Hepatitis E: the forgotten virus

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.