Hepatitis E

Hepatitis E


  • hepatitis E is caused by an infection with hepatitis E virus
  • it is transmitted via the faecal-oral route
  • hepatitis E does not develop into a chronic (life-long) infection, however, the infection is more severe among pregnant women in the third trimester
  • hepatitis E is found most commonly in developing countries, especially India, Asia, Africa and Central America.

About the hepatitis E virus

Hepatitis E is transmitted via the faecal-oral route and can be spread by eating or drinking contaminated food or water. The highest rates of hepatitis E infection occur in regions where there is poor sanitation and sewage management that promotes the transmission of the virus. For example, hepatitis E is common in Central and South-East Asia, North and West Africa and Mexico.

Hepatitis E is not a common cause of liver disease in Australia. Over the last 6 years, there have been approximately 10 to 30 cases of hepatitis E diagnosed and reported to the government each year. (NNDSS)

Hepatitis E causes an acute (short-term) illness but does not cause a chronic (life-long) infection.

Symptoms of hepatitis E

The time between infection with hepatitis E and development of symptoms ranges from 15 to 60 days, with an average of 40 days. (WHO 2005) Common symptoms of acute hepatitis E are similar to those of other types of viral hepatitis and include:

  • fever
  • weakness
  • fatigue
  • loss of appetite
  • nausea
  • vomiting
  • jaundice (yellowish eyes and skin, dark urine and pale-coloured faeces/poo/shit).

In general, people with hepatitis E recover with no long lasting illness. There is a very small chance (1–4%) of developing sudden and life threatening liver disease. Pregnant women who become infected with hepatitis E are at greater risk of severe illness and liver failure and 20% may die because of the infection. However, this occurs mainly in developing countries where hepatitis E is very common and where there is limited healthcare for pregnant women.

Transmission of hepatitis E

Hepatitis E is found in the faeces and spread via the faecal-oral route, similar to hepatitis A. Drinking or eating contaminated water or food could result in infection. Person-to-person transmission of hepatitis E is uncommon. There is no evidence that hepatitis E is spread sexually or through blood or blood product transfusion. (WHO 2005)

Testing for hepatitis E

Diagnosis of hepatitis E is performed by a blood test that detects either the antibodies or the virus itself. The blood tests needed to diagnose hepatitis E are not widely available.

Treatment for hepatitis E

There is no treatment for hepatitis E. Hepatitis E is caused by a virus, therefore, antibiotics are of no value in the treatment of the infection. Treatment of hepatitis E infection is supportive and involves bed rest and fluid replacement.

Prevention is the most effective approach against hepatitis E.


At present, no vaccine exists for the prevention of hepatitis E.

As hepatitis E is spread through the faecal-oral route, prevention of hepatitis E relies primarily on the provision of clean drinking water and good personal hygiene. Travellers to developing countries are advised to take precautions against drinking contaminated water (including beverages with ice), eating uncooked shellfish and uncooked fruits and vegetables that are not peeled or prepared by the traveller.

Travellers also need to be aware of personal hygiene including hand washing. Information about countries where hepatitis E is endemic is available from travel medicine centres.

Related Articles:

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D


National Notifiable Diseases Surveillance System (NNDSS). Available from: URL: http:www9.health.gov.au/cda/Source/CDAindex.cfm. Retrieved November 3, 2006.

World Health Organisation (WHO) (2005). Hepatitis E—fact sheet No 280.

Hepatitis D

Hepatitis D


  • hepatitis D is a liver disease caused by the hepatitis D virus, a defective virus that needs the hepatitis B virus to exist
  • it is found in blood
  • hepatitis D is not a common cause of liver disease in Australia
  • infection with hepatitis D can be prevented by the hepatitis B vaccine.

About the hepatitis D virus

Hepatitis D, also called delta virus, is a defective virus that requires the helper function of the hepatitis B virus to multiply and is therefore only found in people who are infected with hepatitis B. Hepatitis D is the least common but most severe form of viral hepatitis. (Rizzetto, M., et al; 1983)

Worldwide the pattern of hepatitis D infection is similar to the occurrence of hepatitis B infection and it has been estimated that 15 million people with hepatitis B (HBsAg+) are infected with hepatitis D (Farci, P.F. 2006).  Hepatitis D is not a common infection in Australia. Over the past 6 years there have been between 20 and 30 cases of hepatitis D diagnosed and reported each year. (NNDSS)

Hepatitis D infection can occur as a co-infection, which means it occurs at the same time as hepatitis B infection; or it can occur as a superinfection in people who already have chronic hepatitis B.

People who are co-infected with hepatitis B and hepatitis D may experience a more seriously acute illness and have a higher risk (2%–20%) of developing acute liver failure compared to people infected with hepatitis B alone. (CDC 2006)

However, most people who are co-infected will clear hepatitis D and never develop chronic hepatitis D infection.

People with chronic hepatitis B who are infected with hepatitis D (superinfection) usually develop chronic (long term) hepatitis D infection. Long-term studies of people with hepatitis D superinfection show that between 70% and 80% develop cirrhosis (liver scarring) compared to 15% to 30% of people with chronic hepatitis B alone. (CDC 2006)

Symptoms of hepatitis D

The symptoms of hepatitis D are similar to hepatitis B, such as:

  • loss of appetite
  • nausea and vomiting
  • tiredness
  • pain in the liver (upper, right side of abdomen)
  • muscle and joint pain
  • jaundice (yellowish eyes and skin, dark urine and pale-coloured faeces. (CDC 2006)

People who are infected with hepatitis D and hepatitis B have a higher risk of developing chronic liver disease and cirrhosis (scarring of the liver).

Transmission of hepatitis D

Hepatitis D is spread in similar ways to hepatitis B because the virus is found in blood. Therefore, whenever blood from an infected person enters the bloodstream of a person who is not immune there is the risk of transmission. For example, hepatitis D infection can occur through sharing injecting equipment, or through needlestick or sharps injuries. It is less common for hepatitis D to be spread through sexual contact, or mother to baby transmission compared to hepatitis B. (CDC; 2006)

Testing for hepatitis D

Co-infection and superinfection with hepatitis D can be diagnosed by a blood test which, if positive, will show antibodies against the hepatitis D virus.

Treatment for hepatitis D

There is no specific treatment for hepatitis D. Research indicates that the medication used to treat hepatitis B has a limited effect on the activity of hepatitis D virus. For example, Lamivudine has no effect on the hepatitis D virus or liver disease activity (Lau, D.T., et al; 1999), (Niro, G.A., et al; 2005). Clinical trials using Pegylated interferon demonstrate some benefit in people with hepatitis D (Niro, G.A., et al; 2006), (Erhardt, A., et al; 2006)

Vaccination for hepatitis D

Co-infection with hepatitis D can be prevented through hepatitis B vaccination. The hepatitis B vaccine involves multiple doses over a 6–12 month time frame depending on a person’s age. For example, adults require 3 doses of vaccine over 6 months, whereas adolescents need 2 doses over 4 to 6 months and infants need 4 doses over 12 months.

There is no medication or vaccine to prevent hepatitis D superinfection in people with chronic hepatitis B. Prevention of hepatitis D superinfection can only be achieved through education to reduce exposure to infectious blood.

Related Articles:

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis E


Rizzetto, M., Verme,G., Recchida, S. et al. (1983). Chronic hepatitis in carriers of hepatitis B surface antigen, with intrahepatic expression of the delta antigen. An active and progressive disease unresponsive to immunosuppressive treatment. Annals of Internal Medicine; 98:437–441.

Farci, P.F. (2006). Treatment of chronic hepatitis D: new advances, old challenges. Hepatology; 44(3): 536–39.

National Notifiable Diseases Surveillance System (NNDSS). Available from: URL: http:www9.health.gov.au/cda/Source/CDAindex.cfm. Retrieved November 3, 2006.

Centre for Disease Control (CDC) (2006) Viral hepatitis D fact sheet (last updated 15 September 2006).

Lau, D.T., Doo, E., Park, Y. et al. (1999). Lamivudine for chronic hepatitis delta. Hepatology;30:546–49.

Niro, G.A., Ciancio, A., Tillman, H.L. et al. (2005). Treatment of hepatitis D. Journal of Viral Hepatitis; 12:2–9.

Niro, G.A., Ciancio, A., Gaeta, G.B. et al. (2006). Pegylated interferon alpha-2b as monotherapy or in combination with ribavirin in chronic
hepatitis delta. Hepatology;44(3): pp.713–20.

Erhardt, A., Gerlich, W., Starke, C. et al. (2006). Treatment of chronic hepatitis delta with pegylated interferon-alpha2b. Liver Int;26(7):805–10.

Hepatitis A

Hepatitis A


  • Hepatitis A is a viral infection of the liver.
  • It is spread through the faecal-oral route or when infected faecal matter enters the mouth.
  • Symptoms can be debilitating but most people infected with hepatitis A recover completely.
  • Once you have had hepatitis A you cannot get it again.
  • Vaccination against hepatitis A is available.

About the virus

Hepatitis A is an acute (short-term but quite severe) infection of the liver caused by the hepatitis A virus. The hepatitis A virus can survive in the environment on hands for several hours and in food kept at room temperature for considerably longer and is relatively resistant to detergents.

Hepatitis A occurs worldwide. In developing countries most people are infected during childhood due to poor sanitation. With good sanitation and hygiene in the developed world, most people now reach adulthood without being exposed to hepatitis A virus.

In Australia, there are approximately 300–500 cases of hepatitis A reported per year. The number of cases reported has been declining nationally since the late 1990s (DoHA 2006). In 2011 there were 144 diagnosed cases of hepatitis A in Australia (Kirby Institute; 2012).

The real number of hepatitis A infections is likely to be more than the number of infections reported. This is because many people with hepatitis A do not have obvious symptoms, do not go to the doctor and so are not tested for hepatitis A.

Up to 40% of people with hepatitis A have no identifiable risk factors for infection.

In Australia infection with hepatitis A is more likely in particular locations and amongst specific groups of people, including:

  • child day-care centres and pre-schools;
  • men who have sex with men;
  • injecting drug users;
  • residential facilities for the intellectually disabled; and
  • travellers to countries where the infection is common (Asia, Africa, South-Pacific, Central and South America).

Infection resulting from contaminated food or water, or an infected food handler is rare in Australia.

Infants and young children infected with hepatitis A will rarely show symptoms of infection and may appear quite well, or have only mild symptoms. The majority of adults will show symptoms.

Symptoms of Hepatitis A

Symptoms of hepatitis A include:

  • fever;
  • weakness;
  • fatigue;
  • loss of appetite;
  • nausea;
  • joint aches and pains;
  • vomiting; and
  • jaundice (yellowish eyes and skin, dark urine and pale-coloured faeces).

The duration of the illness varies but most people feel better and their Liver Function Tests (LFTs) begin to normalise a month after the onset of infection. Hepatitis A infection never causes a chronic (long-term) infection.

Death because of hepatitis A infection is very rare. The likelihood of severe disease or death resulting from hepatitis A infection is much greater in people with pre-existing liver damage, including people with chronic liver disease due to hepatitis B or C, and people over 50 years of age.

Transmission of Hepatitis A

Hepatitis A is most commonly spread by the faecal-oral route. Faecal-oral transmission of the hepatitis A virus may occur when anything that has been contaminated with infected faeces is put in the mouth, for example:

  • Food, liquid or eating utensils can transmit the virus from an infected person.
  • Touching nappies, linen and towels soiled with the faeces of an infectious person.
  • Direct contact (including sexual) with an infectious person.

Testing for Hepatitis A

The incubation period (time between exposure to the virus and the development of symptoms) varies between 15 and 50 days, with an average of 30 days. Hepatitis A virus is excreted for up to two weeks before the onset of symptoms. Therefore, people with hepatitis A should be considered infectious for a week after the onset of jaundice.

Hepatitis A is diagnosed by a blood test. The detection of IgM hepatitis A antibodies (anti-HAV IgM) confirms recent infection. These antibodies are present for three to six months after infection. The detection of IgG hepatitis A antibodies (anti-HAV IgG) indicates past infection and immunity against hepatitis A infection.

Liver function test (LFTs) abnormalities, specifically elevated serum bilirubin and serum aminotransferase (ALT and AST) values, may also indicate acute liver infection.

There is no medical treatment available for hepatitis A. The symptoms of hepatitis A may be relieved by rest and adequate fluid intake. Medications should be limited to those considered essential and alcohol should be avoided.Treatment


To avoid the transmission of hepatitis A:

  • Always wash hands thoroughly after going to the toilet, before preparing and eating food, after handling soiled linen e.g. nappies.
  • Avoid sharing food, cutlery, crockery, cigarettes and drinks with other people.
  • When travelling in regions with poor sanitation, drink bottled water and avoid eating food that has been cleaned or prepared using contaminated water.
  • In a natural disaster, listen to warnings about contaminated drinking water and follow any instructions issued by the relevant authorities.
  • Consider being vaccinated (see below for more details).

A vaccine is available to protect against hepatitis A infection in people two years of age and older. There are currently five hepatitis A vaccines and two combined hepatitis A/hepatitis B vaccines registered for use in Australia. The vaccines are made from inactive hepatitis A virus. The body reacts with the inactive virus to produce antibodies that protect against infection. Clinical trials have shown that the hepatitis A vaccine is effective in preventing infection in about 95% of people.


Protection begins within 14-21 days after the first dose of the vaccine. A second dose of vaccine is required for long-term protection. The duration of immunity following vaccination is not certain, however, it appears to be at least 10 years, probably longer.

The Australian Immunisation Handbook (NHMRC 2008) recommends hepatitis A vaccinations for:

  • Travellers to endemic areas, which means developing countries;
  • All Aboriginal and Torres Strait Islander children between 18 months and six years of age in north Queensland;
  • Workers in rural and remote Indigenous communities;
  • Child day-care and pre-school personnel;
  • The intellectually disabled and their carers;
  • Healthcare workers employed in pediatric wards, intensive care units and emergency departments that provide for substantial populations of Aboriginal and Torres Strait Islander children and nursing and medical staff on rural and remote Indigenous communities;
  • Sewage workers;
  • Men who have sex with men;
  • Injecting drug users;
  • Patients with chronic liver disease of any aetiology; and
  • Patients with haemophilia who may receive pooled plasma concentrates.

People at risk of exposure to both hepatitis A and hepatitis B, particularly healthcare workers, people who inject drugs, men who have sex with men, travellers and long-term visitors to developing countries, should consider receiving the combined hepatitis A/hepatitis B vaccine.

It is recommended that people with hepatitis C are vaccinated against both hepatitis A and hepatitis B.

The most common adverse event following administration of the hepatitis A vaccine is mild local pain at the site of injection, but this should last only a short time.

Pregnant women should delay being immunised against hepatitis A until after the pregnancy, unless there is a substantial risk of them being exposed to the virus.

People who are in close household or sexual contact with someone with hepatitis A should received normal human immunoglobulin within two weeks of exposure.

Administration of the immunoglobulin will prevent infection for approximately six weeks.

Hepatitis A vaccine can be given at the same time as the immunoglobulin.

Related Articles:

Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E


Department of Health and Ageing (DoHA) (2006). "Number of Notifications of Hepatitis A". Retrieved October 25, 2006, from National Notifiable Diseases Surveillance System.

The Kirby Institute (2012). HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2012. Available from:http://www.kirby.unsw.edu.au/surveillance/2012-annual-surveillance-report-hiv-viral-hepatitis-stis. Retrieved 17 October 2012.

National Health & Medical Research Council (NHMRC), (2008). The Australian Immunisation Handbook 2008. 9th Edition. Available from:http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home. Retrieved 25 October 2012.