Hepatitis E

Hepatitis means inflammation of the liver. It can be caused by chemicals or drugs, or by different kinds of viral infections. Hepatitis E is an infection of the liver caused by the hepatitis E virus.

Hepatitis E occurs most often in developing countries. Cases in Australia are most often associated with recent travel to countries such as North Africa, the Middle East, and many parts of central and south-east Asia. Consumption of raw or undercooked pork products, particularly pork liver, has been known to cause hepatitis E infection in developed countries, including Australia.

Symptoms

Symptoms of hepatitis E infection can include:

• fever
• fatigue (feeling tired)
• loss of appetite
• abdominal pain
• nausea and vomiting
• yellow skin and eyes (jaundice)
• dark urine
• pale faeces.

Symptoms usually start within 40 days of exposure to the virus, but this can range from 15-64 days. Most people recover completely after several days or weeks. Hepatitis E infection can be serious in pregnant women, especially during the third trimester and in those with pre-existing liver disease or suppressed immune systems.

The infectious period is not known but the virus has been detected in faeces 2 weeks after the onset of jaundice.

How hepatitis E is spread

Most people get hepatitis E from drinking water contaminated with sewage. People may also be infected by eating undercooked meat from infected animals (mainly pigs, deer and shellfish). The virus may also be transmitted through blood transfusions, but this is rare.

Who is at risk of infection

People who live in, or travel to, countries with poor sanitation are at most risk.

The virus is common in many parts of:

• central and south-east Asia
• the Middle East
• North Africa
• the Mediterranean region
• Mexico
• South America.

In Australia, those who eat undercooked pork products, particularly pork livers, are at risk of becoming infected.

Diagnosis and treatment

A diagnosis of hepatitis E is based on a blood test. There is no specific treatment for hepatitis E. Most people will clear their infection naturally. While infected, it is best to avoid alcohol and check with your doctor or pharmacist before taking medications that can damage the liver.

Pregnant women, older people, those with weakened immune systems and people with chronic liver disease are at risk of more severe illness and may require hospitalisation.

Prevention

In countries with poor sanitation:

• use bottled or boiled water (for drinking and for brushing your teeth)
• do NOT consume untreated water or ice
• only eat only fruit or vegetables that you peel yourself and food that is freshly cooked and piping hot.

Wash your hands thoroughly using soap for at least 10 seconds and dry them with a clean towel after using the toilet, after caring for someone with diarrhoea and/or vomiting, and before preparing food.

It is important that pork products (including pork liver) are cooked to 75°C at the centre of the thickest part for at least two minutes as measured using a digital probe meat thermometer before removing meat from the heat source. Allow livers to rest for at least three minutes before consuming.

There is no approved vaccine for hepatitis E.

Avoid infecting others

People infected with hepatitis E should wash their hands thoroughly, especially after going to the toilet. They should also avoid the following activities for at least 2 weeks after the onset of symptoms:

• preparing food or drink for other people
• providing health care for others
• sharing eating or drinking utensils with others
• sharing linen and towels with others
• swimming or using hot tubs
• having sex
• donating blood.

More information

Hepatitis E is a notifiable condition. For more information about hepatitis E, contact your GP or call the Health Protection Service, Communicable Disease Control Information Line during business hours on 02 5124 9213.

Acknowledgements

• CDC, Hepatitis E Questions and Answers for Health Professionals, 2018.
• Heymann DL, Control of Communicable Diseases Manual, 20th edition, 2015.
• WHO Fact Sheet, Hepatitis E, 2018.