Hepatitis E Infection A003

Current RMA Instruments:

Changes from Previous Instruments:

ICD coding:

ICD-10-AM:    B17.2

Brief description:

Hepatitis E (HEV) is a viral infection involving the liver. It is usually contracted through the faecal-oral route, commonly through contaminated drinking water or food involving raw or undercooked meat of HEV-infected animals. It can also be contracted via fomites, inanimate objects capable of carrying and transmitting infection between individuals. 

Hepatitis E infection occurs worldwide but is endemic in part of the developing world, particularly Asia and Africa.  

Confirming the diagnosis:

To confirm the diagnosis there needs to be both:

• evidence of clinical symptoms and signs (fever, nausea and vomiting, jaundice, malaise, loss of appetite, abdominal pain, hepatomegaly and jaundice)

AND

• blood serological or nucleic acid markers positive for the hepatitis E virus with a pattern indicative of a recent infection

Either symptoms/signs alone or serological evidence alone is insufficient for diagnosis, both components must be present.

It is common that the date of laboratory confirmation of hepatitis E will be after the date of clinical onset. The serology during an active infection should have positive IgM antibodies. A negative IgM in combination with a positive IgG indicates a past infection. Asymptomatic past infection is common.

The relevant medical specialist is a gastroenterologist or an infectious diseases physician.

Additional diagnoses covered by these SOPs

• Nil

Conditions not covered by these SOPs   

• Hepatitis A*, B*, C*, D*
• Viral hepatitis not due to hepatitis E –
  • Acute infecious mononucleosis*
  • Cytomegalovirus^#
  • Herpes simplex*
  • Coxsackievirus^#
• Toxoplasmosis^#
• Steatohepatitis^#

• Non-infectious hepatitis (e.g. autoimmune, alcoholic, drug induced liver injury etc) ^#

  * another SOP applies  - the SOP has the same name unless otherwise specified

  ^# non-SOP condition

Clinical onset

To confirm hepatitis E infection, there needs to be both laboratory confirmation of recent or current infection as well as medical evidence of a clinical illness involving symptoms and signs consistent with Hepatitis E infection- e.g. malaise, vomiting, loss of appetite, abdominal pain, fever, hepatomegaly and jaundice. The clinical date of onset will be when the symptoms of that illness started. The clinical onset is not the date of the positive serology.

Clinical worsening

Acute hepatitis E infection is typically a self-limiting acute illness, resolving in days to weeks with very low mortality rates and minimal expected ongoing impairment(s). Supportive care is the mainstay of treatment. However, clinical worsening may be indicated by the development of chronic Hepatitis E infection (an infection lasting beyond 6 months) from the initial case of acute hepatitis E infection. Chronic hepatitis E is very uncommon.