aren’t safe during pregnancy. And let your provider know right away if your symptoms get worse or you notice anything new.

When should I see my healthcare provider?

Contact your provider if your symptoms don’t seem to be getting better.

Go to the emergency room if you have:

• Confusion or altered mental state (hepatic encephalopathy)
• Dark-colored or very little pee
• Severe or worsening belly pain
• Severe vomiting, vomiting blood or vomit that looks like coffee grounds

What can I expect if I have this condition?

Most people recover from hepatitis E in fewer than six weeks without any issues. If you’re pregnant or have a weakened immune system, your provider will watch you more closely. You may need treatment in the hospital if you develop complications.

Can hepatitis E be prevented?

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

• Drinking only bottled or treated water
• Using bottled water to brush your teeth and make ice
• Peeling and washing produce with bottled or treated water
• Washing your hands often, especially before eating and after using the bathroom
• Avoiding food from street vendors
• Not eating raw or undercooked shellfish, pork, venison, boar or other wild animals

Is there a hepatitis E vaccine?

The HEV 239 (Hecolin®) vaccine for hepatitis E is available in China. The vaccine is unavailable in the U.S.