What is Hepatitis E?
Hepatitis E is an inflammatory liver disease caused by infection with the Hepatitis E virus (HEV). The virus is primarily transmitted through the fecal–oral route, usually by consuming food or water contaminated with the feces of an infected person.
At a Glance
Cause
Infection with the Hepatitis E virus (HEV)
Route of Spread
Fecal–oral, via contaminated food or water
Symptom Onset
Usually 2–10 weeks after infection
Highest Danger
During pregnancy, especially in the third trimester
How Hepatitis E Spreads
Consumption of contaminated food and drinking water.
Poor sanitation, inadequate hygiene, and improper handwashing.
Eating unhygienically prepared street food or drinking fresh sugarcane juice from unsafe sources.
Eating undercooked meat.
Through transfusion of infected blood or blood products (rare).
From an infected pregnant mother to her newborn (vertical transmission).
Global Burden of Hepatitis E
Approximately 20 million people are newly infected with Hepatitis E each year worldwide.
Around 3.3 million people develop symptoms.
Around 2,700 stillbirths are associated with Hepatitis E infection during pregnancy.
Hepatitis E accounts for approximately 3.3% of deaths due to viral hepatitis worldwide.
The disease is most common in the WHO South-East Asia Region (SEAR).
Infections occur annually in this region
Deaths each year (approximately)
Of all global Hepatitis E cases occur in South-East Asia
An estimated 6.5 million infections occur annually in this region, resulting in approximately 160,000 deaths each year. Nearly 50% of all global Hepatitis E cases occur in South-East Asia.
The exact prevalence of Hepatitis E in Bangladesh remains unknown.
Who Is at Risk?
Hepatitis E most commonly affects adults between 15 and 40 years of age, while children are less frequently affected.
Most commonly affected
Children are less frequently affected
Symptoms
Symptoms usually appear 2–10 weeks after infection and may include:
Some infected individuals may have very mild symptoms or remain completely asymptomatic.
Diagnosis
Your doctor may recommend the following investigations:
Liver Function Tests (LFTs)
- Bilirubin
- AST (Aspartate Aminotransferase)
- ALT (Alanine Aminotransferase)
- Alkaline Phosphatase (ALP)
Other Investigations
- Anti-Hepatitis E Virus IgM (Anti-HEV IgM)
- Complete Blood Count (CBC)
- Abdominal Ultrasound to assess liver enlargement
- Coagulation Profile: PT, APTT, and INR
Treatment
There is no specific antiviral treatment for Hepatitis E.
Management mainly includes:
- Adequate rest
- Symptomatic treatment
- Maintaining hydration and proper nutrition
Most patients recover within 1–3 weeks, although recovery may take up to 12 weeks in some cases.
Important: Avoid unnecessary medications during acute Hepatitis E infection, particularly paracetamol (acetaminophen), unless specifically prescribed by a physician, as inappropriate use may worsen liver function.
Hepatitis E During Pregnancy
Hepatitis E can be particularly dangerous during pregnancy, especially in the third trimester. Possible complications include:
Maternal mortality of up to 20–25% in severe cases.
Approximately 56% of infected pregnancies may result in miscarriage, low birth weight, stillbirth, or other adverse pregnancy outcomes.
Among patients who develop acute liver failure, the mortality rate is approximately 15–22%.
Co-infection with other hepatitis viruses, such as Hepatitis A or Hepatitis B, may further increase disease severity.
Prevention
The most effective way to prevent Hepatitis E is by maintaining good personal hygiene and ensuring food and water safety.
General Prevention
- Practice good personal hygiene.
- Wash your hands thoroughly before eating and after using the toilet.
- Drink safe, clean drinking water.
- Ensure proper sanitation and sewage disposal.
- According to the World Health Organization (WHO), a Hepatitis E vaccine has been developed and licensed in China; however, it is not yet widely available in other countries.
Prevention During Pregnancy
- Maintain strict personal hygiene.
- Drink only safe, clean water.
- Avoid ice unless you are certain it has been made from safe drinking water.
- If jaundice develops during pregnancy, seek immediate medical attention, including testing for Hepatitis E and appropriate treatment.
Key Points to Remember
- Hepatitis E is a food- and water-borne viral infection.
- Good hygiene and safe sanitation are the most effective preventive measures.
- Consult a physician promptly if symptoms of hepatitis develop.
- Pregnant women should take extra precautions to avoid Hepatitis E infection.
- Do not take paracetamol (acetaminophen) or other unnecessary medications during acute Hepatitis E infection unless advised by a healthcare professional.
- All patients with Hepatitis E should receive appropriate supportive medical care to reduce the risk of acute liver failure and other serious complications.