Hepatitis D and E

Cause: Hepatitis D virus and hepatitis E virus. Hepatitis D virus infection always occurs with hepatitis B infection, either with a chronic hepatitis B infection (superinfection) or as two simultaneous new infections (coinfection).

Illness and treatment: Hepatitis D and E typically have abrupt onset of fever, nausea, and abdominal pain followed by jaundice. Hepatitis D may progress to chronic hepatitis.

Sources: Humans are the reservoir for hepatitis D, which is usually transmitted by contact with blood or body fluids, particularly sharing drug paraphernalia. Humans and animals (swine) are the reservoir for hepatitis E which is transmitted most commonly through fecally contaminated food, water, and environment.

Additional risks: Pregnant women have higher risk for hepatitis E complications. Japan has reported more virulent hepatitis E strains.

Prevention: To avoid simultaneous hepatitis B infection, immunize all children and any adults with risks for exposure. Use safe sexual practices, avoid sharing drug paraphernalia, and screen blood and tissue products to prevent hepatitis D transmission. Use precautions while traveling to ensure safe food and water to avoid hepatitis E infection.

Recent Washington trends: Reports are rare. Cases of hepatitis D are typically associated with injection drug use. Cases of hepatitis E are typically travel associated.

Purpose of Reporting and Surveillance

  • To better characterize the epidemiology of infectious hepatitis not due to hepatitis A, B, or C viruses
  • To recommend appropriate preventive measures, including immunization against other types of hepatitis which are vaccine-preventable

Legal Reporting Requirements

Hepatitis D (acute and chronic)

  • Health care providers: notifiable to local health jurisdiction within 3 business days
  • Health care facilities: notifiable to local health jurisdiction within 3 business days
  • Laboratories: Hepatitis D virus (detection of viral antigen, antibody or nucleic acid) notifiable within 2 business days
  • Local health jurisdictions: notifiable to the Washington State Department of Health (DOH) Communicable Disease Epidemiology (CDE) within 7 days of case investigation completion or summary information required within 21 days.

Hepatitis E (acute)

  • Health care providers: notifiable to local health jurisdiction within 24 hours
  • Health care facilities: notifiable to local health jurisdiction within 24 hours
  • Laboratories: Hepatitis E virus (detection of viral antigen, antibody or nucleic acid) notifiable within 24 hours
  • Local health jurisdictions: notifiable to the Washington State Department of Health (DOH) Communicable Disease Epidemiology (CDE) within 7 days of case investigation completion or summary information required within 21 days.