Hepatitis E

The signs and symptoms of hepatitis E are like those of other types of acute viral hepatitis. Check with your physician if you think that you may have hepatitis. Symptoms vary from no symptoms to mild flu-like illness, dark urine, light stools, jaundice, fatigue, and fever. Below is a list of the most common symptoms:  

• Fever 

• Fatigue 

• Jaundice (skin or whites of eyes turning yellow) 

• Loss of appetite 

• Nausea 

• Vomiting 

• Abdominal pain 

• Dark urine  

• Clay-colored stools 

Hepatitis E is diagnosed with a blood test.

There is currently no treatment for hepatitis E.

Hepatitis E virus (HEV) usually spreads by the transfer of germs from feces to the mouth. The germs can last for about two weeks after the person gets sick. In developing countries, the most common way to get infected is by drinking feces-contaminated water. In developed countries, there have been occasional outbreaks linked to eating raw or undercooked pork or deer meat. Eating shellfish was a risk factor in a recent outbreak. 

Incubation Period (the length of time it takes someone to develop symptoms after exposure to a germ)

15-60 days

Hepatitis E virus (HEV) is linked to unclean water sources in countries outside the United States. Consumption of contaminated drinking water in developing countries is the main risk factor. 

Prevention of hepatitis E depends on good sanitation and the availability of clean drinking water. Travelers to developing countries can reduce their risk for hepatitis E by only drinking purified water. Boiling and chlorination of water will inactivate HEV. Immune globulin is not effective in preventing hepatitis E. There is currently no FDA-approved vaccine for hepatitis E in the United States. 

Be careful in foreign countries. Drink only water that is canned, boiled, or bottled. Avoid ice. Boiling is the most effective method to ensure safe water. At high altitudes boil vigorously for a few minutes, then allow it to cool. Use either iodine or chlorine for chemical disinfection. Iodine is the most effective disinfectant. Avoid uncooked shellfish and fruit/vegetables not peeled or prepared by you. 

If your child has a fever, they should not go to school or childcare until they are fever-free for 24 hours without any fever-suppressing medications. If your child has diarrhea, they should not attend school or childcare until they are diarrhea-free for 24 hours without using any diarrhea-suppressing medications. You can find more information about when to keep your child home from school or childcare in the Texas Administrative Code, Rule 97.7 for schools, and Rule 746.3603 for childcare.

Report Hepatitis E within one week with an EPI-1.

CDC Viral Hepatitis Surveillance Report Form  

There are several laws in Texas (Tex. Health & Safety Code, Chapters 81, 84, and 87) that require doctors, hospitals, schools, and labs to inform the Texas Department of State Health Services (DSHS) if they think someone has a notifiable condition (25 Tex. Admin. Code §97.2).

Reporting Forms 

Hepatitis E is uncommon in the United States, but some studies have found that many people have antibodies to HEV in the general population. When hepatitis E occurs, it is usually because someone traveled to a country where hepatitis E is common. Between 2015 and 2019, the average number of cases of hepatitis E reported in Texas was 20 cases per year (ranging from 12 to 31). 

Hepatitis E Virus 
Centers for Disease Control and Prevention, Division of Viral Hepatitis 
Hepatitis E slide set includes Hepatitis E - Clinical Features; Hepatitis E - Epidemiologic Features; Geographic Distribution of Hepatitis E; Prevention and Control Measures for Travelers to HEV-Endemic Regions 

Hepatitis E - World Health Organization (WHO)
Comprehensive health information and liver health advocacy

CDC Viral Hepatitis Serology Training 

Objectives: Upon successful completion of this training, participants will be able to:  

• Understand the different serologic tests for Hepatitis A virus (HAV) infection, Hepatitis B virus (HBV) infection, Hepatitis C virus (HCV) infection, Hepatitis D virus (HDV) infection, and Hepatitis E virus (HEV) infection. 

• Understand the serological diagnosis of HAV, acute and chronic HBV, acute and chronic HCV, and Hepatitis B and Hepatitis D (HBV/HDV) coinfection 

• Understand the meanings of serologic markers 

• Understand and interpret serologic test results 

• Identify appropriate hepatitis serologic tests when presented with patient information. 

Hepatitis E Overview for Students and Epidemiologists (PDF 477.66 KB)