What this test measures
Anti-HEV IgM is the immunoglobulin-M antibody that the immune system produces in the first few weeks of hepatitis E virus (HEV) infection. It is the most sensitive marker of acute hepatitis E and is detectable from about the time symptoms begin (jaundice, nausea, anorexia, abdominal pain).
The IgM typically persists for 3–6 months and then disappears. It is replaced by IgG (anti-HEV total/IgG), which gives long-lasting but not necessarily lifelong immunity.
Why it matters
Hepatitis E is the leading cause of acute viral hepatitis in Indian adults. HEV genotype 1 is endemic in India and spreads through contaminated drinking water — outbreaks regularly accompany monsoon flooding, urban water-line contamination, and inadequate sanitation. Major Indian outbreaks have affected tens of thousands of people at a time (Kanpur 1991, Hyderabad 2005).
In most healthy non-pregnant adults the illness is self-limiting in 4–6 weeks. The dangerous group is pregnant women — particularly in the third trimester — where HEV causes acute liver failure with case fatality rates of 15–25%. Any pregnant woman in India with acute jaundice should have anti-HEV IgM checked urgently. The test is also part of the workup of any adult with acute jaundice and raised SGPT/SGOT.
How to prepare
No fasting required. The test can be done at any time of day. Mention pregnancy status — it changes urgency and management.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
| Marker | Normal range | If low | If high |
|---|---|---|---|
| Anti-HEV IgM (Index / Reactive-Non-reactive)[1][2] | Non-reactive (Negative) | Non-reactive — no current hepatitis E infection. If clinical suspicion is high and symptoms are very recent (within the first week), repeat in 1–2 weeks. Consider other causes — hepatitis A, B, drug-induced, leptospirosis. | Reactive (Positive) — acute hepatitis E infection. Supportive care, hydration, hospital monitoring for pregnant women. Avoid hepatotoxic drugs (paracetamol caution, no alcohol). Notify lab/public health for outbreak surveillance. |
Hepatitis E serology interpretation
| Anti-HEV IgM | Anti-HEV IgG | Interpretation |
|---|---|---|
| Positive | Positive | Acute or recent hepatitis E infection (IgG has started rising). |
| Positive | Negative | Very early acute hepatitis E — IgG will follow. |
| Negative | Positive | Past resolved infection — long-lasting immunity. |
| Negative | Negative | No exposure to HEV — susceptible. |
Frequently asked questions
How is hepatitis E different from hepatitis A?
Both spread through contaminated water and food and both usually self-resolve. Hepatitis A tends to affect children and young adults; hepatitis E predominantly affects adults in India. Most importantly, hepatitis E in pregnancy carries 15–25% mortality — hepatitis A does not.
I am pregnant and tested positive for anti-HEV IgM. What now?
You need close monitoring, ideally in-hospital, with daily liver function tests and PT/INR. Severe HEV in third trimester can rapidly progress to acute liver failure. Do not take paracetamol or any non-essential medication without obstetric input.
How long does anti-HEV IgM stay positive?
Typically 3–6 months. After that the IgM clears and only the IgG (anti-HEV total) persists.
Is there a vaccine for hepatitis E?
A vaccine (HEV 239) is licensed in China but not widely available in India. Prevention currently depends on safe drinking water — boiling or bottled water during outbreaks and avoiding street-side juices and ice.
Can I get hepatitis E twice?
Reinfection is uncommon — IgG immunity usually lasts years. It is not yet known whether immunity is truly lifelong.
How is hepatitis E treated?
There is no specific antiviral routinely used for acute HEV in healthy adults — supportive care is enough. In chronic HEV (which occurs only in immunocompromised patients) and severe cases, ribavirin is sometimes used off-label.
Can my family catch HEV from me?
Person-to-person spread is uncommon. HEV is mainly waterborne — the family is at risk from the same contaminated water source, not from you directly. Treating the water source matters more than isolating the patient.
Related Hepatitis tests
Tests commonly ordered alongside ANTI HEPATITIS E VIRUS (Anti HEV) - IgM, or that help interpret an unexpected result.
Sources & references
- CDC — Hepatitis E · accessed 2026-05-30T00:00:00.000Z
- WHO — Hepatitis E Fact Sheet · accessed 2026-05-30T00:00:00.000Z
- INASL — Acute Viral Hepatitis Consensus · accessed 2026-05-30T00:00:00.000Z
- ICMR — Indian Council of Medical Research, Hepatitis E surveillance · accessed 2026-05-30T00:00:00.000Z
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