As a consequence, HEV infections have become the main cause of symptomatic, enterically transmitted hepatitis. In many areas of the developing world, HEV has been estimated to account for the majority of cases of acute viral hepatitis in young and middle-aged adults. In a report on international travelers returning to the United States, six people were documented to have acute HEV infections. 10,11 Hepatitis E antibodies among nontravelers in industrialized countries have been reported. 12,13 HEV is an RNA virus, transmitted by the enteric route with an incubation period of 2 to 9 weeks.
Drinking water contaminated with sewage is the most common route of transmission.
Transmission from mother to infant has been reported. Although the clinical presentation is variable, acute hepatitis is common and no chronic carrier state has been described. 18 Serum samples from patients thought to have hepatitis E can now be tested by the research techniques described. Supportive care remains standard therapy for hepatitis E. Patients with nausea and vomiting may require hospitalization and intravenous hydration. Close monitoring for synthetic impairment, coagulopathy, and encephalopathy should be done in severe cases of HEV infection.