Hepatitis E and the traveller.

The risk of infection with hepatitis E virus to international travellers to endemic regions such as the subcontinent of India, Nepal, South-East Asia, China, parts of the Middle East, Africa, Mexico and some countries of South America is underestimated. Hepatitis E virus is transmitted enterically usually by drinking water contaminated by sewage and also by raw or uncooked shellfish. Outbreaks occur in number of hot climate countries where the infection is endemic, and a zoonotic element may be significant both in endemic areas and in developed countries where sporadic cases also occur. The clinical course of the infection can be severe with high mortality of up to 20% during the third trimester of pregnancy. Advice to travellers must include strict precautions with regard to drinking water and the consumption of raw food. Specific prophylaxis and treatment against hepatitis E infection are not available at present. Specific immunoglobulin and several recombinant and subunit vaccines are under development. One baculovirus, expressed viral protein vaccine is under phase II/III trial in Nepal.