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Hepatitis E is an illness of the liver caused by hepatitis E virus (HEV), a virus which can infect both animals and humans.
HEV infection usually produces a mild disease, hepatitis E. However, disease symptoms can vary from no apparent symptoms to liver failure. In rare cases, it can prove fatal particularly in pregnant women.
Normally, the virus infection will clear by itself. However, it has been shown that in individuals with suppressed immune systems, the virus can result in a persistent infection which in turn can cause chronic inflammation of the liver.
Public Health England (PHE) follows confirmed cases of hepatitis E.
The ‘hepatitis E surveillance form’ helps us improve our knowledge of the disease’s natural history in the UK.
Symptoms of hepatitis E include:
- yellowing of the skin and eyes (jaundice)
- darkening of the urine
- pale stools
Sometimes symptoms include:
- abdominal pain
- loss of appetite
We advise anyone with symptoms to contact their GP. The illness usually resolves within 1 to 4 weeks.
The average incubation period (the period of time you can have the infection before developing symptoms) for hepatitis E is 40 days, with a range of 15 to 60 days.
Local diagnostic laboratories across the UK also provide testing services for hepatitis E. HEV infection, an acute infectious hepatitis is notifiable to local authority proper officers under the Health Protection (Notification) Regulations 2010. Diagnostic laboratories must notify PHE, through the Second Generation Surveillance System (SGSS), when they identify evidence of HEV infection.
A confirmed acute case is defined as either a PCR positive or IgM and IgG positive. Case definition at local diagnostic laboratories may differ and could include cases positive for IgM only. The UK clinical virology network (CVN) is conducting a survey on how laboratories carry out HEV testing.
PHE’s emerging infections and zoonoses team follows up confirmed hepatitis E cases to investigate non-travel associated cases of HEV in the UK and identify potential risk factors.
Hepatitis E surveillance now includes SGSS reports to help improve our understanding of the current case load. Surveillance of acute HEV infection is done by de-duplicating and combining reports from the reference laboratories and SGSS to reflect this change in reporting behaviour. Cases reported through SGSS are retrospectively analysed and reported from 2010 onwards to show the trend of local HEV testing.
An increase in the number of non-travel cases of hepatitis E was observed in England and Wales in 2010. An epidemiological study was carried out to investigate routes of acquisition and this case-control study implicated the consumption of processed pork products.
Non-travel associated cases are likely to be older men, infected with the genotype 3 strain (related to the pig strain).
A 2014 study found that more than 90% of British pigs were anti-HEV antibody positive.
Recent data (2016 to 2017) show a decreasing trend in the number of hepatitis E cases in England and Wales.
|Year||Reference laboratory confirmed cases||SGSS reported cases (only reported through SGSS)||Total*|
* Number of cases reported by the reference laboratories and SGSS combined after de-duplication
**Provisional data January to June 2018
Hepatitis E occurs worldwide. In regions of the world where sanitation may be poor (Asia, Africa and Central America), the virus spreads by the consumption of sewage-contaminated food and water. The source of contamination is faeces shed from other infected people (or infected animals).
In the developed, world the virus may spread from animals to humans through the consumption of undercooked or raw pig and game meat, processed pork and shellfish.
Person to person transmission of the virus is very rare, though the virus has passed between people through blood transfusion and solid organ transplantation.
Historically, hepatitis E was considered a travel-associated infection, and the disease may have been under diagnosed. The numbers of confirmed hepatitis E cases and infections increased significantly between 2010 and 2016.
We advise that anyone with unexplained hepatitis, regardless of travel history, should be tested for hepatitis E.
Most people do not require treatment, as their infections will clear naturally. While infected, we advise avoiding alcohol during the course of their illness.
Pregnant women and older people, those with weakened immune systems, and people with chronic liver disease can experience more severe infections. These patients can require closer observation in case the infection affects their liver function
Pregnant women should seek advice from their antenatal carer.
During the first 2 weeks of hepatitis E illness:
- avoid preparing food for others
- limit contact with others if possible, especially pregnant women, or people with chronic liver disease
Close contacts should:
- wash hands thoroughly with soap and warm water and then dry properly after contact with an infected person
- wash hands after going to the toilet, before preparing, serving and eating food
Prevention of hepatitis E infection
Currently, there is no licensed vaccine for hepatitis E. Prevent infections by:
- cooking meat and meat products thoroughly
- avoid eating raw or undercooked meat and shellfish
- washing hands thoroughly before preparing, serving and eating food
When travelling to countries with poor sanitation:
- boil all drinking water, including water for brushing teeth
- avoid eating raw or undercooked meat and shellfish