Hepatitis E Symptoms, Transmission, Causes, and Treatment (During Pregnancy)

  • Medical Author:

    Sandra Gonzalez Gompf, MD, FACP is a U.S. board-certified Infectious Disease subspecialist. Dr. Gompf received a Bachelor of Science from the University of Miami, and a Medical Degree from the University of South Florida. Dr. Gompf completed residency training in Internal Medicine at the University of South Florida followed by subspecialty fellowship training there in Infectious Diseases under the directorship of Dr. John T. Sinnott, IV.

  • Medical Editor: Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)
    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Dr. Anand received MBBS degree from Medical College Amritsar, University of Punjab. He completed his Internal Medicine residency at the Postgraduate Institute of medical Education and Research, Chandigarh, India. He was trained in the field of Gastroenterology and obtained the DPhil degree. Dr. Anand is board-certified in Internal Medicine and Gastroenterology.

What should I know about hepatitis E (hep E) viral infection?

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Picture of Hepatitis Virus by Ingram Publishing, Medical RF.com

Hepatitis E is a viral infection, which is caused by the hepatitis E virus that usually comes from dirty water. Hep E is uncommon in the U.S., Canada, Northern Europe, and Australia and very uncommon in the United States, Canada, Northern Europe, and Australia. It is more common in Mexico, Central America, North and Northeast Africa, the Middle East, Asia and Southeast Asia. Most outbreaks of hepatitis E occur in Southeast and East Asia. Hepatitis E viral infection causes symptoms and signs, for example, soreness and swelling of the liver (hepatitis) and yellow eyes (jaundice).

Hepatitis E viral infection symptoms and signs include yellow eyes and skin, nausea and vomiting, pain in the right side of the abdomen, dark or brown urine, and light-colored stool. Rare complications of hepatitis E include severe ("fulminant") hepatitis, liver failure, and death. Hepatitis E can be very serious, especially for pregnant women. Up to one-quarter of pregnant women with HEV can die from it. Hepatitis E is contagious from one week before symptoms start to four weeks afterward. Some people have no symptoms or signs and do not know they are contagious with the infection.

Hepatitis E is diagnosed by blood and stool (feces) tests. People with hepatitis E should not (any type of hepatitis) drink alcohol. There are no specific drugs or treatments to treat and cure hepatitis E, moreover, the only country that has a hep E vaccination is China at this time.

Home remedies and lifestyle changes for hepatitis E include rest, keeping hydrated, and avoiding alcohol. A health professional should be consulted before taking any over-the-counter medications, especially those containing acetaminophen. Recovery time from hepatitis E is about six weeks.

The prognosis and life expectancy for hepatitis E after recovery is usually good. Most people do not have long-term liver problems from it. Hepatitis E does not cause chronic hepatitis except in some people with weak immune systems, especially after organ transplantation.

What Is Hepatitis? How Is It Transmitted?

Hepatitis means "inflammation of the liver." There are several types of viruses that cause hepatitis infections, for example, hepatitis A, B, C, D, E, and G. Hepatitis E is transmitted by the fecal-oral route from eating or drinking contaminated foods or drinks.

Symptoms of hepatitis viral infections depend on the virus causing the infection. For example, symptoms of hepatitis E viral infection includes fever, poor appetite, changes in stool color, and aches or pains on the right side of the belly.

What is hepatitis E (hep E) viral infection? Who has it?

The medical definition of hepatitis E is a kind of inflammation and swelling of the liver that is caused by the hepatitis E virus (hep E). There are about 20 million cases of hep E infections per year in the world. About 3 million of them have symptoms or signs. HEV can be dangerous to some groups of people. About 3.3% of people with hep E infection die. Death rate is much higher in women who are pregnant. Up to one-quarter of pregnant women who get hep E may die. Most hep E infections happen in parts of the world that have poor sanitation or unsafe water supplies.

The hepatitis E virus exists throughout the world. It is most common in Mexico, Central America, North and East Africa, the Middle East, Asia and Southeast Asia. Cases of hepatitis E are very uncommon in developed countries like the United States, Canada, Northern Europe, and Australia. Most hepatitis E outbreaks occur in Southeast and East Asia. Even though hepatitis E virus is uncommon in the U.S., surveys have shown that up to 20% of Americans have antibodies to it and have probably been exposed.

HEV can be acute or chronic. Acute hepatitis E is more common than chronic hepatitis E. Acute hepatitis E lasts for a limited time and then goes away. It does not cause lasting or ongoing liver damage after it has run its course. Chronic hepatitis does not go away and is a long-lasting infection of the liver. Chronic viral hepatitis E can cause cirrhosis (liver scarring) over time that leads to liver failure. Chronic hepatitis E is more common in most people with hepatitis C. However, hep E occurs less often than hep B, and very rarely, with hep E can become chronic in people whose immunity is suppressed by drugs given to prevent rejection of a transplanted organ.

What are the signs and symptoms of hepatitis E infection?

Symptoms and signs of HEV infection include fever, poor appetite (not hungry), tiredness, nausea (feeling sick to your stomach) and vomiting (throwing up), yellow eyes or skin (jaundice), ache in right side of the belly (pain in the liver), soreness in the right side of the belly when pressed (swollen liver), dark or brown urine, light-colored or clay-colored stool, itchy skin, with or without a rash, and painful joints. Symptoms and signs may last for up to six weeks.

Between one in two to one in 13 people with hep E will develop symptoms and signs of acute hepatitis. Often, hepatitis E often causes symptoms and signs in people aged 15 to 40 years. Children generally have no or very mild symptoms and signs.

The fatality rate for most HEV outbreaks is only 1% but may be much higher in women who are pregnant.

How do you get hepatitis E? How does it spread? What are risk factors for HEV infection?

Hepatitis C is like hepatitis A. You get both infections by the "fecal-oral route." This means that it passes on in endemic areas by eating or drinking food or water contaminated by feces. In poor areas of the world, there may be few options for disposing of human feces or public sanitation. Feces may contaminate water that people use for drinking and cooking. Sometimes sanitation, water, and public health systems break down during wars or natural disasters. In these situations, infection often happens from drinking dirty water. Hepatitis E infection can happen if someone is using dirty water to prepare food. A person who has HEV or is caring for a child with hep E can cause an outbreak if he or she does not wash hands before cooking for others.

Less often, people can get HEV food-borne infection from eating undercooked pork or deer meat or organs (especially liver). Hep E genotype 3 or 4 are most likely to be transmitted by meat. Rarely, raw or undercooked shellfish may pose a risk. It is less likely, but possible, to get transfusion-transmitted hepatitis E. Rarely, a woman who is pregnant can pass HEV infection to her baby.

Hepatitis E has not been reported to be a sexually transmitted disease (STDs). However, it may be possible that we aren't aware of it yet because it is so uncommon in areas with clean water and sanitation. Hepatitis A spreads the same way as hepatitis E, except it has been transmitted by mouth-to-anus (oral-anal) sex. Theoretically, it is possible for hepatitis E infection to spread like an STD.

Is hepatitis E contagious?

HEV appears in the feces about one week before symptoms and signs begin and may last for up to four weeks. People who are shedding the virus are contagious if they do not wash their hands after using the bathroom. Babies and young children in diapers may be contagious to anyone who handles their diapers without washing their hands afterward. Some people may not be aware they are sick or shedding a virus.

To prevent the spread of hepatitis E virus (and other infections), people who prepare food or drinks for others should wash their hands with soap and water, whether they feel sick or not. Anyone can start a hepatitis E outbreak without realizing it.

How do medical professionals diagnose hepatitis E? Is there a way to test for it?

Blood or stool (feces) tests diagnose hepatitis E infection. Blood tests can be used for testing for antibodies against the hepatitis E virus or HEV RNA. Hep C IgM is found during current infection. Hepatitis E IgG detects past infection. Blood and feces can be tested for the presence of hepatitis E virus (hep E) "viral load" or "PCR". There is no antigen test for the hep E.

Because hepatitis E infections are rare in the U.S., it can cause outbreaks of the infection. Doctors and other health professionals should call the Centers for Disease Control and Prevention (CDC) if they suspect that they have hepatitis E. CDC has a Viral Hepatitis Reference Lab. They offer testing at no cost. Specimens must be ordered by a health professional and shipped by a medical laboratory according to instructions provided by the CDC. Not all commercial laboratories offer these tests, and they are not free of charge.

What if you have hepatitis E during pregnancy or while breastfeeding?

Pregnant women are at very high risk of problems from hep E infections, especially severe hep E, and acute liver failure. The body shuts down parts of the immune system in order to keep from "rejecting" the baby. This makes the second half of pregnancy a time of weakened immunity. Women who get hep C after 12 weeks of pregnancy are more likely to experience severe hepatitis, acute liver failure, loss of the fetus, or even death from liver failure. Death rate (case-fatality or mortality) may be as high as 25% for women infected after 29 weeks.

Breastfeeding is not known to increase the risk of passing hep E infections to infants and toddlers. Collecting and preparing breast milk for bottle feeding requires careful sanitation of equipment, safe storage, and clean hands.

QUESTION

Liver disease refers to any abnormal process that affects the liver. See Answer

What drugs and other therapies are used for the treatment hepatitis E?

There is no antiviral drug recommended for most cases of acute hepatitis E at this time. The disease must run its course. For people with weak immune systems from drugs taken to prevent transplant rejection, the doses may be lowered if it is safe to do so.

There is a small amount of experimental evidence for using ribavirin or pegylated interferon-alpha drugs for cases in which hep E becomes a chronic infection. This only happens to people who have weak immunity after organ transplant. These drugs have a lot of side effects and are not used for most people who get acute hep E. If you are pregnant and have hep E talk, talk to your OB/GYN to discuss options for hep E treatment because they can cause birth defects and other serious side effects.

Is there a diet for hepatitis E?

There are no special foods that should be eaten or avoided if a person has hepatitis E, but alcohol should be completely avoided. Usually, a person with hep E has a poor appetite, and then he or she may lose weight. The best diet for hep E is eating a well-balanced diet with foods that are appealing to the person infected.

Can I drink alcohol if I have hepatitis E?

Alcohol (like beer, wine, or hard liquor) is inflammatory to the liver, especially a liver that is already sick. Alcohol worsens liver inflammation from hep E. It can increase the risk of severe hepatitis and liver failure from acute viral hepatitis. Alcohol should be completely avoided when a person has any type of hepatitis or liver disease.

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What home remedies and lifestyle changes are used for the treatment hepatitis E?

A person with hepatitis E should listen to their body's signals of fatigue and get plenty of rest. The infected person should be encouraged to at least drink plenty of liquids every day. This is especially important if they have been vomiting, have fevers, or do not feel like taking much by mouth. Alcohol must be eliminated completely with all types of hepatitis (A, B, C, E, D, F, G) until the liver has fully healed.

If you are pregnant with hepatitis E, eat and keep hydrated, and keep in close contact with your OB/GYN or midwife. He or she may want to monitor you frequently. You may need to be hospitalization to ensure the well-being of you and your baby if you cannot keep up fluids, or if you lose weight at home.

The liver's most important job is to process chemicals (like drug), toxins, and waste products. This job is weakened during acute hepatitis. Consult your doctor before taking any over-the-counter (OTC) medications. For example, usually acetaminophen (Tylenol) and NSAIDs (nonsteroidal anti-inflammatories) like ibuprofen (Motrin and others) are safe when used for fevers and body aches, but it may need to be limited while the liver is inflamed. The normal dose might create too much damage to the liver to handle and may even cause overdose or more liver damage.

What is the recovery time for hepatitis E?

In most people with acute hepatitis E infection, it will resolve on its own without specific treatment in one to six weeks. Unlike hepatitis B or C virus, hep E is usually self-limiting and rarely causes chronic infection. This can happen to people with weakened immunity after organ transplantation.

What are the complications of treated and untreated hepatitis E?

There is no antiviral drug for acute hepatitis E. There is no complication related to lack of treatment. However, dehydration can cause weakness and further reduce the person's ability to take in fluids. It can cause dangerously low blood pressure (hypotension). A person who is not eating may lose fat and muscle mass. This harms the immune functions needed to fight the infection. These complications are especially threatening to a woman who is pregnant. They can cause premature labor, poor fetal growth, or loss of the baby. Her health care professional may decide to monitor her in the hospital when the infection is at its worst. Severe hepatitis may cause acute liver failure that may affect other organ systems. People with weakened immunity who get chronic HEV infection may develop scarring of the liver (cirrhosis).

Rarely, complications in organs other than the liver may be related to hepatitis E. Hepatitis E has been associated with Guillain-Barré syndrome, glomerulonephritis (a type of kidney inflammation), acute pancreatitis, hemolytic anemia in people who have glucose phosphate dehydrogenase deficiency (G6PD), and thrombocytopenia (very low platelets).

What is the prognosis and life expectancy for hepatitis E?

Prognosis (outcome) is excellent for most people with hepatitis E infection, and a full recovery is common. Hepatitis E itself does not cause lasting complications or liver damage once the disease runs its course, even in pregnant women or their babies.

Unfortunately, people who have liver disease from other causes, like chronic hepatitis C or cirrhosis (scarring) of the liver, can worsen if they get another type of hepatitis viral infection. If the person does contract hepatitis A, B, or E infections on top of their hepatitis C, it may worsen their liver scarring and even shorten their lifespan from liver failure. People who develop chronic hep E because of weakened immunity can develop cirrhosis and liver failure over time, leading death.

Can you die from hepatitis E infection? Can it be cured?

There is no vaccine to prevent hepatitis E except in China at this time. The only way to prevent hepatitis E is to ensure that you use proper sanitation, dispose of human waste, and proper treatment of water supplies.

If you are pregnant, have received an organ transplant, or have liver problems like cirrhosis, you should protect yourself from hepatitis E by not eating undercooked or raw pork, deer, or seafood.

While traveling to poorer parts of the world, you can protect yourself against hepatitis E by drinking only purified or chlorinated water and eating only fully cooked foods. Always wash your hands with purified or chlorinated water before handling or eating food or drink to help prevent other diseases that are transmitted the same way, such as traveler' diarrhea, hepatitis A, and typhoid fever (Salmonella).

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Medically Reviewed on 3/19/2019
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