Seroepidemiology of water-borne hepatitis in India and evidence for a third enterically-transmitted hepatitis agent.

Abstract

Many epidemics of water-borne hepatitis have occurred throughout India. These were thought to be epidemics of hepatitis A until 1980, when evidence for an enterically transmitted non-A, non-B hepatitis was first reported. Subsequently, hepatitis E virus was discovered and most recent dem of enterically ted non-A, non-B hepatitis have been attributed to hepatitis E virus infection. However, only a limited number of cases have been confirmed by immuno electron microscopy, polymerase chain reaction, or seroconversion. In the present study we have performed a retrospective seroepidemiologic study of 17 epidemics of waterborne hepatitis in India. We have confirmed that 16 of the 17 epidemics were caused at least in part by serologically closely related hepatitis E viruses. However, one epidemic, in the Andaman Islands, and possibly a signifnt minrit of cases in other epidemics, appears to have been caused by a previously unrecognized hepatitis agent.

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.…”

Epidemic of hepatitis E in a military unit in Abbotrabad, Pakistan.

“…Hepatitis E virus (HEV) is recognized as a common cause of epidemic and sporadic viral hepatitis, especially in Asia 1,2 and Africa, [3][4][5][6] with epidemic 7 and sporadic cases 8 also reported from Mexico. In addition to civilian cases, hepatitis E outbreaks have been documented in military populations in Chad, 9 Djibouti, 10 Nepal, 11 Ethiopia, 12 and among Bangladeshi soldiers serving with the United Nations Forces in Haiti.…”

Deletions of the Hypervariable Region (HVR) in Open Reading Frame 1 of Hepatitis E Virus Do Not Abolish Virus Infectivity: Evidence for Attenuation of HVR Deletion Mutants In Vivo

“…Hepatitis E is an important public health disease in many developing countries and is also endemic in some industrialized countries (1,2,4,8,19,41). HEV transmission occurs primarily by the fecal-oral route through contaminated drinking water or water supplies in areas with poor sanitation (35).…”