Preventing Hepatitis E infection is possible with the right strategies. This article will guide you through them. With a solid understanding of how the virus spreads, combined with practical measures, the risk of contracting Hepatitis E can be reduced.

To avoid Hepatitis E infection, focus on these preventive measures:

• Ensure safe water: Drink only clean, treated, or boiled water. Avoid consuming ice made from untreated sources
• Practice good hygiene: Wash your hands regularly with soap, especially after using the bathroom or before preparing food
• Safe Food Practices: Avoid raw or undercooked meat, especially pork or liver. Proper washing of fruits and vegetables before consumption
• Vaccination: If you are travelling to a high-risk area or fall under a vulnerable category, consider getting vaccinated if available

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These are just some of the important steps you can take to protect yourself from Hepatitis E. 

Read on to learn more about effective community-level interventions, specific advice for travellers, and real-world examples of successful prevention campaigns.

Introduction

Hepatitis E is an inflammatory infection of the liver caused by the Hepatitis E virus (HEV). Annually, there are about 200 million infections of Hepatitis E globally, out of which 3.3 million cases are symptomatic, with a record of up to 70,000 deaths.^1,2 Hepatitis E outbreaks have been recorded in many places, including Africa, Central America, South and Central Asia and tropical East Asia, especially among refugees and people in camps. Some regions have less common outbreaks of hepatitis, these include North and South America, parts of Europe, China and the Middle East.³

HEV is a small virus that does not have an outer coating (non-enveloped), and it is made of genetic material known as RNA, similar to other viruses.³ It is the most common source of sudden liver inflammation globally.⁴

One out of eight people worldwide has been infected by this virus at some point.⁵ This virus exists in different types (genotypes), which are HEV 1- 4 and HEV-7, but types 3 and 4 spread not just from human to human but also from animals to humans (zoonotic transmission).⁵ These zoonotic types have been found in pigs, and people can contract them through contaminated food, especially uncooked meat.⁶ HEV-3 and HEV-7 cause hepatitis E in developed countries, while HEV-1, HEV-2, HEV-4 and HEV-7 are associated with the infection in developing and underdeveloped countries.² Globally, HEV-1 is the most prevalent cause of all HEV infections.²

Usually, if a healthy person gets infected, they may not show symptoms, or they could recover from HEV infection without treatment.³ However, people with weakened immune systems, such as those with underlying health conditions (those who have had organ transplants), are at higher risk of the infection, which persists long term (chronic).³

Importance of preventing HEV infection 

It is important to prevent hepatitis because it is a major cause of liver illness, particularly in developing countries. The infection can be very severe and deadly for pregnant women and young children.

Transmission of Hepatitis E

The transmission of the virus hepatitis E, which causes Hepatitis E infection, may differ based on the genotype that is contracted:

• Types 1 and 2 spread through water contaminated with human waste; this is why areas with poor sanitation are at risk of the infection³
• Type 3 spreads through consumption of raw or undercooked meat, especially from animals such as pigs, boars or deer. Eating shellfish was also linked to an outbreak of hepatitis E on a cruise ship³
• Type 7 has also been associated with eating camel meat and drinking camel milk
• There are also some cases of hepatitis E spreading through blood transfusion in Europe
• There is also a risk of mother-to-child transmission (vertical transmission) in pregnant women³

Symptoms and risk factors of hepatitis E 

After an individual is exposed to hepatitis E, it can take up to 10 weeks before symptoms manifest. Most sickness occurs around 5 to 6 weeks later.¹ The virus can be detected in the body of infected persons a few days before symptoms start, and it can keep spreading 3 to 4 weeks after getting sick.¹ This indicates that it is a highly contagious infection.

In locations where hepatitis E is very common (Endemic locations), the infection is symptomatic among young adults between 15 to 40 years old. Children in these areas usually get infected as well, but do not show symptoms or have a very mild illness without noticeable signs such as yellow skin (jaundice).¹

Symptoms of Hepatitis E are:

• Fever
• Tiredness
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Light-coloured stool
• Skin rash/itching
• Joint pain

The symptoms of hepatitis E are very similar to those of other liver diseases and usually last between 1- 6 weeks. Most of the illnesses are mild, but occasionally they can be very serious and lead to sudden liver failure, which is life-threatening.

Pregnant women, particularly those in their second or third trimester, are at much higher risk, which can result in miscarriage, liver problems or death. If hepatitis E occurs in the third phase of pregnancy, there is a 20-25% chance she could die.¹

Hepatitis E can become long-lasting (chronic), especially in people with weak immune systems, although it rarely occurs.

Importance of preventive measures 

The lack of clean water and adequate sanitation is a major challenge in preventing hepatitis E, especially in developing countries. Some of the challenges in preventing hepatitis E infection include: 

Contaminated water sources

Hepatitis E is an emerging waterborne disease native in regions with poor hygiene and sanitary conditions, including large parts of Asia, Africa and South America. When there is limited access to clean (portable) water, people are left with no choice but to use water from polluted sources, which increases their risk of infection. 

Poor sanitation and hygiene

Lack of good sewage and proper waste disposal leads to contamination of water supplies and spreads the infection rapidly among the population. Without good hygiene practices, such as proper hand washing, the risk of transmission is higher.

Limited access to healthcare facilities

Lack of healthcare facilities in areas with poor sanitation makes it difficult to diagnose and treat hepatitis E. This often leads to more severe outcomes.

Higher risk in crowded conditions

Overcrowded areas with inadequate sanitation facilities are also at risk. This is because the virus spreads quickly, affecting large numbers of people, as everyone shares the same limited water and sanitation resources.

According to the World Health Organisation (WHO), prevention is the most effective approach against hepatitis E.¹ Preventive measures for hepatitis E include:

• At community or population level
  1. Provision of a clean water supply that is safe to drink
  2. Proper waste management and disposal: The government should set up good systems to dispose of human waste safely to prevent water contamination
• At the individual level
  1. Good hygiene practices, especially before eating or preparing food
  2. Proper cooking of meat and meat products
  3. Avoid using ice if you are not sure it is made of clean water
• Vaccination: The only vaccine that is available in the market for hepatitis E is the HEV 239 vaccine ( Hecolin, Xiamen Innovax Biotech, China), which has been approved in China since 2011. Although the vaccine is not available globally, the WHO recommends using the hepatitis E vaccine as a way to prevent and reduce outbreaks, especially in pregnant women¹

• Screening of blood and blood products before transfusion.⁷
• To prevent hepatitis E spread, it is important to strengthen screening, timely identification of infection sources, and management of infected patients by isolation and treatment for up to 3 weeks after symptoms begin.
• One Health approach of preventing Hepatitis E, such as animal biosecurity: implementation of strategies that prevent the delivery of HEV-infected pigs to slaughters, including cleaning pig pens and formites, and controlling flies⁸ 

FAQs

What is the best way to prevent hepatitis E?

By drinking clean, safe water, maintaining good hygiene and avoiding consumption of undercooked meat.

Is hepatitis E common in areas with clean water?

It is less common in places with clean water and good sanitation, although it can still occur on rare occasions.

Can a person get hepatitis E from drinking tap water?

In areas where sanitary conditions are poor, drinking untreated tap water can increase the risk of hepatitis E. Always use filtered or boiled water if you are unsure.

Summary 

Hepatitis E is a virus that causes liver infection, and it is transmitted through contaminated water or undercooked meat from animals such as pigs. Pregnant women and people with a weak immune system are particularly at higher risk of contracting the infection. Prevention strategies should be tailored towards ensuring access to clean water, proper sanitation and good hygiene practices. Avoiding raw or undercooked meat and drinking clean water also reduces risk. Vaccination is available for those at most risk, and adequate animal husbandry practice (such as keeping pig pens clean) should be in place to prevent the virus from spreading to humans. These simple steps can help reduce the risk of getting infected with hepatitis E for both entire communities and individual people.