Hepatitis E

What is hepatitis E?

Hepatitis E is an infectious-inflammatory liver disease caused by an RNA-containing virus, which can occur in an acute or (much less commonly) chronic form. In most cases, the disease is mild and resolves with the patient developing lifelong immunity. However, in certain patient groups (such as pregnant women and those receiving massive immunosuppressive therapy), the condition can be severe, often progressing rapidly and requiring treatment in intensive care units.

About the disease

The source of the hepatitis E virus is an infected carrier or a person suffering from this pathology. The infectious agent is released into the environment during the last 5-7 days of the incubation period and for a month after the onset of hepatitis E symptoms. The disease affects people worldwide, but the highest incidence is in countries with low living standards and poor sanitation conditions, where the disease occurs in outbreaks rather than sporadic cases.
Many patients, especially in childhood, experience asymptomatic infection and recover. It is dangerous for pregnant women, leading to fetal death and the development of life-threatening complications in the mother (acute liver failure, disseminated intravascular coagulation syndrome), which are the cause of death in 20-25% of pregnant women with hepatitis E.

Depending on the severity of the pathological process, there are four forms of hepatitis E:

  • mild;
  • moderate;
  • severe;
  • fulminant (otherwise known as acute liver failure).
    Factors that increase the likelihood of a fulminant form include:
  • pregnancy;
  • therapy with immune-suppressing drugs (immunosuppressants);
  • severe immunodeficiencies (especially HIV);
  • male gender;
  • age over 50-60 years;
  • alcohol abuse;
  • severe somatic comorbidities (coronary heart disease, diabetes mellitus, decompensated kidney and liver diseases, autoimmune diseases);
  • chronic viral liver diseases.
    Depending on the course of the disease, acute and chronic viral hepatitis E are distinguished.

According to clinical manifestations, there are two variants:

  • anicteric;
  • icteric.
    Based on the outcome of hepatitis E, the following classification exists:
  • complete recovery of the patient or recovery with short-term residual symptoms (feeling of heaviness in the right side, signs of asthenia);
  • transformation of acute hepatocyte inflammation into chronic;
  • development of acute liver failure and patient death (typical for pregnant women).


The main symptoms of hepatitis E are similar to those of any other type of viral hepatitis. The disease can be asymptomatic or present with mild to severe symptoms. In the clinically apparent variant, during the first few weeks, there may be no symptoms at all – this is the incubation period, during which the virus actively replicates (on average, lasting a month). Then the patient may experience the following symptoms gradually:

  • General weakness, increased fatigue, reduced productivity.
  • Emotional instability, depressed mood.
  • Dizziness, headaches.
  • Nausea, decreased appetite or complete loss of appetite.
  • Sleep disturbances.
  • Heaviness, discomfort, pain, and tenderness in the right side.
  • Sometimes mild joint pain, low-grade fever.
  • Various degrees of yellowing of the sclera, mucous membranes, and skin.
  • Skin itching.
  • Darkening of urine, lightening of stool color.

Symptoms of viral hepatitis E persist for up to 3-4 weeks, then gradually regress, and the patient recovers. The development of liver inflammation of this nature in pregnant women significantly affects their condition, causing fetal death in the first and second trimesters, and acute liver failure, hepatic encephalopathy, bleeding, and coma in the third trimester. Symptoms progress rapidly, within 1-2 days.


Hepatitis E virus is an RNA virus. There are five genotypes, among which types I and II infect only humans, types III and IV also infect animals, from which the pathogen can be transmitted to humans (these genotypes cause chronic forms of infection in predisposed patients), and type V affects birds. The hepatitis E virus thrives in aquatic environments and can persist there for a long time. It is released into the environment through the feces of infected humans and animals. The primary mode of transmission is fecal-oral (meaning, transmission occurs through ingestion of contaminated water, undercooked meat, or via dirty hands). Less commonly, transmission occurs through oral-anal sexual contact, during blood transfusion (extremely rare), or from a pregnant woman with hepatitis E to her fetus. The virus enters the human body through the mouth, then reaches the small intestine, where it replicates, spreads into the bloodstream, reaches the liver, binds to receptors on the surface of hepatocytes, and enters inside them. There, the virus actively produces viral proteins, disrupting the structure and functions of the cells, causing them to fill with fluid and eventually die. The virus spreads from damaged hepatocytes to healthy ones, and the process repeats. The immune system responds to the infection, but it takes some time to produce antibodies – from 2 to 4 weeks. When this happens, the recovery process begins.


The basis of diagnosis includes detecting antibodies to hepatitis E virus of class G, M, and/or viral RNA (by PCR method) in the patient’s blood. Other tests (complete blood count, biochemical analysis of blood and urine, ultrasound of the liver and bile ducts, MRI) are auxiliary and allow evaluating the degree of inflammatory process activity but do not indicate its nature.


Patients with mild forms of viral hepatitis E receive treatment on an outpatient basis. Cases of moderate severity are hospitalized in infectious disease departments. Severe and particularly fulminant variants of the disease require urgent initiation of treatment in the intensive care unit.

Patients are advised to follow a gentle diet: consume a large amount of fluids (more than 1500 ml per day), exclude fried foods, spicy foods, pastry, mushrooms, alcohol, and carbonated drinks from their diet.

Medical treatment includes:

  • Hepatoprotectors.
  • Sorbents.
  • In some cases, antiviral drugs (interferon).
  • Intravenous infusion of detoxification solutions.
  • Vitamin therapy.
  • Hormone therapy.

Plasmapheresis and hyperbaric oxygenation may also be prescribed to patients.


Specific prevention of hepatitis E is only carried out in China, where a vaccine has been developed, which is not yet registered.

Non-specific prevention involves controlling the quality of drinking and tap water, observing personal hygiene rules (washing hands before eating), and ensuring proper production, storage, and transportation of food products. Conducting preventive examinations of food industry workers is also recommended. Pregnant women should avoid traveling to regions where hepatitis E is prevalent, especially in Asian countries.


Patients recovering from viral hepatitis E undergo dispensary observation by an infectious disease specialist or hepatologist for a period of 6 months or more, depending on the severity of the disease course and the presence of complications. They receive monthly check-ups and undergo a minimum of examinations to assess the body’s condition dynamically.