Video:Hepatitis E

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Hepatitis E is inflammation of the liver caused by infection with the hepatitis E virus[1][2] it is a type of viral hepatitis.[3]

Definition similarities

Hepatitis E has mainly a fecal-oral transmission route that is similar to hepatitis A, although the viruses are unrelated.[4][5][6]

Signs and symptoms

Hepatitis E can be either acute or chronic.The average incubation period of hepatitis E is 40 days, ranging from 2 to 8 weeks. After a short prodromal phase symptoms may include jaundice, fatigue, and nausea, though most HEV infections are asymptomatic. The symptomatic phase coincides with elevated hepatic aminotransferase levels.[7][8][9][10]

Viral distribution

HEV can be clustered genetically into 8 genotypes, and genotypes 3 and 4 tend to be the ones that cause chronic hepatitis in the immunosuppressed.[11][12]

Viral transmission

Hepatitis E genotype 1 and, to a lesser extent genotype 2, is endemic and can cause outbreaks in Southeast Asia, northern and central Africa, India, and Central America.[2][13] It is spread mainly by the fecal–oral route due to contamination of water supplies or food; direct person-to-person transmission is uncommon.[2][8]

Viral transmission genotypes

In contrast to genotypes 1 and 2, genotypes 3 and 4 cause sporadic cases thought to be contracted zoonotically, from direct contact with animals or indirectly from contaminated water or undercooked meat.[2][14]

Natural course

Like hepatitis A, hepatitis E usually follows an acute and self-limiting course of illness the condition is temporary and the individual recovers with low death rates in resource-rich areas, however, it can be more severe in pregnant women and people with a weakened immune system, with substantially higher death rates. [5][15]

Natural course liver

In pregnant women, especially in the third trimester, the disease is more often severe and is associated with a clinical syndrome called fulminant liver failure, with death rates around 20%.[5][15]


In terms of the diagnosis of hepatitis E, only a laboratory blood test that confirms the presence of HEV RNA or IgM antibodies to HEV can be trusted.[16]


There is no drug that has established safety and effectiveness for hepatitis E, and there have been no large randomized clinical trials of antiviral drugs.[5] Reviews of existing small studies suggest that ribavirin can be considered effective in immunocompromised people who have developed chronic infection.[17][18]


A preventive vaccine (HEV 239) is approved for use in China.[19]


The earliest known epidemic of hepatitis E occurred in 1955 in New Delhi,[20] but the virus was not isolated until 1983 by Russian scientists investigating an outbreak in Afghanistan.[21]


  1. "Hepatitis E: Background, Etiopathophysiology, Epidemiology". Medscape. 2019.
  2. 2.0 2.1 2.2 2.3 Kamar, Nassim; Dalton, Harry R.; Abravanel, Florence; Izopet, Jacques (2014). "Hepatitis E Virus Infection". Clinical Microbiology Reviews. 27 (1): 116–138. doi:10.1128/CMR.00057-13. ISSN 0893-8512. PMC 3910910. PMID 24396139.
  3. "Hepatitis (Viral) NIDDK". The National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2020-06-19.
  4. "What is hepatitis?". WHO. Retrieved 17 April 2019.
  5. 5.0 5.1 5.2 5.3 "Hepatitis E". WHO. Retrieved 17 April 2019.
  6. Weston, Debbie; Burgess, Alison; Roberts, Sue (2016). Infection Prevention and Control at a Glance. John Wiley & Sons. p. 12. ISBN 9781118973554.
  7. Sanford, Christopher A.; Jong, Elaine C.; Pottinger, Paul S. (2016). The Travel and Tropical Medicine Manual E-Book. Elsevier Health Sciences. p. 324. ISBN 9780323417426.
  8. 8.0 8.1 "Hepatitis E Fact sheet". WHO. Retrieved 17 April 2019.
  9. Hoofnagle, J. H.; Nelson, K. E.; Purcell, R. H. (2012). "Hepatitis E". New England Journal of Medicine. 367 (13): 1237–1244. doi:10.1056/NEJMra1204512. PMID 23013075.
  10. "Facts about hepatitis E". European Centre for Disease Prevention and Control. Retrieved 17 April 2019.
  11. Dalton, Harry R.; Kamar, Nassim; Baylis, Sally A.; Moradpour, Darius; Wedemeyer, Heiner; Negro, Francesco (June 2018). "EASL Clinical Practice Guidelines on hepatitis E virus infection". Journal of Hepatology. 68 (6): 1256–1271. doi:10.1016/j.jhep.2018.03.005. PMID 29609832.
  12. Sridhar, Siddharth; Teng, Jade L. L.; Chiu, Tsz-Ho; Lau, Susanna K. P.; Woo, Patrick C. Y. (20 April 2017). "Hepatitis E Virus Genotypes and Evolution: Emergence of Camel Hepatitis E Variants". International Journal of Molecular Sciences. 18 (4): 869. doi:10.3390/ijms18040869. ISSN 1422-0067. PMC 5412450. PMID 28425927.
  13. Liu, Dongyou (2010-11-23). Molecular Detection of Human Viral Pathogens. CRC Press. p. 102. ISBN 9781439812372.
  14. Dai, Xing; Dong, Chen; Zhou, Zhenxian; Liang, Jiuhong; Dong, Min; Yang, Yan; Fu, Jianguang; Tian, Hua; Wang, Song; Fan, Jie; Meng, Jihong; Purdy, Michael A. (2013). "Hepatitis E Virus Genotype 4, Nanjing, China, 2001–2011". Emerging Infectious Diseases. 19 (9): 1528–1530. doi:10.3201/eid1909.130013. ISSN 1080-6040. PMC 3810912. PMID 23965731.
  15. 15.0 15.1 Patra, Sharda; Kumar, Ashish; Trivedi, Shubha Sagar; Puri, Manju; Sarin, Shiv Kumar (2007-07-03). "Maternal and Fetal Outcomes in Pregnant Women with Acute Hepatitis E Virus Infection". Annals of Internal Medicine. 147 (1): 28–33. doi:10.7326/0003-4819-147-1-200707030-00005. ISSN 0003-4819. PMID 17606958. S2CID 44504380.
  16. Aggarwal, Rakesh (2 October 2012). "Diagnosis of hepatitis E". Nature Reviews Gastroenterology & Hepatology. 10 (1): 24–33. doi:10.1038/nrgastro.2012.187. ISSN 1759-5045. PMID 23026902. S2CID 11958858.subscription needed
  17. Dalton, Harry R.; Kamar, Nassim (2016). "Treatment of hepatitis E virus". Current Opinion in Infectious Diseases. 29 (6): 639–644. doi:10.1097/QCO.0000000000000316. ISSN 1473-6527. PMID 27607911. S2CID 25304902.
  18. Peters van Ton, A. M.; Gevers, T. J. G.; Drenth, J. P. H. (Dec 2015). "Antiviral therapy in chronic hepatitis E: a systematic review". Journal of Viral Hepatitis. 22 (12): 965–973. doi:10.1111/jvh.12403. ISSN 1365-2893. PMID 25760481. S2CID 10199788.
  19. Li, Shao-Wei; Zhao, Qinjian; Wu, Ting; Chen, Shu; Zhang, Jun; Xia, Ning-Shao (2015-02-25). "The development of a recombinant hepatitis E vaccine HEV 239". Human Vaccines & Immunotherapeutics. 11 (4): 908–914. doi:10.1080/21645515.2015.1008870. ISSN 2164-5515. PMC 4514148. PMID 25714510.
  20. Kumar, Subrat; Subhadra, Subhra; Singh, Bhupinder; Panda, B.K. (April 2013). "Hepatitis E virus: the current scenario". International Journal of Infectious Diseases. 17 (4): e228–e233. doi:10.1016/j.ijid.2012.11.026. ISSN 1201-9712. PMID 23313154.
  21. Izopet, Jacques; Abravanel, Florence; Dalton, Harry R.; Kamar, Nassim (1 January 2014). "Hepatitis E Virus Infection". Clinical Microbiology Reviews. 27 (1): 116–138. doi:10.1128/CMR.00057-13. ISSN 0893-8512. PMC 3910910. PMID 24396139.