Microbiology
Virus. NEJM Review.
Epidemiologic Risks
World wide. Where there are pigs there is Hepatitis E.
Fecal oral, there is evidence of human to human spread. Mostly from eating pig meat, innards, home-prepared pork products, or tasting raw pig meat. One guy got it from his pet pig. Really. In Denmark (PubMed) and Germany (PubMed), it is mostly an asymptomatic zoonosis from eating swine and wild boars. Especially common after flooding.
About 21% of Americans are seropositive ( PubMed) although other studies have put it at 6% (PubMed); pets and eating liver are the risks; I assume these risks are rarely combined. I bet Hannibal Lecter is seropositive.
It is in US pigs, " Hepatitis E virus RNA was detected in 6.3% and HEV IgG in 40% of 5,033 serum samples from market- weight pigs at 25 slaughterhouses in 10 US states"(Pubmed).
It is in the Red Deer in Spain (PubMed). I thought Franco got rid of all the Reds. In Rabbits in West Virginia and France; about 3% of rabbits in Europe have it, so be careful splitting hares (Pubmed). And rats in LA (PubMed). And ferrets. And eating camel meat and milk (PubMed). There goes my diet.
Rat hepatitis E can cause chronic hepatitis in transplant patients but not be picked up on standard testing (PubMed) (PubMed).
It has been passed on by transfusions.
Syndromes
Acute hepatitis.
It can be chronic in them what have bad immune systems (PubMed)(PubMed).
In HIV patients with unexplained increased ALT, chronic hepatitis E was found in 2.6%, so it wasn't so unexplained, was it?
Pregnant women in Asia die and the use of acetaminophen is a risk for death (PubMed).
There are a smattering of cases of encephalitis and other neurologic diseases (PubMed).
Treatment
Supportive. Highly effective (95%) vaccine is in the works (PubMed).
Chronic infection responds to ribavirin (PubMed) for at least 3 months (PubMed). Oh. My. God. A disease that responds to ribavirin.
Notes
Kills pregnant women in Africa that may be genotype dependent, the genotypes in the US and Europe are not so virulent in the pregnant. (All pregnant men are spared, an issue here in Oregon).
Chronic Hepatitis B increases the risk of death with acute Hepatitis E (PubMed).
Curious Cases
Relevant links to my Medscape blog
Last Update: 01/30/20.