Genetic heterogeneity of hepatitis E virus in Darfur, Sudan, and neighboring Chad

SUMMARY Hepatitis E virus (HEV), identified over 30 years ago, remains a serious threat to life, health, and productivity in developing countries where access to clean water is limited. Recognition that HEV also circulates as a zoonotic and food-borne pathogen in developed countries is more recent. Even without treatment, most cases of HEV-related acute viral hepatitis (with or without jaundice) resolve within 1 to 2 months. However, HEV sometimes leads to acute liver failure, chronic infection, or extrahepatic symptoms. The mechanisms of pathogenesis appear to be substantially immune mediated. This review covers the epidemiology of HEV infection worldwide, the humoral and cellular immune responses to HEV, and the persistence and protection of antibodies produced in response to both natural infection and vaccines. We focus on the contributions of altered immune states (associated with pregnancy, human immunodeficiency virus [HIV], and immunosuppressive agents used in cancer and transplant medicine) to the elevated risks of chronic infection (in immunosuppressed/immunocompromised patients) and acute liver failure and mortality (among pregnant women). We conclude by discussing outstanding questions about the immune response to HEV and interactions with hormones and comorbid conditions. These questions take on heightened importance now that a vaccine is available.

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“…Other HEV-2 strains have appeared in Africa, where they have also been implicated in outbreaks (57,58).…”

Section: Epidemiologic Patterns Of Hepatitis E Virus Infectionmentioning

confidence: 99%

Host Immune Status and Response to Hepatitis E Virus Infection

2014

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“…Genotype 2 sequences were first reported from an epidemic in Mexico (Huang et al 1992) and subsequently identified from endemic cases in several African countries (Buisson et al 2000;Maila et al 2004;Nicand et al 2005). Genotype 3 is widely distributed and has been isolated from sporadic cases of acute human HEV infection and /or domestic pigs in several countries throughout the world (Okamoto, 2007).…”

Section: Geographical Distributionmentioning

confidence: 99%

Molecular Epidemiology of Hepatitis E Virus (Hev) in South America: Current Status

Mirazo¹,

Ramos²,

Arbiza³

2012

VR&R

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Hepatitis E virus (HEV) is a common causative agent of acute hepatitis in many developing countries where standards of sanitation and hygiene are poor. HEV is transmitted primarily by the fecal-oral route. However, zoonotic trasmission from animal reservoirs to human by consumption of raw or undercooked meat has also been suggested. In endemic areas, HEV infection occurs as large waterborne epidemics and/or small outbreaks. Sporadic cases of HEV infection have also been reported in developed countries, where its occurrence is not always associated with travel to highly endemic areas. HEV mammalian isolates are classifi ed into four genotypes 1-4, which appear to have a specifi c host range and geographical distribution. The epidemiology of HEV in South America seems to be complex and seroprevalence in human and domestic pigs diff ers both among populations within the same countries and between countries. Additionally, HEV strains have been detected and molecularly characterized and genotype 3 is the most frequently genotype found in the region. Moreover, except for two strains isolated from autochthonous cases of acute hepatitis that occurred in Venezuela and belonged to genotype 1, all sequences detected in South America were classifi ed as within genotype 3. Our understanding of HEV epidemiology has undergone major changes in recent years and despite the fact that several attempts to shed light over the epidemiology of this infection have been carried out in South America, data about the molecular characterization of HEV isolates is still lacking and further investigation is needed. This review summarizes the current status of HEV molecular epidemiology from a regional point of view.

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“…2 Epidemics of HEV have been reported in African countries, including Sudan, Ethiopia, Somalia, Chad, the Democratic Republic of the Congo, and Uganda. [3][4][5][6] HEV infection in pregnancy can progress to fulminant hepatitis with a high mortality rate among pregnant women. [7][8][9] A recent study showed that pregnant Indian women with acute hepatitis E virus infection had a three times higher relative risk for fulminant hepatic failure and a six times higher risk for mortality.…”

Section: Introductionmentioning

confidence: 99%

An outbreak of hepatitis E and high maternal mortality at Port Sudan, Eastern Sudan

Rayis

Jumaa

Gasim

et al. 2013

Pathogens and Global Health

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During 4 months (November 2010-March 2011) of an outbreak of hepatitis E virus (HEV), 39 pregnant women presented at Port Sudan Hospital, Sudan, with various symptoms of viral hepatitis. The diagnosis of viral hepatitis was confirmed by serology using ELISA anti-HEV IgG and IgM. The mean (SD) maternal age and gestational age were 24.0 (4.2) years and 33.6 (3.7) weeks, respectively. Eight (20.5%) women were primigravidae. There were 11 (28.2%) maternal deaths, 14 (36.0%) intrauterine fetal deaths, and eight (20.5%) cases of postpartum haemorrhage. There were nine (23.0%) cases of preterm (,37 weeks of gestation) deliveries. Fulminant hepatitis with hepatic encephalopathy was the most common cause of death among these patients. Nine of these women died before delivery and the other two died immediately following the delivery due to severe haemorrhage. There were no significant differences in clinical and biochemical data between the women who died (11) and those who survived.

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Genetic heterogeneity of hepatitis E virus in Darfur, Sudan, and neighboring Chad

Cited by 69 publications

References 7 publications

Host Immune Status and Response to Hepatitis E Virus Infection

Host Immune Status and Response to Hepatitis E Virus Infection

Molecular Epidemiology of Hepatitis E Virus (Hev) in South America: Current Status

An outbreak of hepatitis E and high maternal mortality at Port Sudan, Eastern Sudan

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