Hepatitis E outbreaks have recently been reported in Iraq, the Sudan, and Chad. Hepatitis E is extremely uncommon in the United States, but endemic in other parts of the world, and thrives in conditions of social and political disruption and violence.
Hepatitis E resembles hepatitis A in transmission and disease course – people get infected through “fecal-oral” routes (contaminated food or water, as occurs with poor sanitation). There is little or no evidence for person-to-person (e.g., sexual) transmission. In the U.S., virtually all hepatitis E cases are seen in people who recently traveled to endemic (high-prevalence) areas, such as Mexico, Africa, and Asia, though a small number of cases may originate in the United States and other industrialized countries (see Clemente-Casares et al., Hepatitis E Virus Epidemiology in Industrialized Countries, Emerging Infectious Diseases vol. 9, no. 4, April 2003).
Questions about hepatitis E and other forms of viral hepatitis often come up in hepatitis C education sessions. Some people have heard (incorrectly) that the letters assigned to each virus (A, B, C, etc.) indicate severity – that if hepatitis A is bad, then hepatitis B and C are even worse, and hepatitis E must be instantly fatal. The reality is that the letters don’t correspond to any grade for how dangerous each virus is, and were assigned (roughly) in order of discovery.