What causes Hepatitis E?
The hepatitis E virus is usually spread through food or water that has been contaminated with poo from people or animals with the infection.
The illness does not usually spread easily within families, except when all members of the family have been drinking the same infected drinking water or contaminated food.
However, people who have the virus should avoid preparing food for others for two weeks after symptoms begin. If possible they should also limit contact with anyone who is pregnant, immunosuppressed or has a liver condition.
The illness can also be caused by what is known as ‘zoonosis’. This means the virus can be found in animals such as pigs, wild boar, deer, rabbits and rats. It does not cause the animals any illness, however, the virus can sometimes be passed from the animal to humans. One way this can happen is by eating raw or undercooked meat. In most cases the source and route of infection is unknown.
There is no evidence of the hepatitis E virus being transmitted through sharing needles, bodily fluids or through sexual contact. However, there is a risk of transmission if there is mouth contact with the anal area.
There have also been a number of cases reported where hepatitis E has been transmitted through blood transfusions and organ transplants.
What are the symptoms of Hepatitis E?
After the virus enters your body there are no symptoms for a period of two to nine weeks. This is known as the incubation period. After this, some people will develop symptoms.
Symptoms of hepatitis E infection are like those of many other liver diseases and can include:
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- mild flu-like symptoms
- fatigue (extreme tiredness), this can continue for some time after clearing the virus
- change in urine colour – dark or brown
- abdominal pain
- jaundice
- fever (high temperature)
- loss of appetite
- itching
- nausea and vomiting (sickness)
- aching joints and muscles
- tingling, numbness and weakness in your arms and legs.
People at risk can develop a serious, long lasting (chronic) infection. This can lead to cirrhosis of the liver, and needs medical care. You can find out more about cirrhosis here.
In some people, hepatitis E can affect the nervous system. This causes severe pain in the arms and legs.
Treatment for hepatitis E
Most people with hepatitis E will get better by themselves and will not need any medical treatment.
If you are pregnant, have another liver condition or are immunosuppressed, and your doctor confirms you have hepatitis E, you should be referred to see a specialist urgently.
If you do not get better in a few months, there are some treatments can help to get rid of the virus.
If you are taking immunosuppressant drugs, for example after a transplant, your doctor might reduce these so that your immune system can deal with the virus. Always talk to your doctor before stopping or changing your medication.
If you are not taking immunosuppressants, or reducing them wouldn’t be safe, your doctor might prescribe antiviral drugs to help get rid of the virus.
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Further Information
Looking after yourself when you have Hepatitis E
Alcohol
Alcohol is processed by your liver and, as a result, it can be dangerous for anyone with liver problems. If you have hepatitis E it is important that you stop drinking alcohol for the duration of infection (the whole time) as it can make your symptoms worse11.
Alcohol can accelerate the rate of liver damage in those with hepatitis B and C, and can limit the effectiveness of anti-viral treatment30. Therefore, it is recommended to avoid alcohol in these circumstances.
Smoking
Smoking is dangerous to everyone’s health31, 32, 33. Smoking can increase the severity of liver damage34. People with liver disease are more vulnerable to infection and to general poor health, so smoking or exposure to passive smoking is not advisable. If you smoke, speak to your doctor about what help is available for cutting down and giving up.
Diet
Being overweight or obese can affect the progression, or treatment of, your liver condition. If you have a liver condition, there may be some special considerations you need to make in your diet to stay nutritionally well and to help manage your condition. Some of these are specific to certain liver diseases, others relate to how advanced your liver disease is (see our ‘Diet and liver disease’ publication).
For most people with hepatitis E there is no special diet, however, eating a good, balanced diet is one of the most important things you can do to keep yourself well. Regular low calorie meals containing protein (such as meat, fish or beans), starch (such as bread, potatoes or rice) and vitamins (in fruit and vegetables) is the best approach.
Exercise
If you have hepatitis E, and are experiencing symptoms, you should try to take gentle exercise such as a regular walk or a gentle swim. You should avoid strenuous exercise until after your symptoms have gone.
Maintaining a healthy weight is vital for the health of your liver. Once you no longer have the symptoms of hepatitis E, continuing to take regular exercise will help you to maintain a healthy weight. The Department of Health recommends adults should take at least half an hour’s gentle exercise a day, leaving you warm and slightly out of breath. You can do this all at once or, if you find it easier, in shorter 10-minute bouts. If you are overweight, the amount of exercise you do may need to be increased from 30 minutes to 45-90 minutes a day to help you to lose weight.
Finding an exercise that you enjoy will help; try walking, swimming, cycling or dancing. Make sure you start at a sensible rate with the aim to gradually build up the amount and intensity of exercise you do.
Complementary and alternative treatments
Many complementary and alternative medicines suggest they can ease the symptoms of liver disease. Before taking any medicine you should check with your doctor that it is safe to do so, as most of these are processed by the liver, so they can be toxic to people with liver conditions. Some can damage the liver and make you more severely ill. At present, healthcare professionals are not clear on the role and place of some complementary medicines in managing liver disease; further research is needed on their use.
Licensing has been introduced for some traditional herbal medicines; however, many herbal products are not classified as a medicine so there is no regulation of the product. This means you cannot be sure how much of the active ingredient you are getting or how pure it is. Unregulated products are not monitored or assessed for how effective or safe they are. Some remedies can damage the liver and make you more severely ill.
It is wise to be cautious about the claims made for herbal remedies, particularly those advertised on the internet, as they can offer false hope. It is important to discuss the use of these remedies with your doctor before taking them.
Some people choose to use complementary therapies alongside their conventional medical treatment, both to ease symptoms and emotional wellbeing. Such therapies may include massage, aromatherapy, meditation or acupuncture.
To ensure your chosen therapy does not adversely affect your health or medical treatment, you should discuss any therapies you are thinking of using with your doctor. Make sure your practitioner is registered with an accredited body; your doctor may be able to refer you to a locally recommended practitioner. Always inform your practitioner of your medical conditions as these may impact on the type of therapies that are safe for you.
Support if you have Hepatitis E
Please visit the support section of our website for information on Support groups in your area or visit our Useful Links section for other organisations who may be able to offer information and support. Other organisations which may be able to offer information:
The National Travel Health Network and Centre (NaTHNaC)
Web: www.nathnac.org
A centre funded by the Department of Health to promote clinical standards in travel medicine. The NaTHNaC website provides general health information for people travelling overseas. Advice covers infectious and non-infectious health risks, where they are found, and links to other resources to help you plan your travel.
Fit For Travel
Web: www.fitfortravel.nhs.uk
A website provided by the NHS (Scotland). It gives travel health information for people travelling abroad from the UK.
Please visit the support section of our website for information on Support groups in your area.