Fatal outbreaks of jaundice in pregnancy and the epidemic history of hepatitis E

Abstract

<jats:title>SUMMARY</jats:title><jats:p>Space–time clustering of people who fall acutely ill with jaundice, then slip into coma and death, is an alarming phenomenon, more markedly so when the victims are mostly or exclusively pregnant. Documentation of the peculiar, fatal predisposition of pregnant women during outbreaks of jaundice identifies hepatitis E and enables construction of its epidemic history. Between the last decade of the 18th century and the early decades of the 20th century, hepatitis E-like outbreaks were reported mainly from Western Europe and several of its colonies. During the latter half of the 20th century, reports of these epidemics, including those that became serologically confirmed as hepatitis E, emanated from, first, the eastern and southern Mediterranean littoral and, thereafter, Southern and Central Asia, Eastern Europe, and the rest of Africa. The dispersal has been accompanied by a trend towards more frequent and larger-scale occurrences. Epidemic and endemic hepatitis E still beset people inhabiting Asia and Africa, especially pregnant women and their fetuses and infants. Their relief necessitates not only accelerated access to potable water and sanitation but also vaccination against hepatitis E.</jats:p>

Evolution of the Hepatitis E Virus Polyproline Region: Order from Disorder

“…Another explanation is that modern genotype 1 is actually composed of a subset of subgenotypes from a genotype 1 ancestor. Paleoepidemiological research indicates that epidemic HEV was more common in Australia, North America, and Europe in the 18th and 19th centuries than today (26). An analysis of the evolution of HEV suggests further that genotype 1 went through an evolutionary bottleneck about 80 to 90 years ago (22).…”

Fetal and Neonatal Health Consequences of Vertically Transmitted Hepatitis E Virus Infection

“…15,27 The first (retrospectively) serologically confirmed hepatitis E outbreak occurred in Delhi, India in the mid-1950s, 17,28,29 although molecular evidence suggests that HEV may already have been circulating in humans for several hundred years. 30,31 A hospital-based study during the Delhi epidemic documented an~10% maternal case-fatality rate along with miscarriage, stillbirth, or neonatal death in 56% of infants of women with HEV infection.…”

“…[4][5][6][7][8][9][10][11][12][13][14] High case-fatality ratios among pregnant women, particularly during the third trimester of pregnancy, remain an almost pathognomonic feature of hepatitis E epidemics caused by HEV genotype 1. [15][16][17][18][19][20][21] There is mounting evidence that hepatitis E is an important contributor to maternal morbidity and mortality in south Asia, even outside of periodic large outbreaks. [22][23][24][25][26] In the early literature on hepatitis E, there was much conjecture about the extent to which maternal hepatitis E threatened fetal and neonatal health beyond catastrophic maternal illness or death.…”

Hepatitis E: Epidemiology and Natural History

“…Even in geographical areas where currently hepatitis E is infrequent, epidemics of acute hepatitis with features resembling those of HEV infection were common place during the 18th and 19th centuries. 15 Further, a molecular-clock analysis of the currently-available HEV genomic sequences suggests origin from a common ancestor that existed between 500 and 1300 years ago. 16 …”