Hepatitis E is a viral infection that primarily affects the liver and is caused by the hepatitis E virus (HEV).
Hepatitis E virus (HEV) is primarily transmitted through the **fecal-oral route**, like hepatitis A. While the virus is most associated with contaminated drinking water, it can also be transmitted through food, particularly:
HEV is often found in the liver of infected animals, particularly pigs and wild boar. Consuming undercooked or raw meat products from these animals can lead to infection.
In areas where hepatitis E is endemic, water supplies can become contaminated with feces containing the virus, which can then contaminate crops and other foods.
Food items that have encountered contaminated water or soil can also pose a risk.
While foodborne transmission is less common than waterborne transmission, it is still a significant route of infection, especially in areas with poor sanitation and hygiene practices.
Symptoms of hepatitis E usually appear 2 to 8 weeks after exposure and can include:
- Fatigue
- Fever
- Nausea and vomiting
- Abdominal pain
- Loss of appetite
- Dark urine and jaundice (yellowing of the skin and eyes)
Hepatitis E typically manifests as an acute infection. Unlike hepatitis B and C, it does not usually lead to chronic infection in the general population, but it can cause chronic hepatitis in immunocompromised individuals. Hepatitis E can be particularly severe in pregnant women, leading to a higher risk of liver failure and complications.
Diagnosis is typically made through blood tests that detect antibodies to HEV or the virus's RNA.
There is no specific antiviral treatment for hepatitis E. Management generally involves supportive care, including rest, hydration, and proper nutrition.
Improving sanitation, access to clean water, and proper food handling can help prevent hepatitis E. Vaccines are available but are not widely used or accessible in all countries.
There have been documented outbreaks of Hepatitis E linked to food, although these outbreaks are less common than those associated with Hepatitis A. Here are a few notable examples:
In the United Kingdom, a significant outbreak of Hepatitis E was linked to the consumption of undercooked or raw pork products. The strains of the virus identified in affected individuals were closely related to strains found in pigs. This highlighted the risk of Hepatitis E transmission through contaminated pork.
In the Netherlands, an outbreak of Hepatitis E was linked to the consumption of imported food products, particularly those containing pig liver. Investigations revealed that some cases were associated with eating products such as liver sausage made from infected pigs.
In some coastal regions, particularly in Asia, outbreaks of Hepatitis E have been linked to the consumption of raw or undercooked shellfish. Shellfish can become contaminated with Hepatitis E virus from sewage contamination in water.
In several developing countries, outbreaks of Hepatitis E have been associated with waterborne transmission, but there have also been instances where zoonotic transmission through the consumption of contaminated animal products, especially from pigs, has been noted.
A study in Spain identified cases of Hepatitis E linked to the consumption of undercooked pork. The researchers noted that most cases were related to certain types of processed pork products.
There have been reported cases of Hepatitis E in the United States, but large outbreaks are relatively rare compared to other countries, particularly those in Asia and Africa where the virus is more endemic. However, there have been some notable examples of Hepatitis E infection in the U.S.
Several studies and case reports have linked Hepatitis E infections in the U.S. to the consumption of undercooked or raw pork products. The U.S. Centers for Disease Control and Prevention (CDC) has reported that certain strains of Hepatitis E found in infected individuals were genetically like strains circulating in pigs. Although these instances are not classified as large outbreaks, they indicate potential zoonotic transmission.
Many cases of Hepatitis E reported in the U.S. have been associated with travel to countries where the virus is more common, such as parts of Asia, the Middle East, and Africa. Travelers returning from these regions can bring the virus back, leading to sporadic cases.
Surveillance studies in the U.S. have identified seroprevalence of Hepatitis E antibodies in the population, indicating past infections. For example, a study published in 2019 indicated that about 2% of the U.S. population might have been exposed to the virus, with some cases likely linked to consumption of contaminated food products.
An outbreak of Hepatitis E was reported among a group of individuals who had consumed game meat, specifically boar. This case emphasized the potential for Hepatitis E transmission through consumption of undercooked or raw meat from infected animals.
There have also been reports of Hepatitis E infections in immunocompromised individuals, such as organ transplant recipients, who may develop chronic infections. These cases are often linked to the presence of the virus in pork or other animal products.
While Hepatitis E is not as prevalent in the U.S. as in some other parts of the world, awareness of its transmission through food, particularly pork products, is important for public health. The CDC continues to monitor and investigate cases to better understand the epidemiology of Hepatitis E in the United States.