Hepatitis E

Hepatitis E is a viral infection. It's route of spread and symptoms are similar to Hepatitis A. Therefore, it is spread via the faecal-oral route - this is when food or drink is contaminated with faeces from a person infected by Hepatitis E.

Hepatitis E (HEV) is another viral infection which can lead to acute hepatitis (short lived inflammation of the liver). It tends not to cause chronic (longer term) liver damage. However, contracting HEV infection is of particular concern for pregnant women as HEV leads to a higher incidence of miscarriage at all ages of pregnancy. More specifically, HEV can often lead to a serious infection in women who are in their last trimester (final 3 months) of pregnancy. For these women, this infection can be fatal in up to 20% of cases. This is a major difference between HEV and HAV infection for which mortality rates are significantly lower.

HEV outbreaks can occur in small clusters or larger epidemics especially in underdeveloped countries. It is principally seen in Asia, Africa, Middle East and Central America. Its mode of transmission is through water contaminated with faeces from a person infected with HEV. Outbreaks therefore mainly occur in areas where there is poor sanitation, untreated sewage or flooding with contamination of water supplies with sewage.

Vertical transmission is also possible with transfer of the virus from an infected mother to her baby. This may cause significant illness and mortality in these infants.

To reduce the chances of contacting HEV, travelers should avoid the following;

  • eating raw foods which may have been washed in infected water such as unpeeled fruits and salads,
  • drinking tap water from contaminated mains supplies,
  • having ice cubes in drinks made from infected water,
  • poorly cooked shellfish
  • unpasteurised milk,
  • brushing teeth using infected water.

Most importantly, common sense measures such as careful hand washing after going to the toilet are paramount. This is similar to avoidance of HAV.

Symptoms of HEV infection are also similar to infection with HAV. These include, lethargy, aches & pains, headaches, nausea, vomiting, abdominal pain and diarrhoea. Jaundice (when an individual looks yellow) may also occur. Jaundice develops with a build up of bilirubin which causes the whites of eyes and skin to appear yellow. It may also turn urine very dark and faeces very pale. Jaundice can also cause itching of the skin.

The incubation period for HEV is thought to be around 2-12 weeks. Individuals infected with this virus may remain infectious to others for up to 2 weeks from the onset of their symptoms.

A blood test can be taken to confirm the diagnosis but no vaccine is yet available to prevent contraction of HEV. There is no specific treatment for this infection but symptoms usually resolve spontaneously. Sufferers can be left feeling more fatigued than normal. Advise on adequate diet and hydration is usually given and alcohol is best avoided until recovery is complete.

However, pregnant women should seek specialist advice as soon as the diagnosis is suspected.

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