Merck Manual

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Hepatitis E


Sonal Kumar

, MD, MPH, Weill Cornell Medical College

Last full review/revision Oct 2019| Content last modified Oct 2019
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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 hepatitis E, but most people recover completely.

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 drugs 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 developed countries, most cases occur in travelers returning home from a country where sanitation is poor and access to safe water is limited.


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)

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.

Hepatitis E may cause severe symptoms, especially in pregnant women.


  • 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.


Good sanitation and personal hygiene can help prevent hepatitis E. Travelers to developing countries can reduce their risk of infection by not drinking unpurified water. Boiling and chlorination of water inactivates the hepatitis E virus.

A new vaccine is available but not in the United States. It is available in China, where hepatitis E is more common.


  • General measures

  • Possibly ribavirin

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 hepatitis E.

If itching occurs, cholestyramine, taken by mouth, may relieve the itching.

Ribavirin (an antiviral drug) may be an effective treatment for chronic hepatitis E, but further study is needed.

Most people can safely return to work after jaundice resolves.

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