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BBB - Hepatitis E Virus

Bad Bug Book:
Foodborne Pathogenic Microorganisms and Natural Toxins Handbook
Hepatitis E Virus

A new version of the Bad Bug Book was released in 2012, below is a previous version.


1. Name of the Organism: Hepatitis E Virus

Hepatitis E Virus (HEV) has a particle diameter of 32-34 nm, a buoyant density of 1.29 g/ml in KTar/Gly gradient, and is very labile. Serologically related smaller (27-30 nm) particles are often found in feces of patients with Hepatitis E and are presumed to represent degraded viral particles. HEV has a single-stranded polyadenylated RNA genome of approximately 8 kb. Based on its physicochemical properties it is presumed to be a calici-like virus.

2. Nature of Acute Disease:

The disease caused by HEV is called hepatitis E, or enterically transmitted non-A non-B hepatitis (ET-NANBH). Other names include fecal-oral non-A non-B hepatitis,and A-like non-A non-B hepatitis.

Note: This disease should not be confused with hepatitis C, also called parenterally transmitted non-A non-B hepatitis (PT-NANBH), or B-like non-A non-B hepatitis, which is a common cause of hepatitis in the U.S.

3. Nature of Disease:

Hepatitis caused by HEV is clinically indistinguishable from hepatitis A disease. Symptoms include malaise, anorexia, abdominal pain, arthralgia, and fever. The infective dose is not known.

4. Diagnosis of Human Illness:

Diagnosis of HEV is based on the epidemiological characteristics of the outbreak and by exclusion of hepatitis A and B viruses by serological tests. Confirmation requires identification of the 27-34 nm virus-like particles by immune electron microscopy in feces of acutely ill patients.

5. Associated Foods:

HEV is transmitted by the fecal-oral route. Waterborne and person-to-person spread have been documented. The potential exists for foodborne transmission.

6. Relative Frequency of Disease:

Hepatitis E occurs in both epidemic and sporadic-endemic forms, usually associated with contaminated drinking water. Major waterborne epidemics have occurred in Asia and North and East Africa. To date no U.S. outbreaks have been reported.

7. Course of Disease and Complications:

The incubation period for hepatitis E varies from 2 to 9 weeks. The disease usually is mild and resolves in 2 weeks, leaving no sequelae. The fatality rate is 0.1-1% except in pregnant women. This group is reported to have a fatality rate approaching 20%.

8. Target Populations:

The disease is most often seen in young to middle aged adults (15-40 years old). Pregnant women appear to be exceptionally susceptible to severe disease, and excessive mortality has been reported in this group.

9. Food Analysis:

HEV has not been isolated from foods. No method is currently available for routine analysis of foods.

10. Selected Outbreaks:

CDC/MMWR: Hepatitis E Virus
Provides a list of Morbidity and Mortality Weekly Reports at CDC relating to this organism or toxin. The date shown is the date the item was posted on the Web, not the date of the MMWR. The summary statement shown are the initial words of the overall document. The specific article of interest may be just one article or item within the overall report.
NIH/PubMed: Hepatitis E Virus
Provides a list of research abstracts contained in the National Library of Medicine's MEDLINE database for this organism or toxin.
Agricola: Hepatitis E Virus
Provides a list of research abstracts contained in the National Agricultural Library database for this organism or toxin.

For more information on recent outbreaks see the Morbidity and Mortality Weekly Reports from CDC.

11. Education and Background Resources:

Literature references can be found at the links below.

  • Loci index for genome Hepatitis E

    Available from the GenBank Taxonomy database, which contains the names of all organisms that are represented in the genetic databases with at least one nucleotide or protein sequence.