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Iowa Department of Health and Human Services

Hepatitis E


Hepatitis E (HEV) is a liver disease caused by the hepatitis E virus (HEV). Hepatitis E, however, does not occur often in the United States.

Hepatitis E is reportable to the Iowa Department of Public Health by Iowa Administrative Code 641 Chapter 1.


Persons with hepatitis E infection may have no symptoms at all. Typical symptoms of acute hepatitis E include:

  • Abdominal pain
  • Anorexia
  • Dark urine
  • Fever
  • Enlarged liver
  • Jaundice
  • Tiredness
  • Nausea
  • Vomiting


HEV is transmitted primarily by the fecal-oral route. Fecally contaminated drinking water or food are the most commonly documented methods of transmission.

Risk Factors

People who travel primarily in developing countries (Asia, Africa, Mexico) with inadequate environmental sanitation are at risk for disease. Infection is more common among adults than children. Symptom severity increases with age.


There is no vaccine to prevent hepatitis E. Travelers to areas where HEV is found should drink only bottled or boiled water or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes if water purity is unknown. Also avoid uncooked shellfish, and uncooked fruits/vegetables not peeled or prepared by traveler.


Supportive care only. The person usually gets well without treatment.

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