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Hepatitis E, sometimes called hep E or HEV, is a liver disease caused by the hepatitis E virus. A virus is a microscopic particle that needs to get inside living cells in order to reproduce (spread)6.

What is hepatitis?
Your liver responds to injury by becoming inflamed. Any inflammation of the liver is known as hepatitis7, whatever its cause. Sudden inflammation of the liver is known as acute hepatitis. Where inflammation of the liver lasts longer than six months, the condition is known as chronic hepatitis8.

Hepatitis can be caused by a number of things including:

• drinking too much alcohol (the most common cause of liver damage)
• a virus, such as hepatitis E or glandular fever
• the body’s own immune system – a liver disease called autoimmune hepatitis
• the side effects of some drugs and chemicals
• trauma/ injury to the body.

Inflammation is part of the process of repairing damaged tissue. In a similar way to a scab forming over a skin wound, a temporary fibrous ‘scaffold’ forms while liver cells regenerate9,10. If your liver is repeatedly injured, new liver cells cannot regenerate fast enough and the fibrous tissue remains as a scar10. This is called fibrosis and can take a variable amount of time to develop.

There are a number of viruses that infect the liver. The best known are hepatitis A, B, C, D and E. The ways in which they are transmitted (spread or passed on), how they cause liver damage and the effects they can have on your health are different. Of these viruses hepatitis B, C, D and E can cause chronic or long term disease.

Most people in the UK will not have heard of hepatitis E. Until very recently, it was thought to be a disease only found in developing countries. However, it is now accepted that the virus is also transmitted here11.

Hepatitis E is generally mild in its effect unless you have pre-existing liver disease or are pregnant12. Chronic infection (infection lasting over six months) caused by hepatitis E is very rare and usually only reported in patients with a suppressed immune system, for example in patients taking drugs to prevent rejection after an organ transplantation13.

There are four strains of hepatitis E called “genotypes.” Genotypes 1 and 2 are found in Asia and Africa; genotype 3 is found worldwide, including Europe and the UK; and genotype 4 is found in China and Japan14. In the UK, hepatitis E diagnosed in people who have travelled abroad is usually genotype 1, and in those who have not travelled it is genotype 3.

Among pregnant women there is a risk of the virus causing a severe and rapidly occurring form of hepatitis that can lead to liver failure. This is called fulminant hepatitis and can cause premature delivery and infant mortality in the third trimester15.Up to 25% of infected pregnant women can develop liver failure resulting in loss of life16to both mother and baby.
In patients with pre-existing liver disease the virus can also cause liver failure, which may be fatal17.

How is hepatitis E passed on?

The hepatitis E virus is spread in a way similar to hepatitis A, known as ‘faecal-oral’ transmission. This means that the virus is passed out in bowel motions (faeces) and finds its way into the mouth (orally), usually through contaminated food or water. This is one of the reasons why it is important to wash your hands after going to the toilet15. The illness does not usually spread easily within families, except when all members of the family have been drinking the same infected drinking water18 and/or contaminated food.

In European countries, such as the UK, the illness can also be caused by what is known as ‘zoonosis’. This means the virus can be found in animals such as pigs, wild boar, deer, rabbits and rats15. It does not cause the animals any illness, however, the virus can sometimes be passed from the animal to humans11,15. One way this can happen is by eating raw or undercooked meat16. In most cases the source and route of infection is unknown19.

Widespread outbreaks of the virus can occur frequently or constantly in overseas countries (referred to as ‘endemic areas’) where water supplies are contaminated with sewage after monsoons and flooding14.

Unlike hepatitis B, C or D, there is no evidence of the hepatitis E virus being transmitted through sharing needles, bodily fluids or through sexual contact20. However, there is a risk of transmission if there is mouth contact with the anal area21.

There have also been a number of cases reported where hepatitis E has been transmitted through blood transfusions and organ transplants22.

What are the symptoms of hepatitis E?

After the virus enters your body there may be no symptoms for a period of two to nine weeks. This is known as the incubation period23.

Symptoms of hepatitis E infection can include23:

• mild flu-like symptoms
• fatigue (extreme tiredness), this can continue for some time after clearing the virus
• change in urine colour – dark or brown
• abdominal pain
• jaundice
• fever (high temperature)
• loss of appetite
• itching
• nausea and vomiting (sickness)
• aching joints and muscles
• tingling, numbness and weakness in your arms and legs.