Hepatitis E

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Most people, when they think about hepatitis, are aware of types A, B, and C. But there is a type D and a type E as well. Today’s topic is hepatitis E (HEV). All five types of viral hepatitis cause similar symptoms. They infect the liver, causing it to become inflamed. Symptoms include fever, nausea, vomiting, abdominal pain, fatigue, joint pains, jaundice (yellowing of the skin and eyes), dark tea-colored urine, and light colored, tannish stools. Many people with HEV are not even aware that they have it, as symptoms are often mild. Most recover fully and chronic liver disease is rare with HEV. The exception to this is in pregnant women, especially if they are in the third trimester. They can have severe disease which can sometimes lead to death. The incubation period (time between infection and symptoms) for hepatitis E is 15 – 60 days.

HEV is rare in the U.S. It is similar to hepatitis A in that it is a foodborne illness and is not transmitted by needles, blood products, or sexual contact. It is more common in developing countries due to inadequate sanitation and hygiene, for example the Middle East, Africa, central America, and in East and South Asia. When seen here in the US, it is often in people who travelled to these areas. Large outbreaks have occurred in refugee camps and other environments subject to overcrowding. Also, it is a zoonotic disease, meaning it is found in animals and can be transmitted by them. Infection may occur after consuming undercooked or raw animal meats, especially pork, bear, and venison. It is also found in raw shellfish in the areas where it is more common (see above). Eating raw fish, shellfish, and meats in these areas is never a good idea and can be dangerous.

HEV may be diagnosed with a blood test, although the sample needs to be sent to a specialized lab as not all labs can perform the test. Most people will fully recover with rest, fluids, avoidance of alcohol, acetaminophen, and other medications that may damage the liver. Supportive hospital care may be necessary, especially for pregnant women. There is no antiviral medicine to treat HEV. Ensuring good hygiene and sanitation is important to prevent HEV infection. When travelling to areas where it is more common avoid ice of unknown purity, drink bottled water and use it to brush your teeth and rinse produce and wash your hands frequently with soap and water. Avoid raw meats and seafood. China has developed a vaccine for HEV, but it is not available in the U.S.

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 By Peter Galvin, MD

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