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Epidemic Control Toolkit
for community volunteers
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Hepatitis E

Last update: 2023-07-05

Key facts

Transmission: Faecal-oral route (** food and blood-borne transmission can occur, but is rare **)

  • Food or water contaminated with human waste
  • Eating raw or undercooked meat or meat products (rarely causes epidemics)
  • Other transmission modes exist but these rarely cause epidemics (for example during blood transfusion or vertical mother-child transmission)

Most vulnerable to severe consequences

  • Pregnant women, especially those later in pregnancy 
  • Adults often develop more severe symptoms than children 

Most vulnerable to contracting the disease

  • People, such as displaced populations, living in situations where there are poor water, sanitation and hygiene facilities and services


  • Mild fever 
  • Loss of appetite
  • Nausea and vomiting 
  • Abdominal pain
  • Itching and skin rash
  • Joint pain
  • Dark urine
  • Pale stools
  • Yellow skin or eyes (jaundice)

** Many people (especially children) show no symptoms, even though they are infected and can spread the disease **

What can you do to prevent and control an epidemic?

Monitoring the community and identifying sick people  

  • Identify possible source or point of contamination if applicable
  • Identify community members with community case definition for suspected hepatitis

Treatment and management

  • Refer symptomatic cases to health facilities according to pre-established protocol
  • Provide psychosocial support to the sick person and their family members

Sanitation and waste management

  • Promote use of appropriate sanitation and waste facilities (toilets/latrines) 
    • No open defecation

Hand hygiene

  • Promote good hand hygiene (handwashing with soap) 
    • BEFORE: preparing food; eating; feeding a child; treating wounds; or caring for sick people
    • AFTER: using the toilet or cleaning a baby; touching garbage or waste; touching or feeding animals; blowing nose, coughing or sneezing; treating wounds; or caring for sick people 

Food and water hygiene and safety

  • Encourage household water treatment for safe drinking water
    • Store water in clean, covered water container
  • Promote thorough cleaning, cooking and storage of food
    • Cover and store food safely (protected from insect/animal contamination)
    • Use clean utensils and storage containers
  • Encourage exclusive breastfeeding for the first six months of life, and complementary breastfeeding until the age of two years (especially when a child is sick) 

Social mobilization and health promotion

  • Find out the specific advice being given by health and other relevant authorities 
  • Model following this advice and inform community members of current health practice advice 
  • Offer support and encouragement to follow the advice  
    • Try to gain understanding about if and why health practice advice is not being followed  
    • With the guidance of your supervisor and health authorities, work with communities to overcome barriers to following health advice and recommended practices

Mapping and community assessment

  • Make a map of the community.
  • Mark the following information on the map:
    • How many people have fallen sick with hepatitis E? Where?
    • How many people have died? Where? When?
    • Who and where are the vulnerable people?
    • Where are the local health facilities and services? (include traditional healers)
    • Where do people obtain their drinking water?
  • Record the following information on the back of the map:
    • When did people start to fall sick with Hepatitis E? 
    • How many people live in the affected community? How many are children under five years?
    • Is breastfeeding common?
    • Is the water source safe? 
    • Do people treat their drinking water? 
      • How do they do it?
    • What sanitation facilities are available? (put communal toilets/latrines on map) 
      • Do people use them? 
    • What handwashing facilities are available? (put communal handwashing stations on map) 
      • Do they have soap?
    • What are the community’s habits, practices and beliefs about caring for and feeding sick people? Consider any differences in roles and responsibilities between men and women.
      • When babies and infants are sick, do women continue to breastfeed them?
    • Is a social mobilization or health promotion programme in place?
    • What are the roles, responsibilities, specific needs and priorities of women and girls, men and boys, and people with disabilities in handling, storing and treating water? Make sure you think about cultural and social traditions and perceptions, household decision-making, livelihoods such as agriculture and livestock raising, etc.
    • What are the barriers people face in accessing water points and sanitation and hygiene facilities, of all gender identities, ages, disabilities and backgrounds? 
    • Which sources do people use/trust the most for information?
      • Are there rumours or misinformation about Hepatitis E? What are the rumours?