HEV is considered a zoonotic disease with reservoirs in pigs, wild boar, and deer. Transmission is fecal–oral, similar to HAV, and HEV can occur in outbreaks. Acute hepatitis E is clinically indistinguishable from other types of acute viral hepatitis and is usually self-limited, with the exception of cases during pregnancy (mortality can be as high as 10%–30% in the third trimester), preexisting chronic liver disease, and organ transplantation. Hepatitis E can rarely progress to chronic infection (HEV RNA for >6 months). Most chronic cases have occurred in solid organ transplant recipients or immunosuppressed individuals. In a retrospective multicenter study of 59 transplant recipients with chronic hepatitis E, ribavirin monotherapy for 3 months achieved an SVR of 78%.¹