Hepatitis E is an important disease in many developing countries of Asia and Africa with large explosive outbreaks and is also endemic with sporadic or cluster cases of hepatitis in many industrialized countries. The causative agent, hepatitis E virus (HEV), is currently classified in the family Hepeviridae. Thus far, four putative genera of HEV representing mammalian, avian, and fish species have been identified and characterized worldwide. Within the mammalian HEV that infects humans, genotypes 1 and 2 are associated with epidemics and restricted to humans, whereas genotypes 3 and 4 are zoonotic and associated with sporadic and cluster cases of hepatitis E. As a fecal-orally transmitted disease, waterborne transmission is still an important route of HEV transmission especially for large outbreaks associated with genotypes 1 and 2. However, genetic identification of numerous animal strains of HEV and the demonstrated ability of cross-species infection by these animal strains have significantly broadened the host range and diversity of HEV and raised public health concerns for zoonosis and food safety associated with genotypes 3 and 4 HEV infection. Pigs and likely other animal species serve as reservoirs for HEV. Direct contact with infected pigs and other animals and consumption of contaminated animal meat and meat products pose risks for HEV infection. In this article, the current understanding of the zoonotic and foodborne transmissions of HEV as well as strategies to prevent zoonosis and ensure food safety is discussed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
