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Nat Rev Dis Primers. 2017 Nov 16;3:17086. doi: 10.1038/nrdp.2017.86.

Hepatitis E virus infection.

Author information

Departments of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR-BMT, Université Paul Sabatier, TSA 50032, 31059 Toulouse Cedex 9, Toulouse, France.
Department of Virology, CHU Purpan, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse, France.
Anses, Animal Health Laboratory, Unités Mixtes de Recherche (UMR) 1161 Virology, Institut National de la Recherche Agronomique (INRA), École Nationale Vétérinaire d'Alfort (ENVA), Maisons-Alfort, France.
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Medizinische Hochschule Hannover, Hannover, Germany.
Royal Cornwall Hospital and European Centre for Environment and Human Health, University of Exeter, Truro, UK.


Hepatitis E virus (HEV) infection can lead to acute and chronic hepatitis as well as to extrahepatic manifestations such as neurological and renal disease; it is the most common cause of acute viral hepatitis worldwide. Four genotypes are responsible for most infection in humans, of which HEV genotypes 1 and 2 are obligate human pathogens and HEV genotypes 3 and 4 are mostly zoonotic. Until quite recently, HEV was considered to be mainly responsible for epidemics of acute hepatitis in developing regions owing to contamination of drinking water supplies with human faeces. However, HEV is increasingly being recognized as endemic in some developed regions. In this setting, infections occur through zoonotic transmission or contaminated blood products and can cause chronic hepatitis in immunocompromised individuals. HEV infections can be diagnosed by measuring anti-HEV antibodies, HEV RNA or viral capsid antigen in blood or stool. Although an effective HEV vaccine exists, it is only licensed for use in China. Acute hepatitis E is usually self-limiting and does not require specific treatment. Management of immunocompromised individuals involves lowering the dose of immunosuppressive drugs and/or treatment with the antiviral agent ribavirin.

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