Hepatitis E

An overview of viral hepatitis, including a table comparing the clinical features of hepatitis A, B, C, D and E, is provided here.

Hepatitis E virus (HEV) is a common cause of acute hepatitis worldwide, and is endemic in many areas of the world, particularly where access to safe drinking water is limited. It is estimated that one-third of the world’s population has been infected with hepatitis E virus.

In low-resource settings, transmission of hepatitis E infection is usually via faecally contaminated water. In Australia, locally acquired hepatitis E is uncommon, but cases of zoonotic infection have been reported (associated with reservoirs of infection in pigs, wild boar, deer and possibly shellfish). Ingestion of undercooked meat and offal from these species appears to be the main mode of transmission. Older males and people who work with swine, including veterinarians, farmers, abattoir workers and butchers, may be at increased risk of infection.

Hepatitis E infection is diagnosed by the presence of HEV antibodies in patients with clinical evidence of hepatitis. Consider checking HEV antibodies in patients with unexplained acute hepatitis, even if there is no history of travel to an endemic region.

Acute hepatitis E infection often resolves spontaneously, but pregnant females, older adults and patients with pre-existing liver disease are at risk of developing acute liver failure, which may be fatal.

Chronic hepatitis E infection has been reported in immunocompromised patients, including organ transplant recipients and people with HIV infection. The mainstay of management is restoring immune function (eg reducing immunosuppression). Antiviral therapy with ribavirin may be effective for the treatment of chronic hepatitis E infection—seek expert advice.