What is Hepatitis E?
Hepatitis E is a viral infection of the liver that is spread by the faecal-oral route, usually when sewage contaminates water or food, particularly raw shellfish. Large-scale epidemics periodically occur in Asia, the Middle East, Africa, and Central America, especially after floods and other natural disasters.
Destinations with poor sanitation and health infrastructure are more likely to report outbreaks of hepatitis E; however Japan and Europe have the occasional case usually associated with eating meat and offal from pigs and deer. In fact the virus could be far more pervasive than previously thought, according to a US study. The World Health Organisation has estimated the number of new Hep E infections worldwide each year at 20 million, with around 1-in-100 resulting in death.
In countries where it is endemic, hepatitis E is most common in children. Like Hep A, it often goes undetected because there may be no obvious signs that the child is infected. Young adults aged 15–40 are most likely to have the usual symptoms, which include jaundice, loss of appetite, a tender liver, abdominal pain and tenderness, nausea, vomiting, fatigue and fever, which can last for up to 2 weeks.
In most people, hepatitis E disappears without treatment and with no long-term effects. However, people with weakened immune systems, such as those with leukaemia or post-organ transplant patients, may develop a chronic form of the disease which can quickly lead to cirrhosis and permanent liver damage.
One group is far more susceptible to severe illness and death from Hep E than any other – pregnant women. Hepatitis E is fatal for between 15-30% of mothers-to-be in their third trimester. Tragically, even if the mother survives, it’s common for the foetus to die. It’s not known why pregnant women are at higher risk of severe outcomes.
While there are highly effective vaccines for hepatitis A and hepatitis B, no vaccine is currently available for hepatitis E in Australia, although one has been approved for use in China. To minimise the risk of Hep E infection, it is important for travellers to:
– Avoid drinking untreated water. If sealed, reputable bottled water isn’t available, treating tap water by boiling or chlorinating will kill both the hepatitis A and E viruses.
– Choose safe food and beverage options. (While Hep E is usually transmitted via drinking water, food-borne transmission may occur from raw shellfish, and un/undercooked meat or offal from infected animals.)
– Observe strict personal hygiene including hand washing after using the toilet and before eating.
Treatment is supportive only.