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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2026; 18(2): 112467
Published online Feb 27, 2026. doi: 10.4254/wjh.v18.i2.112467
Published online Feb 27, 2026. doi: 10.4254/wjh.v18.i2.112467
Environmental considerations in hepatitis E virus transmission: Is there a missing link?
Ross Campbell, Department of Acute Medicine, Raigmore Hospital, Inverness IV2 4UJ, Highland, United Kingdom
Cerys Russell, Centre for Rural Health Sciences, University of Highlands and Islands, Inverness IV2 5NA, Highland, United Kingdom
Jacques Izopet, Laboratory of Virology, National Reference Center on HEV, Institut Fédératif de Biologie, Toulouse University Hospital, Toulouse 31300, France
Jacques Izopet, Kamar Nassim, Mark Sonderup, Sven Pischke, Sebastian J Wallace, Richie G Madden, HEV International Direct-Action Group, Riverland Academy of Clinical Excellence, Adelaide 5005, South Australia, Australia
Jacques Izopet, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse 31024, France
Kamar Nassim, Departments of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse 31059, France
Mark Sonderup, Division of Hepatology, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town ZA-7925, Western Cape, South Africa
Sven Pischke, Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg D-20246, Germany
Sebastian J Wallace, Department of Gastroenterology, Raigmore Hospital, Inverness IV2 3UJ, Highland, United Kingdom
Sebastian J Wallace, Department of Medicine, University of Aberdeen, Aberdeen AB24 3FX, Aberdeen City, United Kingdom
Richie G Madden, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5005, South Australia, Australia
Richie G Madden, Riverland Mallee Coorong Local Health Network, Government of South Australia, Adelaide 5005, South Australia, Australia
Richie G Madden, Department of Medicine, University of Adelaide, Adelaide 5005, South Australia, Australia
Author contributions: Campbell R contributed to first draft and review of subsequent drafts; Russell C contributed to compilation and design of figures and tables; Izopet J, Nassim K, Sonderup M, Pischke S, Wallace SJ, and Madden RG reviewed and redrafted the manuscript; Wallace SJ and Madden RG designed of the review narrative and concept. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sebastian J Wallace, BMBS, BSc, PhD, Consultant, MRCP, Department of Gastroenterology, Raigmore Hospital, Perth Road, Inverness IV2 3UJ, Highland, United Kingdom. sebastian.wallace3@nhs.scot
Received: July 29, 2025
Revised: September 24, 2025
Accepted: December 16, 2025
Published online: February 27, 2026
Processing time: 198 Days and 19.9 Hours
Revised: September 24, 2025
Accepted: December 16, 2025
Published online: February 27, 2026
Processing time: 198 Days and 19.9 Hours
Core Tip
Core Tip: Globally, hepatitis E infection remains a common but unpredictable cause of acute viral hepatitis. Environmental contamination represents the critical missing link in understanding the transmission of hepatitis E virus from animal reservoirs to humans, particularly the pathways enabling interspecies transmission. Whilst many countries screen blood donors for the virus, circulation within the food chain and water supply inhibits our ability to protect those particularly vulnerable to infection.