What is hepatitis E?
Hepatitis E is a viral infection of the liver caused by the hepatitis E virus (HEV), primarily transmitted through the faecal–oral route, most commonly via contaminated water or food.
The World Health Organisation estimates that there are around 20 million HEV infections each year, resulting in approximately 3.3 million symptomatic cases and thousands of deaths annually. The condition carries a high mortality in pregnancy.
For Australian travellers, hepatitis E is considered rare domestically but transmission continues internationally. Most cases in Australians are acquired overseas, particularly in regions where sanitation, water treatment, and food hygiene standards may be lower.
The virus is classified into several genotypes that differ in their geographic distribution, modes of transmission, and epidemiological patterns. In developing regions, infection is often linked to contaminated drinking water and can cause outbreaks, while in developed countries sporadic cases are more commonly associated with consumption of undercooked pork or game meat.
FAQs
Which destinations carry a higher risk of hepatitis E?
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Hepatitis E is rare in Australia due to high standards of sanitation and water treatment. However, the risk increases with international travel, particularly to regions where access to clean water and safe food handling may be limited. Higher-risk areas include parts of Asia, Africa, the Middle East, and Central and South America. Travellers visiting rural areas, staying in basic accommodation, or consuming untreated water or street food may be at greater risk of exposure.
How is hepatitis E transmitted?
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Hepatitis E is most commonly spread through the faecal–oral route. This typically occurs when food or drinking water becomes contaminated with microscopic amounts of infected faecal matter, often due to inadequate sanitation, unsafe water supplies, or poor hygiene practices. usually via contaminated drinking water.
Infection can also occur through consumption of contaminated food, particularly undercooked pork, game meats such as venison, and shellfish. Inadequate food handling practices can further increase risk. While person-to-person transmission is less common, it may occur in environments with poor sanitation and hygiene.
Is there a vaccine for hepatitis E?
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A vaccine against hepatitis E exists but is currently only licensed in a limited number of countries and is not widely accessible. It is not included in the Australian National Immunisation Program or routinely recommended for Australian travellers. As a result, prevention focuses primarily on careful food and water hygiene, as well as general infection control measures during travel.
Who is at increased risk of severe illness from Hepatitis E?
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Most hepatitis E infections are mild and self-limiting; however, certain groups are more vulnerable to severe disease. Pregnant women, particularly in the third trimester, are at significantly higher risk of complications, including acute liver failure. Individuals with underlying liver disease, those who are immunocompromised, and older adults may also experience more severe illness. These travellers should seek individualised medical advice prior to departure to assess risks and preventive strategies.
What to Know
Hepatitis E Symptoms
Symptoms of hepatitis E can vary widely, ranging from asymptomatic infection to acute inflammation of the liver, referred to as hepatitis. Many individuals, particularly younger people, may have no noticeable symptoms.
When symptoms do occur, they typically start to develop between two and eight weeks after exposure. Early symptoms often resemble other viral illnesses and may include fatigue, fever, nausea, vomiting, abdominal pain, and loss of appetite.
As the infection progresses, more specific signs of liver involvement may appear. These can include jaundice, which causes yellowing of the skin and eyes, dark urine, pale stools, and itching. Some individuals may also experience joint pain or a general sense of being unwell.
Most people recover fully within several weeks without long-term liver damage. However, severe disease can occur, particularly in pregnant women and individuals with underlying liver conditions, and may lead to acute liver failure.
Hepatitis E Diagnosis and Treatment
Hepatitis E is diagnosed through blood tests that can detect antibodies specific to hepatitis E, or genetic material of the virus. These tests confirm recent or active infection and help distinguish hepatitis E from other causes of liver inflammation.
There is no specific antiviral treatment routinely used for hepatitis E in most cases. Management is supportive and focuses on relieving symptoms, maintaining adequate hydration, and monitoring liver function. Most individuals can recover at home with rest and careful observation.
In more severe cases, particularly in high-risk individuals, hospital care may be required to manage complications such as dehydration or liver dysfunction. In rare instances of acute liver failure, specialised care and transplantation may be necessary.
People diagnosed with hepatitis E are generally advised to avoid alcohol and medications that may further stress the liver during recovery. Follow-up with a doctor is important to ensure complete resolution of the infection.
Hepatitis E Prevention
Preventing hepatitis E is particularly important for travellers, as there is no widely accessible vaccine in Australia. The cornerstone of prevention is strict attention to food and water hygiene.
When uncertain about whether water is safe to drink, travellers should stick to bottled, boiled, or appropriately treated water, and avoid ice in areas where water safety varies. Food should be freshly prepared, thoroughly cooked, and served hot. Raw or undercooked meats, particularly pork and game, as well as shellfish, should be avoided, as these have been linked to infection.
Good hand hygiene is also essential, particularly before eating or preparing food. Washing hands with soap and water or using alcohol-based hand sanitiser when facilities are unavailable can significantly reduce the risk of infection.