Atlas of foodborne infections
transmitted by contaminated food and water

Atlas of Patogens Contents Information sources Glossary Administration

Hepatitis E Virus (HEV)

CZ: hepatitida E
EN: hepatitis E

Water and Beverages


Foodborne Disease:
Untitled document

Food-borne viruses are generally enteric, being transmitted by the fecal-oral route. However, transmission by person-to-person contact and via contaminated water is common, as with other enteric viruses (malaise, anorexia, abdominal pain, arthralgia, and fever).

Hepatitis A and NLV are more commonly transmitted via foods than other food-borne viruses. The most important food-borne viruses are: hepatitis A, NLV, astrovirus and rotavirus.


Untitled document

It is only in recent years that the role of viruses as etiological agents of food-borne illness have emerged. A recent Centers for Disease Control (CDC) report from the USA in 2000, on surveillance of food-borne disease outbreaks from 1993 to 1997, revealed that viruses accounted for 6% of all food-borne outbreaks and 8% of cases. Hepatitis A accounted for the majority of these, followed by Norwalk-like virus (NLV).

In addition, hepatitis A is the only notifiable food-borne viral disease in many countries, so it is highly likely that the incidence of food-borne illness attributed to viruses is grossly underestimated. These failures in attributing viral illness to food have mainly been due to the diagnostic difficulties in detecting viruses in an implicated food and underreporting owing to the mild nature of illness.

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

Note: This disease should not be confused with hepatitis C. Hepatitis caused by HEV is clinically indistinguishable from hepatitis A disease.

Symptoms include malaise, anorexia, abdominal pain, arthralgia, and fever. 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 faeces of acutely ill patients.

HEV is transmitted by the faecal-oral route. Waterborne and person-to-person spread have been documented. The potential exists for food-borne transmission, but HEV has not been isolated from foods. 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. 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%. The disease is most often seen in young to middle aged adults (15-40 years old).


Hepatitis A virus
Source: Hepatitis E virus
Hepatitis E
Source: Virus of hepatitis E - structure

<<< Back