Article Text

Hepatitis E: the forgotten virus
  1. Dennis A Freshwater
  1. Correspondence to Surg Cdr D A Freshwater, The Liver & Hepatobiliary Unit, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, West Midlands B15 2WB, UK; dennis.freshwater{at}


Hepatitis E virus (HEV) has a long military association being first discovered during the Soviet occupation of Afghanistan in the 1980s after an outbreak of unexplained hepatitis at a military camp. HEV is now endemic in the UK, and should be considered in all cases of jaundice. The prevalence is high in certain operational areas (28.5% in Afghanistan), and maintenance of integrity of food and water supplies together with scrupulous attention to environmental hygiene remains paramount. Pregnancy confers a much higher risk of fulminant hepatitis, with a mortality rate of up to 25%. Management is usually symptomatic, but ribavirin can be considered in non-pregnant patients with fulminant hepatitis. This narrative review examines the presentations and management of Hepatitis E in military populations.

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