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Hepatitis E is more dangerous than you thought, and people in developed countries may be at risk, too. What else didn't you know about this kind of viral hepatitis?

Hepatitis E is a virus that can cause liver infection and damage. It's usually self-limiting and acute, posing much less of a health risk than, say, hepatitis B and C. This virus is more prevalent in areas with poor sanitation and unsafe drinking water, because exposure to even minute particles of infected feces is the most common way to become infected — but eating things like raw or undercooked meats can also do the trick. Drinking bottled water in areas where the disease is common, and making sure your food is cooked properly, are some good ways to try to prevent it. 

So, that about sums up the very basics — things you may already know about hepatitis E, and that are also covered in our overview of hepatitis E. What might you not know about the disease? Let's take a look. 

1. Hepatitis E can be fatal

Read up about hepatitis E, and you'll usually gain the impression that hepatitis E isn't all that serious. The CDC, for instance, says that hepatitis E "usually results in a self-limited, acute illness", which means a short-term nuisance that typically goes away without treatment. While this is true in the majority of cases, hepatitis E can also be incredibly dangerous. 

That is because a portion of infected people develop fulminant hepatitis, or rapid liver failure. This can be caused by a wide variety of different things, including Tylenol overdoses, other kinds of viral hepatitis, eating poisonous mushrooms, and autoimmune hepatitis. People with hepatitis E are more likely than those infected with hepatitis A to end up with fulminant hepatitis — at a rate of between one and four percent.

The World Health Organization reports that approximately 44,000 people succumbed to hepatitis E in 2015 alone. This is, despite it being a very small portion of total cases (which number about 20 million a year), still significant. 

2. You can contract hepatitis E regardless of where you live

Hepatitis E is often seen as a disease of poor sanitation for good reason. Countries that fall into the low- or middle-income categories are more likely to have a problem with highly endemic hepatitis E, for obvious reasons considering how the disease is spread. Natural disasters, such as flooding, hurricanes, and earthquakes can make the situation even worse, considering that these factors can mess up sanitation structures that were previously in place. Highly crowded areas in which sanitation is a problem — like refugee camps — also make hepatitis E much more likely. 

Not all cases of hepatitis E result from poor sanitation, however.

3. People in developed countries are more likely to get hepatitis E from food

While countries including China, India, Kazakhstan, Mexico, Saudi Arabia, much of North Africa and a few countries in sub-Saharan Africa are considered "highly endemic", you may be surprised to learn that European Union countries, the United Kingdom, Russia, South Africa, South Korea, and the United States are also classified as "endemic". 

In these cases, where sanitation is good and drinking water is safe, people are most likely to get hepatitis E from the foods they eat. Pigs, deer, chickens, rabbits, rodents, ferrets, wild boar, bats, sheep, and even fish (trout) are all known to be able to fall victim to some kinds of hepatitis E. This is why consuming only properly-cooked meat is so very important. To hammer this in some more, one study found that almost half of all Scottish pigs tested positive for hepatitis E. 

4. Hepatitis E comes in multiple kinds

Not all hepatitis E is the same — rather significant genetic differences exists among this viral "population, and four different genotypes that can infect humans have been identified thus far. If you see someone referring to "HEV1", "HEV2", and so on, that's what they'll be talking about. The first two only infect humans, while hepatitis E 3 infects pigs, rabbits, deer, and some other animals too, and the fourth type infects both humans and pigs. Then, there are some more kinds that only infect other animals and don't pose a risk to humans. 

This means, in short, that you'll get hepatitis E 1 or 2 from poor sanitation, and hepatitis E 3 or 4 from eating unsafe food. 

5. Some other ways to end up with hepatitis E

Did you know that blood transfusions are quite a "popular" way to acquire hepatitis E in developed nations? One study conducted in South-East England, for instance, screen a total of 225,000 blood donors whose blood was already used in transfusions. They found that 79 were were infected with the third genotype of Hepatitis E. The fact that donor blood is screened for other kinds of viral hepatitis doesn't mean that hepatitis E is looked at, too. 

Another way to get hepatitis E is to be born to a mother who has it, and this "vertical" route of transmission is on the increase. Having hepatitis E during pregnancy can pose a risk to the fetus too, with some data suggesting that over 3,000 stillbirths are caused by the virus in developing countries! What's more, expectant mothers with hepatitis E have a higher risk of acute liver failure, too.

6. There is a vaccine for hepatitis E — but you probably can't have it

A vaccine against hepatitis E was developed in China. Called Hecolin, it protects against the four serotypes known to infect humans. If you don't live in China, you're probably out of luck, however. In order to minimize your risk, your best bet is to eat properly cooked meats, and use bottled water if your local drinking water is not safe. 

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