Hepatitis E

The virus usually spreads by the fecal-oral route: swallowing water or food contaminated with stool containing the virus. Eating undercooked or raw pork, game or shellfish can also pass it on in some regions. Person-to-person spread is uncommon. It can pass from a pregnant mother to her baby. It is not spread by casual contact such as shaking hands.

Hepatitis E occurs worldwide. It is more common in places where clean water and sanitation are limited. In other regions, occasional cases are linked to certain undercooked meats. Many infections cause no symptoms and are never diagnosed.

Travel to areas with limited safe water carries a higher risk. Pilgrims and travelers should drink bottled or properly treated water, eat freshly cooked food and wash hands carefully. Pork is not consumed by Muslims, but contaminated water or raw shellfish can still be a source.

Blood tests show liver inflammation (raised liver enzymes) and can detect antibodies to the virus or the virus itself (HEV RNA). Because several viruses and other causes can look the same, the doctor usually also tests for hepatitis A, B and C and reviews medicines and alcohol use. In people with weakened immunity, a test for the virus itself is important, because antibody tests can be unreliable.

Rest and prevention of spread are the main steps for most people.

• Rest and return to activity gradually as energy returns

• Wash hands with soap and water after the toilet and before preparing food

• Avoid alcohol until your doctor says your liver has recovered

• Do not prepare food for others while you have symptoms

There is no special diet; the goal is to eat and drink enough and to eat safely.

• Eat small, frequent meals if you feel nauseated

• Drink plenty of fluids to avoid dehydration

• Cook meat, especially pork and game, and shellfish thoroughly

• Use safe, clean drinking water and wash fruit and vegetables with safe water

There is usually no specific medicine for acute hepatitis E. Your doctor decides about any treatment.

• Check with your doctor or pharmacist before using any medicine, including herbal products, because the liver is inflamed

• Be careful with paracetamol (acetaminophen) and follow medical advice on safe use

• In chronic infection in people with weak immunity, doctors may reduce immune-suppressing drugs or use an antiviral medicine

Procedures are not needed for most people.

• Hospital care with monitoring for those who are very unwell or pregnant

• Liver transplant assessment in the rare case of acute liver failure

Most people recover fully within a few weeks to a couple of months and become immune afterwards. Severe illness is uncommon but is more likely in pregnancy and in people with existing liver disease. Chronic infection in people with weak immunity can usually be treated and is followed by a specialist.

• How do you know this is hepatitis E and not another cause?

• When will my liver tests return to normal?

• When can I return to work, school and exercise?

• Do my family members need to do anything?

• I am pregnant or on immune-suppressing drugs; what should I do?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.