High prevalence of hepatitis E antibodies in pregnant Egyptian women

Abstract

The epidemiology of hepatitis E virus (HEV), an enterically-transmitted cause of acute viral hepatitis (AVH), is not fully understood. During outbreaks on the Indian subcontinent and elsewhere, HEV causes severe AVH with mortality rates around 20% during pregnancy. In Egypt, where prevalence of HEV antibodies (anti-HEV) in rural communities is very high, severe HEV-caused AVH in pregnant women has not been reported. This study examined a cohort of 2,428 pregnant women in the Nile Delta to assess prevalence of, and risk factors for, anti-HEV and correlated these with history of liver disease. Anti-HEV prevalence was 84.3%. Several risk factors associated with anti-HEV included older age, many siblings, not using soap to wash produce and frequent contact with cats. History of jaundice and liver disease was rare and not increased in those having anti-HEV. Our results confirm Egypt's high HEV endemicity and show that almost all women of childbearing age in these communities had prior HEV exposures without a history of liver disease. Reasons for the lack of clinical hepatitis remain unclear but could be the result of early childhood HEV exposures, producing long-lasting immunity and/or modify subsequent responses to exposure. Alternatively, the predominant HEV strain(s) in Egypt are less virulent than those in South Asia.

Hepatitis E virus replication and interferon responses in human placental cells

“…The first HEV outbreak with reported cases of symptomatic pregnant women was documented in 1987 in Nepal,38 and most of the recent gt1 outbreaks were detected in refugee camps in developing countries, including Somalia,39 Kenya,40 Sudan,41 and Uganda 9. There are, in addition, reports mainly from Egypt in which gt1 infections during pregnancy were not associated with morbidity 42, 43, 44. Importantly, a few cases of gt3 infection during pregnancy were also observed in industrialized countries, for example, in a study from the United Kingdom,45 France,46 and Germany 47.…”

Acute Hepatitis E Virus infection in two geographical regions of Nigeria

“…The reason being that acute HEV in pregnancy can progress to fulminant hepatitis with a high mortality rate, especially, if it occurs in the 3rd trimester [17,51]. Further, reports have shown that HEV infection during pregnancy can lead to maternal mortality rate of 15% to 25%, especially, with genotype 1, which together with genotype 2 are prevalent in the developing countries [52].…”

“…HEV infection is usually asymptomatic and self-limiting [16]; however, in some cases, acute infection may develop to fulminant hepatitis with high mortality especially among pregnant women in their third trimester [17], even as chronic forms of HEV have been documented among different populations [18][19][20]. Diagnosis of HEV infection is based on detection of anti-HEV IgM, anti-HEV IgG, and HEV RNA.…”

Hepatitis E and Acute Liver Failure in Pregnancy

“…30 Similar decline in IgG anti-HEV titers was also documented in Nepal. 31 The prevalence of IgG antibodies in asymptomatic pregnant females across the world varies from 3.6 32 -84.3%, 33 the highest being reported in Egypt. None of these patients had any symptoms of liver disease in the past.…”

“…Seroprevalence of IgG anti-HEV is higher in developing countries than in developed countries as shown in Table 2. [32][33][34][35][36][37][38]39 These studies indicate that HEV exposure/infections are frequent in endemic area of HEV and IgG-anti HEV titers decline over time. Further, long term protective role of IgG-anti HEV in such individuals remains unclear.…”