What is hepatitis E?

"Hepatitis" means inflammation or swelling of the liver. It can be caused by chemicals or drugs, or by infection with different kinds of diseases, including viruses. Most people recover within four to six weeks of getting hepatitis E.

Hepatitis E can be serious for:

• pregnant women, especially during the third trimester
• people who have existing chronic liver disease.

What are the symptoms of hepatitis E?

The symptoms of hepatitis E include:

• loss of appetite
• nausea
• vomiting
• tiredness
• abdominal/gut pain
• fever
• dark urine
• pale stools
• joint pain
• yellowing of skin and eyeballs (jaundice).

Symptoms normally start 3 to 6 weeks after the infection. For some people, symptoms may occur anywhere from 15 to 64 days after infection.

Some people, especially children, have no symptoms but can still spread the virus to others.

Hepatitis E can worsen chronic liver disease. Occasionally, hepatitis E can cause acute liver failure, which can lead to death.

How is it hepatitis E spread?

Hepatitis E can be spread through:

• eating food or drinking water in countries with poor sanitation
• eating undercooked meat, especially pork liver, venison (deer) and wild boar
• eating raw shellfish that has been contaminated by sewerage
• eating food prepared by an infectious person
• direct contact with infectious animals
• transmission from a pregnant woman to her baby
• direct contact with an infected person such as a household member or sexual partner, or in childcare or health care settings (although direct person-to-person transmission of hepatitis E is uncommon).

Hepatitis E is uncommon in Australia and normally due to travel overseas. However sources of infection in Australia have included pork livers or products made from pork livers such as pork liver sausages or pork pâté.

People with hepatitis E are normally infectious for around 2 weeks after the start of symptoms, but the virus has been detected for up to 6 weeks after the start of symptoms.

Who is at risk of getting hepatitis E?

People who live in or travel to countries with poor sanitation are at most risk. The virus is common in many parts of central and south-east Asia, the Middle East and North Africa, the Mediterranean region, Mexico and South America. Over 60% of all hepatitis E infections occur in East and South Asia.

In Australia, those who eat undercooked pork products, particularly pork livers, are at risk of becoming infected.

How is hepatitis E prevented?

If you are visiting countries with poor sanitation:

• drink bottled or boiled water (for drinking and for brushing your teeth)
• do not drink untreated water or ice
• only eat only fruit or vegetables that you peel yourself and food that is freshly cooked and piping hot.
• wash your hands thoroughly using soap for at least 10 seconds and dry them with a clean towel:
• after the toilet
• after caring for someone with diarrhoea and/or vomiting
• before preparing food.

If you have hepatitis E

If you have hepatitis E always wash your hands thoroughly with soap and water for at least 20 seconds.

You should avoid the following activities while infectious (for at least 2 weeks after onset of symptoms):

• making food or drink for other people
• providing health care for others
• sharing eating or drinking utensils with others
• sharing linen and towels with others
• swimming or using hot tubs
• having sex
• donating blood

People who have hepatitis E should check with their doctor before returning to:

• work involving handling food or drink
• work involving close personal contact, such as childcare and health work
• childcare or school

As there is a small risk that some people may be infectious for up to 6 weeks after the start of symptoms, continue to wash hands thoroughly with soap and water.

If you are preparing pork products

• cook pork products, including pork liver to 75°C at the centre of the thickest part for at least two minutes
• measure the temperature using a digital probe meat thermometer before removing meat from the heat source
• allow livers to rest for at least three minutes before consuming

How is hepatitis E treated?

There is no specific treatment or commercially available vaccine in Australia for hepatitis E.

Prevention is the most effective way to protect you from hepatitis E.

How is hepatitis E diagnosed?

Diagnosis is based on the patient's symptoms and confirmed by a blood test showing antibodies to hepatitis E.

What is the public health response?

• Doctors, hospitals and laboratories must confidentially notify cases of hepatitis E infection to the local public health unit.
• Public health unit staff will work with the doctor, the patient or the patient's family to identify close contacts at risk of infection and arrange for those at risk to receive information about the disease.
• Public health unit staff have guidelines for managing cases of hepatitis E in people who attend or work at a childcare centre, and in people who handle food for sale.
• In the event of an outbreak of hepatitis E, public health unit staff will investigate to identify the cause and prevent further infections.

Further information

For further information please call your local public health unit on 1300 066 055.