Hepatitis E virus (HEV)

Hepatitis E virus (HEV)

Infection: Hepatitis E virus (HEV) infection

Brief description:
  • Virus that causes an acute hepatitis that self resolves
  • Majority of infections are asymptomatic.
  • Previously thought to only be acquired overseas, however 8-10% of NZ blood donors have serological evidence of infection.
  • Can cause chronic infection in people with significant immunosuppression (e.g. liver transplantation)
Did you know?
  • Hepatitis E is transmitted by the faecal-oral route.
  • Genotypes 1 and 2 cause infection in humans only and are endemic in Asia and Africa
  • Genotypes 3 and 4 are zoonotic and are present in Europe, USA and Asia. Infection is usually transmitted by consumption of undercooked meat such as pork. 90% of NZ pigs show serological evidence of infection.
Who should I test?

Testing generally reserved for patients with acute hepatitis (ALT > 500) with history of travel to endemic regions or with no alternative diagnosis.

  • Mimics to consider in patients with hepatitis: hepatitis A, B and C, HIV, syphilis
  • In an outbreak setting a lower threshold for testing is usually warranted
Test of choice:

Request Hep E serology

Hepatitis E virus serology – IgM and IgG

  • Anti-HEV IgM is usually detectable 2-3 weeks after exposure and is usually negative after 3-6 months. Therefore detection is consistent with acute infection.
  • Anti-HEV IgG is detectable early in the illness and is long lasting. Detection is usually consistent with prior infection.
Tests to avoid/specialist tests:

Hepatitis E virus PCR

  • Used to diagnose chronic HEV infection in immunosuppressed patients