Hepatitis E: an emerging infection in developed countries

Lancet Infect Dis. 2008 Nov;8(11):698-709. doi: 10.1016/S1473-3099(08)70255-X.


Hepatitis E is endemic in many developing countries where it causes substantial morbidity. In industrialised countries, it is considered rare, and largely confined to travellers returning from endemic areas. However, there is now a growing body of evidence that challenges this notion. Autochthonous hepatitis E in developed countries is far more common than previously recognised, and might be more common than hepatitis A. Hepatitis E has a predilection for older men in whom it causes substantial morbidity and mortality. The disease has a poor prognosis in the context of pre-existing chronic liver disease, and is frequently misdiagnosed as drug-induced liver injury. The source and route of infection remain uncertain, but it might be a porcine zoonosis. Patients with unexplained hepatitis should be tested for hepatitis E, whatever their age or travel history.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Communicable Diseases, Emerging / diagnosis
  • Communicable Diseases, Emerging / epidemiology*
  • Communicable Diseases, Emerging / therapy
  • Developed Countries*
  • Hepatitis E / diagnosis
  • Hepatitis E / epidemiology*
  • Hepatitis E / therapy
  • Hepatitis E virus / classification
  • Humans
  • Incidence
  • Seroepidemiologic Studies
  • Zoonoses / transmission