Hepatitis E
Hepatitis E is a liver infection caused by a virus you can get from drinking or eating something contaminated. Most people recover within a few weeks without treatment. But if you’re pregnant, the risks are much more serious. Hepatitis E can lead to liver failure, miscarriage or stillbirth — so, getting care right away is critical.
What Is Hepatitis E?
Hepatitis E is a virus that infects your liver. It can make you feel sick to your stomach, with symptoms like throwing up, belly pain and diarrhea.
Most people get better in a few weeks without treatment. But if you’re pregnant, hepatitis E can be dangerous. It may lead to liver failure or pregnancy complications.
Let your pregnancy care provider know right away if you’re pregnant and think you could have hepatitis E.
Hepatitis E causes
Hepatitis E virus (HEV) causes hepatitis E. Transmission occurs through:
- Drinking dirty water: This is the most common way. The water has tiny bits of poop that carry the virus.
- Eating undercooked meat: In places like the U.S., you can get it from eating raw or undercooked pork, deer, boar or shellfish.
- During pregnancy: A pregnant female can pass the virus to the fetus before birth.
Hepatitis E rarely spreads from person to person.
Symptoms of hepatitis E
Not everyone has symptoms of hepatitis E infection. If you do, early symptoms may include:
- Belly pain.
- Fever.
- Loss of appetite.
- Nausea and vomiting.
After a few days, you might notice other symptoms like:
- Dark-colored pee and clay-colored poop.
- Diarrhea.
- Itching.
- Joint pain.
- Rash.
- Yellow tinge to your skin or eyes (jaundice).
Hepatitis E is more common in parts of Asia, Africa and Central America. People who don’t have clean water or good bathrooms are more likely to get it. Individuals with weakened immune systems are also more at risk in every region.
Outbreaks can happen in areas experiencing crises or when large numbers of people are displaced, like during war. But there are also sporadic (individual) cases all over the world that don’t affect large numbers of people.
Women who are pregnant have the highest risk of complications from hepatitis E, especially in the third trimester. Tell your healthcare provider if you’re pregnant and have symptoms.
Complications can include:
- Liver failure.
- Miscarriage.
- Stillbirth.
People with weak immune systems may develop chronic hepatitis E. Their bodies can’t clear the virus like most people do. When hepatitis lasts a long time, it can cause serious liver damage. This can put you at risk of acute liver failure.
How doctors diagnose hepatitis E
Your healthcare provider can diagnose hepatitis E with a blood or poop test. A lab looks for signs of the virus, like its genetic material or antibodies. Because hepatitis E symptoms resemble many other diseases, your provider may test for other infections, too.
Is there a cure or treatment for hepatitis E?
There’s no specific treatment for hepatitis E. Most people get better in one to six weeks as their immune systems clear the virus. During that time, get plenty of rest and drink lots of fluids.
If you have a weak immune system and get chronic hepatitis E, your provider might give you antiviral medicine (like ribavirin) or a treatment that boosts your immune system (like interferon). These treatments aren’t safe if you’re pregnant.
If you’re pregnant
If you’re pregnant, especially in your third trimester, your healthcare provider will need to closely monitor you and the fetus. You may need to stay in the hospital or check in often. Let your provider know right away if your symptoms get worse or you notice anything new.
When should I call my healthcare provider?
Contact your provider if your symptoms don’t get better.
Go to the ER if you have:
- Confusion or altered mental state (hepatic encephalopathy).
- Dark or very little pee.
- Severe or worsening abdominal pain.
- Severe vomiting, vomiting blood or vomit that looks like coffee grounds.
- Yellow eyes and skin (jaundice).
Can hepatitis E be prevented?
If you live in or travel to an area where hepatitis E is common, you can reduce your risk by:
- Drinking only bottled or treated water.
- Using safe water to make ice.
- Peeling or washing produce with bottled or treated water.
- Washing your hands often, especially before eating and after using the bathroom.
Is there a vaccine for hepatitis E?
The HEV p239 vaccine for hepatitis E is available in China, but not yet in the U.S.
What can I expect if I have this condition?
Most people recover from hepatitis E in less than six weeks without any issues. If you’re pregnant or have a weak immune system, your provider will watch you more closely. You may need treatment in the hospital if you develop complications.
What’s the mortality rate for hepatitis E?
Hepatitis E is rarely deadly, except during pregnancy. If you get it in your third trimester, the risk of death may be as high as 30%. The risk is also higher for the fetus. About 33% may not survive the pregnancy, and 8% may die shortly after birth.
References
- Bergløv A, Hallager S, Weis N. Hepatitis E during pregnancy: Maternal and foetal case-fatality rates and adverse outcomes-A systematic review (https://pubmed.ncbi.nlm.nih.gov/31095813/). J Viral Hepat. 2019 Nov;26(11):1240-1248. Accessed 6/27/2025.
- Centers for Disease Control and Prevention (U.S.). Hepatitis E: CDC Yellow Book 2024 (https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/hepatitis-e). Last reviewed 5/1/2023. Accessed 6/27/2025.
- Julin, C.H., Hjortaas, K., Dembinski, J.L. et al. Hepatitis E in Pregnant Women and the Potential Use of HEV Vaccine to Prevent Maternal Infection and Mortality (https://doi.org/10.1007/s40475-019-00193-y). Curr Trop Med Rep 6, 197–204 (2019). Accessed 6/27/2025.
- Liang Z, Wang L, Wang L. Updates on hepatitis E virus (https://pmc.ncbi.nlm.nih.gov/articles/PMC9337248/). Chin Med J (Engl). 2022 May 20;135(10):1231-1233. Accessed 6/27/2025.
- Liu AF, Zucker SD. Viral Hepatitis. In: Friedman S, Blumberg RS, Saltzman JR, eds. Greenberger’s CURRENT Diagnosis & Treatment Gastroenterology, Hepatology, & Endoscopy. 4th ed. McGraw-Hill Education; 2022.
- Wu C, Wu X, Xia J. Hepatitis E virus infection during pregnancy (https://pubmed.ncbi.nlm.nih.gov/32522266/). Virol J. 2020 Jun 10;17(1):73. Accessed 6/27/2025.
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