Hepatitis E

Hepatitis E

Organism, Causative Agent, or Etiologic Agent  

Hepatitis E virus (HEV) is the only member of the genus Hepevirus in the family Hepeviridae. It is a single-stranded, positive-sense RNA virus.  Four genotypes of HEV-infecting mammals are currently recognized.  The host range includes pigs, sheep, deer, rabbits, and humans.  Other mammals including dogs, cats, and rodents may be hosts. 


Hepatitis E virus is usually spread by the fecal-oral route. Viral shedding lasts for about two weeks after disease onset.  The most common source of infection, particularly in developing countries, is feces-contaminated drinking water. In developed countries, sporadic outbreaks have happened after consuming uncooked/undercooked pork or deer meat. Consumption of shellfish was a risk factor in a recently described outbreak. 


The signs and symptoms of Hepatitis E are like those of other types of acute viral hepatitis:  

  • Fever 

  • Fatigue 

  • Jaundice (skin or whites of eyes turning yellow) 

  • Loss of appetite 

  • Nausea 

  • Vomiting 

  • Abdominal pain 

  • Dark urine  

  • Clay-colored stools 


Prevention of Hepatitis E relies on good sanitation and the availability of clean drinking water. Travelers to developing countries can reduce their risk for Hepatitis E by not drinking unpurified water. Boiling and chlorination of water will inactivate HEV. Immune globulin is not effective in preventing Hepatitis E. No FDA-approved vaccine for Hepatitis E is currently available in the United States. 

School Exclusion Policy  

Exclude children with fever from school or childcare until fever-free for 24 hours without fever suppressing medications. Exclude children with diarrhea from school or childcare until diarrhea-free for 24 hours without the use of diarrhea suppressing medications. See the rules for exclusion of sick children from school and childcare in the Texas Administrative Code, Rule 97.7 for schools and Rule 746.3603 for childcare. 



Reporting and Resources

Recent Texas Trends 

Hepatitis E is uncommon in the United States. Yet, some studies have found a high prevalence of antibodies to HEV in the general population. When Hepatitis E does occur, it is usually the result of travel to a developing country where Hepatitis E is endemic. Between 2015-2019, the average number of cases of Hepatitis E reported in Texas has been 20 cases per year (ranging from 12 to 31). 

 Lone Star icon 




Report Hepatitis E within one week with an EPI-1


The  CDC Viral Hepatitis Surveillance Report Form  

Several Texas laws (Tex. Health & Safety Code, Chapters 81, 84, and 87) require specific information about notifiable conditions to be provided to the Texas Department of State Health Services (DSHS). Healthcare providers, hospitals, laboratories, schools, and others are required to report patients suspected of having a  notifiable condition ( 25 Tex. Admin. Code §97.2). 


Viral Hepatitis Case Track Record 




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) 


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 


The International Hepatitis Foundation 
Hepatitis Foundation International Newsletter; Living with Hepatitis; Online Learning Center; Resource Center; Education 


Hepatitis E Fact Sheet


HEV (Hepatitis E Virus) 


Virus: hepatitis E 


Hepatitis E is transmitted through eating or drinking contaminated food or water supplies, poor personal hygiene, and person-to-person (uncommon). 


Fifteen to sixty days 


May have no symptoms (especially in young children). Some persons have mild flu-like symptoms, dark urine, light stools, jaundice, fatigue, and fever. 


Blood test. 


There is currently no treatment for hepatitis E. 


To prevent transmission of the hepatitis E virus avoid consuming potentially contaminated water or food. 


Mortality (death rate) of those infected with hepatitis E is 1-2% although in pregnant women it approaches 20%. 


The occurrence of hepatitis E in the U.S. is very rare and is mostly associated with U.S. residents who travel to developing countries. 

DSHS Publication Number 13-11896