HEV genotypes 1 and 2 affect only humans, primarily through fecally contaminated water. Epidemics of acute HEV-associated hepatitis occur in developing areas, along with ongoing infections transmitted through contaminated groundwater. Medical professionals blame contaminated food for outbreaks of genotypes 3 and 4 in developing nations, with sporadic cases in developed countries as well. Transmission of HEV through blood transfusions occurs in countries where the infection is prevalent among the general population. Research shows no evidence that individuals can contract hepatitis E by sharing needles or through sexual contact, although there is a risk with oral-anal contact.

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