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Hepatitis E


Sonal Kumar

, MD, MPH, Weill Cornell Medical College

Last full review/revision Jan 2021| Content last modified Jan 2021

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.

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 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.

Symptoms of Hepatitis E

People with hepatitis E have typical symptoms of acute hepatitis. These symptoms include

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.

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 Blood Tests Liver tests are blood tests that represent a noninvasive way to screen for the presence of liver disease (for example, hepatitis in donated blood) and to measure the severity and progress of... read more ). 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.

Prevention of Hepatitis E

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.

Treatment of Hepatitis E

  • General measures

  • Possibly ribavirin for chronic hepatitis E

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.

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

Ribavirin (an antiviral drug), given for 12 weeks, 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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