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Hepatitis E

Hepatitis E

4 October 2018

Causative agent

Hepatitis E is a liver disease caused by the hepatitis E virus (HEV).

Clinical features

Clinical features of acute hepatitis E are similar to those of other types of viral hepatitis. Typical signs and symptoms of hepatitis E include:

  • an initial phase of fever, reduced appetite, nausea and vomiting, lasting for a few days;
  • abdominal pain, itching, skin rash, or joint pain;
  • jaundice (yellow discolouration of the skin and sclera of the eyes), with dark urine and pale stools;
  • a slightly enlarged, tender liver (hepatomegaly).

These symptoms are largely indistinguishable from those experienced during any acute phase of hepatic illness and typically last for 1 - 6 weeks.

In rare cases, acute hepatitis E can result in fulminant hepatitis (acute liver failure) and death. Fulminant hepatitis occurs more frequently when hepatitis E occurs during pregnancy. Pregnant women with hepatitis E are at an increased risk of acute liver failure, fetal loss and mortality. Case fatality rates as high as 20 - 25 % have been reported among pregnant women in their third trimester.

Cases of chronic hepatitis E infection have been reported in immunosuppressed people.

Mode of transmission

HEV is transmitted mainly through the faecal-oral route due to faecal contamination of drinking water. Besides, foodborne transmission can result from ingestion of undercooked meat or meat products produced from infected animals (HEV has also been detected in pig livers). Other rare transmission routes identified include:

  • transfusion of infected blood products;
  • organ transplant; and
  • vertical transmission from a pregnant woman to her foetus.

Hepatitis E outbreaks usually follow periods of faecal contamination of drinking water supplies and may affect several hundred to several thousand persons. The ingestion of raw or undercooked shellfish may be the source of sporadic cases in endemic areas.

The infected persons are believed to excrete the virus beginning a few days before to around 3 - 4 weeks after the onset of disease.

Incubation period

The incubation period following exposure to HEV ranges from 2 - 10 weeks, with a mean of 5 - 6 weeks.


There is no specific treatment capable of altering the course of acute hepatitis E. Prevention is the most effective approach against the disease. As hepatitis E is usually self-limiting, hospitalisation is generally not required. However, hospitalisation is required for people with fulminant hepatitis and should also be considered for symptomatic pregnant women.


At the population level, the risk of infection and transmission can be reduced by:

  • Maintain quality standards for public water supplies.
  • Establish proper disposal systems to eliminate sanitary waste.

On an individual level, adopts the 5 Keys to Food Safety in handling food, i.e. Choose (Choose safe raw materials); Clean (Keep hands and utensils clean); Separate (Separate raw and cooked food); Cook (Cook thoroughly); and Safe Temperature (Keep food at safe temperature) to prevent foodborne diseases:

  • Maintain hygienic practices such as hand washing with safe water, particularly before handling food or eating, and after using the toilet or handling vomitus or faecal matter.
  • Obtain drinking water from the mains and boil it before consumption.
  • Avoid consumption of water and ice of unknown purity.
  • Purchase fresh food from reliable sources. Do not patronise illegal hawkers.
  • Clean and wash food thoroughly.
  • Cook food, especially seafood (e.g. shellfish), pork and pig offal, thoroughly before consumption. Avoid raw food or undercooked food.
  • Use separate chopsticks for handling raw food and cooked food when having hotpot.

* Please visit the website of Centre for Food Safety for more information on food safety.