Hepatitis A and E: Safe Water and Food

Two liver infections spread the same way in much of the world: through water and food. Both can be prevented.

What are hepatitis A and hepatitis E?

Both are liver infections caused by viruses. They are not the same as hepatitis B and C, which spread through blood and body fluids. Hepatitis A and hepatitis E spread mainly by what doctors call the faecal-oral route: someone swallows food or water contaminated with small amounts of faeces from an infected person. The World Health Organization (WHO) lists hepatitis A among the diseases carried by unsafe drinking water, along with cholera, diarrhoea, dysentery, typhoid and polio.

Hepatitis E spreads mainly through contaminated water, and some types also spread through raw or undercooked meat. WHO estimates about 20 million hepatitis E infections happen worldwide each year, about 3.3 million of them causing symptoms. Large outbreaks usually start when a water supply is contaminated, and nearly half of reported outbreaks happen in camp settings.

How soon do symptoms appear?

Hepatitis A symptoms usually start 14 to 28 days after infection, and the illness clears on its own within 3 to 6 months. Hepatitis E takes longer to appear, from 2 to 10 weeks, and usually lasts 1 to 6 weeks.

Hepatitis A can cause fever, feeling generally unwell, loss of appetite, diarrhoea, nausea, stomach discomfort, dark urine and jaundice, which is yellowing of the skin and whites of the eyes. Hepatitis E often begins with mild fever, poor appetite, nausea and vomiting for a few days, then can bring stomach pain, itching, a rash, joint pain, jaundice, dark urine and pale stools.

Children under 6 often catch hepatitis A without looking sick, and only about 1 in 10 develop jaundice. Adults get symptoms far more often, and the illness tends to be more severe in older people. A person with hepatitis A can still pass the virus on for about 7 days after symptoms or jaundice begin.

Who is at highest risk?

• Pregnant women. WHO reports that up to 20–25% of pregnant women who catch hepatitis E in the third trimester can die from it. It can also cause loss of the baby and liver failure.
• People without safe drinking water or proper sewage disposal.
• People living with, or sexual partners of, someone infected.
• Anyone who has never had hepatitis A and has not been vaccinated.
• Older adults, who tend to get more severe hepatitis A.

How do you avoid them?

• Drink water you know is safe. If unsure, use bottled or properly treated water, and skip ice made from untreated water.
• Keep stored water covered. WHO notes that covering storage containers reduces contamination with faeces.
• Wash hands with soap after the toilet, after changing a baby, and before preparing or eating food.
• Avoid shellfish and uncooked fruit and vegetables when you cannot be sure the water used to grow or wash them was clean. Peel fruit yourself.
• Cook meat thoroughly, since some types of hepatitis E spread through undercooked meat.
• Make sure toilets and sewage are managed so waste cannot reach drinking water.
• Ask a doctor about the hepatitis A vaccine. Injectable vaccines exist, though none is licensed for babies under 1 year.

How are they treated?

There is no medicine that kills either virus. Care is supportive: rest, enough fluids to avoid dehydration, and enough food. WHO advises avoiding medicines that are hard on the liver, so do not take anything, including painkillers, without asking a doctor or pharmacist first. Hospital care is needed for severe illness or liver failure, and a pregnant woman with hepatitis E symptoms should be treated in hospital.

When to see a doctor

See a doctor if you or your child has jaundice, dark urine, pale stools, or a fever with nausea and stomach pain that is not settling. Get advice urgently if you are pregnant, over 60, or have a liver condition.

Go to hospital without waiting if someone with jaundice is vomiting repeatedly and cannot keep fluids down, becomes very drowsy or hard to wake, or is clearly getting worse. In an emergency, call Rescue 1122 where available, or go to the nearest hospital emergency department.