Hepatitis E as a cause of adult hospitalization in Bangladesh: Results from an acute jaundice surveillance study in six tertiary hospitals, 2014-2017

Abstract

In the absence of reliable data on the burden of hepatitis E virus (HEV) in high endemic countries, we established a hospital-based acute jaundice surveillance program in six tertiary hospitals in Bangladesh to estimate the burden of HEV infection among hospitalized acute jaundice patients aged �14 years, identify seasonal and geographic patterns in the prevalence of hepatitis E, and examine factors associated with death. We collected blood specimens from enrolled acute jaundice patients, defined as new onset of either yellow eyes or skin during the past three months of hospital admission, and tested for immunoglobulin M (IgM) antibodies against HEV, HBV and HAV. The enrolled patients were followed up three months after hospital discharge to assess their survival status; pregnant women were followed up three months after their delivery to assess pregnancy outcomes. From December'2014 to September'2017, 1925 patients with acute jaundice were enrolled; 661 (34%) had acute hepatitis E, 48 (8%) had hepatitis A, and 293 (15%) had acute hepatitis B infection. Case fatality among hepatitis E patients was 5% (28/ 589). Most of the hepatitis E cases were males (74%; 486/661), but case fatality was higher among females-12% (8/68) among pregnant and 8% (7/91) among non-pregnant women. Half of the patients who died with acute hepatitis E had co-infection with HAV or HBV. Of the 62 HEV infected mothers who were alive until the delivery, 9 (15%) had miscarriage/stillbirth, and of those children who were born alive, 19% (10/53) died, all within one week of birth. This study confirms that hepatitis E is the leading cause of acute jaundice, leads to hospitalizations in all regions in Bangladesh, occurs throughout the year, and is associated with considerable morbidity and mortality. Effective control measures should be taken to a1111111111 a1111111111 a1111111111 a1111111111 a1111111111

Hepatitis E Virus (HEV) Synopsis: General Aspects and Focus on Bangladesh

“…Previous cross-sectional studies indicated HEV seroprevalence to range from 22% in rural areas to 60% in the capital of Dhaka [ 8 ]. Although the case fatality rate is 5% among hospitalized HEV patients in urban and rural areas in Bangladesh, the fatality rate is much higher among pregnant women (12%) [ 9 ]. In this article, we comprehensively review the literature to give an overview of the history, taxonomy, transmission, epidemiological aspects, clinical manifestations, and diagnosis and treatment options available to combat this emerging disease, focusing on Bangladesh.…”

Hepatitis E in Bangladesh: Insights From a National Serosurvey

“…While HEV was only identified in 1981 [ 4 ], retrospective analyses have identified a number of large outbreaks, which occurred on the Indian subcontinent in the 1970s and 1980s, including India and Bangladesh [ 5 , 6 ]. In Bangladesh, hepatitis E is endemic with large outbreaks from time to time [ 7–9 ]. Hepatitis E is the leading cause of acute jaundice in Bangladesh and may be responsible for up to 25% of maternal mortality [ 7 , 8 , 10 ].…”

“…In Bangladesh, hepatitis E is endemic with large outbreaks from time to time [ 7–9 ]. Hepatitis E is the leading cause of acute jaundice in Bangladesh and may be responsible for up to 25% of maternal mortality [ 7 , 8 , 10 ].…”

Outcome of Hepatitis-E Virus Infection among Pregnant Women Admitted in a Tertiary Care Hospital

“…Hepatitis E virus (HEV) infection in developing countries is one of the main reason of morbidity and mortality among pregnant women and there are disproportionate mortality rates in low-income and developing countries among pregnant women. 1 Hepatitis E infection among pregnant women poses a great challenge for the obstetrician due to severe pregnancy-related complications including Maternal complications like preterm labour, preterm premature rupture of membrane (PPROM), antepartum hemorrhage (APH), postpartum hemorrhage (PPH), and maternal coagulopathy and Fetal complications like meconium stained liquor and intrauterine fetal death. 2 The situation of the Hepatitis E virus (HEV) in Pakistan is endemic in nature although most cases among young adults are asymptomatic.…”

“…5 The data collected during 2001-2007 surveillance of more than 110,000 pregnancies among 650,000 women in rural Bangladesh showed 9.8% of pregnancy-related deaths due to acute hepatitis and the majority of these deaths were attributed to hepatitis E. The findings of this and other similar studies show that as many as 10,500 maternal deaths each year are mainly due to HEV infection during pregnancy and can be prevented by the use of HEV vaccines. 1,6,7 HEV infection among pregnant women is very prevalent in low and middle-income countries mainly due to very limited access to clean potable water, poor sanitation, hygienic condition, and limited access to health services. 8,9 HEV infection among these pregnant women occurs both as sporadic cases and seasonal outbreaks in these areas.…”