Content Information
Disease Information
Overview
Also known as: Viral hepatitis E, Enteric non-A non –B hepatitis, “A-like” non-A non-B hepatitis
Responsibilities
- Hospital: Report by IDSS, facsimile, mail, or phone
- Lab: Report by IDSS, facsimile, mail, or phone
- Physician: Report by facsimile, mail, or phone
- Local Public Health Agency (LPHA): Follow-up required
Iowa Department of Public Health
Disease Reporting Hotline: (800) 362-2736
Secure Fax: (515) 281-5698
A. Agent
Hepatitis E virus (HEV) is a spherical, nonenveloped, single-stranded RNA virus. It is classified in the Heperviridae family.
B. Clinical Description
Symptoms Signs and symptoms resemble hepatitis A. These symptoms include fever, malaise, anorexia, nausea and abdominal pain followed by jaundice. The severity can range from a mild illness lasting 1 - 2 weeks to severe disease lasting several months. It has a relatively low case-fatality rate (=4%), which increases with age. Unlike hepatitis A, the fatality rate in pregnant women can be 10-30%, particularly those in their third trimester.
Onset is usually sudden.
Complications of hepatitis E are uncommon. There is no evidence of a chronic form.
C. Reservoirs
Humans are the only known reservoir, however, domestic animals, including pigs, may be a reservoir.
D. Modes of Transmission
Hepatitis E is usually spread through the fecal-oral route. Contaminated water is the most commonly documented route. Fecal-oral transmission probably also occurs person to person. Recent studies show that hepatitis E may be a zoonotic infection.
E. Incubation Period
The range is 15 - 64 days; mean incubation period has ranged from 26 - 42 days in recent outbreaks.
F. Period of Communicability or Infectious Period
This period is unknown. HEV has been detected in stool 14 days after onset of jaundice, and 4 weeks after ingestion of contaminated food or water, persisting for 2 weeks.
G. Epidemiology
Outbreaks and sporadic cases have occurred over a wide geographic area, primarily in countries with poor sanitation. Highest rates of disease occur in young to middle-aged adults; younger age groups may have disease without jaundice or be asymptomatic. Hepatitis E is believed to be uncommon in the United States. When HEV infection does occur, it is usually the result of travel to a developing country where Hepatitis E is endemic.
H. Bioterrorism Potential
None.
I. Additional Information
The Council of State and Territorial Epidemiologists (CSTE) surveillance case definitions should not affect the investigation or reporting of a case that fulfills the criteria in this chapter. (CSTE case definitions are used by the state health department and the CDC to maintain uniform standards for national reporting.)
Fact Sheets and Forms
References
American Academy of Pediatrics. 2006 Red Book: Report of the Committee on Infectious Diseases, 27th Edition. Illinois, American Academy of Pediatrics, 2006.
CDC Website
Heymann, D.L., ed. Control of Communicable Diseases Manual, 20th Edition. Washington, DC, American Public Health Association, 2015.