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Hepatitis E – An Evolving Disease

Sandra Rodriguez, MD
William D. Carey, MD



A multitude of viruses may cause hepatic inflammation but 5, designated A, B, C, D, and E primarily infect the liver and produce hepatitis as their primary clinical manifestation (Table 1). Historically, hepatitis E virus (HEV) has been known to cause acute hepatic inflammation almost exclusively. Usually, in a self-limiting fashion that may infrequently progress to fulminant hepatitis. Transmission is predominantly through the fecal-oral route, through contaminated water. In such ways, it has been known to cause epidemics in high prevalence areas.1-3

Table 1. Comparison of the worldwide burden of hepatitis
  Global† United States
  Acute Chronic Acute Chronic
HAV 1.4 N/A 21000 N/A
HBV 4 240 38000 1.4
HCV 3-4 150 16000 3.9
HEV 20/3* Unknown Unknown Unknown

†All numbers are reported in millions.

*20 million new infections and 3 million cases of acute hepatis.

Hepatitis data can be found at www.who.int/topics/hepatitis/factsheets/en/.

In none endemic areas the prevalence of the disease used to be practically nil. However, in recent years there has been a major increase in the number of cases. Recent seroprevalence reports estimate that about one-third of the world population is positive for anti-HEV IgG antibody; a statistic that arguably makes HEV the new leading cause of acute hepatitis in the world and a major universal public health burden.4-6,11