Hepatitis E‐Associated Hospitalizations in the United States: 2010–2015 and 2015–2017

Abstract

Hepatitis E is considered rare in the United States (US) despite its widespread occurrence in Asian and African countries. The objective of this study was to describe the characteristics of hepatitis E‐related pregnancies and acute‐on‐chronic liver failure and analyse trends for hepatitis E diagnosis among hospitalized patients in the US. We examined data from the 2010–2017 National Inpatient Sample from Healthcare Cost and Utilization Project to determine mortality, morbidity, pregnancy diagnoses, chronic liver disease diagnoses, and other conditions during hospitalization. Data were extracted for hospitalizations with hepatitis E as defined by ICD‐9 codes 070.43 and 070.53 and ICD‐10 code B17.2. Of 208,462,242 hospitalizations from 2010–2015, we identified 960 hepatitis E hospitalizations. The hospitalization rate of hepatitis E was 3.7 per 10 million in 2010 and 6.4 per 10 million in 2015 (β = 0.60, p = 0.011). From 2015 to 2017, the hospitalization appeared to increase with slope (β) of 0.50. Among those hospitalizations, 34 (4%) died and 85 (9%) had acute‐on‐chronic liver failure. Ninety‐five (10%) had a diagnosis of pregnancy, there were no reports of maternal or foetus/neonate deaths, but there was a high proportion of adverse events for both during hospitalization. Having a chronic liver disease was associated with hepatic coma diagnosis (OR = 10.94, p = 0.002). Although the hospitalization rate of hepatitis E in the US is low, it appears to be increasing over time. Further studies are necessary in order to conclude a causal association of hepatitis E with adverse events and mortalities in pregnancy and chronic liver disease in the US.

Hepatitis E in immunocompromised individuals

“…National Inpatient Sample (NIS) data from Healthcare Cost and Utilization Project showed the rate of hospitalization due to hepatitis E increased from 3.7 per 10 million in 2010 to 6.4 per 10 million in 2015. Although hospitalization is still low in the United States, the increasing rate is worrisome[ 20 ]. The National Health and Nutrition Examination Survey (NHANES) data also demonstrated an increase in HEV seropositivity (IgG/IgM) from 5% in 2013-2014 to 7.7% in 2015-2016.…”

Prevalence of Hepatitis E Virus and Its Associated Outcomes among Pregnant Women in China

“…Some studies have explored the impact of sporadic HEV infection on the health of pregnant women and their fetuses or neonates in developed countries and contemporary China, where HEV-3 and HEV-4 infections play a dominating role and lead to sporadic cases [ 4 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. However, these studies have provided conflicting conclusions [ 4 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

“…Some studies have explored the impact of sporadic HEV infection on the health of pregnant women and their fetuses or neonates in developed countries and contemporary China, where HEV-3 and HEV-4 infections play a dominating role and lead to sporadic cases [ 4 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. However, these studies have provided conflicting conclusions [ 4 , 17 , 18 , 19 , 20 , 21 , 22 ]. For instance, Bouthry et al [ 20 ] reported that HEV-infected pregnant women in France exhibited nonspecific symptoms or asymptomatic alanine aminotransferase elevation, and no adverse outcomes were noted in these women or their neonates.…”

“…Similar findings were observed in previous studies conducted in China [ 22 ] and Germany [ 17 ]. Nevertheless, recent studies have demonstrated that HEV infections can lead to various adverse outcomes in pregnant women and their fetuses or neonates in China and the United States [ 4 , 18 , 19 , 21 ]. Wasuwanich et al [ 18 ] documented that although no maternal or fetus/neonate deaths were reported in the United States, considerable adverse events were observed in HEV-infected pregnant women and their fetuses/neonates.…”

Efficacy of an accelerated vaccination schedule against hepatitis E virus infection in pregnant rabbits

“…In countries prevalent with HEV1 and HEV2, hepatitis E‐induced high mortality in pregnant women still exists and remains a serious and severe public health problem 3 . In developed countries and China where HEV3 and HEV4 are prevalent, high mortality in HEV‐infected pregnant women is rarely seen 4–6 but relative high rate of premature delivery was reported 7,8 . There is currently no approved drug against HEV.…”