Travel Health Information Sheets

Updated January 2011

Hepatitis E

What is hepatitis E?

Hepatitis E is a virus spread by contaminated food and water. It is one of several viruses, such as hepatitis A and B, which can cause liver damage. Hepatitis E virus (HEV) can be more dangerous for pregnant women and anyone with liver problems.

How do I catch it?

The most common way to get HEV is by drinking water polluted with sewage. You might also get it by eating undercooked, contaminated food, such as pork products. Direct person-to-person spread is rare. HEV has recently been linked to blood transfusions and organ transplants.

Where is it found?

HEV is found anywhere with poor sanitation. The largest epidemics have occurred in South Asia, Mexico and Africa. Cases and small outbreaks have been reported in European countries, including the UK, France, Germany and the Netherlands. Some of these cases were linked to eating pork or contact with pigs. Evidence of infection has been found in about 15% of adults living in England.

The largest reported outbreak was in India in 1991, with over 79,000 cases. It was thought to have been caused by drinking water contaminated with sewage from the River Ganges.

HEV is one of the leading causes of hepatitis in adults in Asia, the Middle East and North Africa.

What’s my risk?

Your risk of contracting HEV is higher if you are visiting friends and relatives, staying in risk areas for a long time and/or visiting places with poor sanitation. Outbreaks are more common after heavy rains and flooding, as drinking water can become tainted with untreated sewage.

It is hard to say exactly how many UK travellers catch HEV, as their destination is not always recorded when the diagnosis is made. When the destination was known, the most common countries visited were; India, Bangladesh and Pakistan.

In 2008, HEV was diagnosed in passengers on a world cruise. Altogether, 789 of the cruise passengers, from all over the world, were tested and 33, including four from the UK, were found to be infected. They were thought to have caught HEV by eating contaminated seafood.

What are the symptoms?

HEV infections can go by unnoticed, be a mild, self-limited feverish illness, or a more typical hepatitis syndrome. Symptoms, in those who have typical hepatitis, appear two to nine weeks after exposure and last 1 to 4 weeks. These can include:

  • Extreme tiredness
  • Fever (high temperature)
  • Itchy skin
  • Loss of appetite
  • Sickness
  • Stomach pain
  • Yellow skin/eyes (jaundice)
Pregnant women have the greatest risk of serious illness, liver failure and death.

Can it be treated?

There is no specific drug or medicine, treatment is supportive.

How can I prevent it?

Reduce your risk with careful food and water precautions and good personal hygiene. Make sure anything you drink has been treated or purified and that food, particularly meat and seafood, is thoroughly cooked. Pregnant women must be particularly aware of the importance of this. Hand washing helps to reduce your risk of hepatitis E

Currently there is no vaccine to protect against HEV.

Image courtesy of International Association for Food Protection