Surveillance at Private Laboratories Identifies Small Outbreaks of Hepatitis E in Urban Bangladesh

Sazzad, Hossain M.S.; Labrique, Alain; Teo, Chong Gee; Luby, Stephen P.; Gurley, Emily S.

doi:10.4269/ajtmh.16-0411

Cited by 12 publications

(9 citation statements)

References 24 publications

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“…A previous study conducted in a private laboratory in Dhaka identified small outbreaks of HEV infections throughout the year [9]. The patients in our surveillance hospitals might be sporadic cases of hepatitis E or cases from small outbreaks that occurred throughout the year, as was observed in that study [9]. There are a number of limitations of our study.…”

Section: Characteristicsmentioning

confidence: 77%

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

et al. 2020

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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

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Section: Characteristicsmentioning

confidence: 77%

“…HEV can cause sporadic cases and small outbreaks [9], but is often responsible for epidemics in Asia and many parts of Africa [1,[10][11][12]. The most common clinical feature of symptomatic HEV infection is jaundice; it is symptomatically indistinguishable from other causes of acute viral hepatitis [13].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Although there was no outbreak reported during the study period, the possibility of unidentified and/or unreported outbreak cannot be excluded. Smaller outbreaks often remain unreported due to lack of active surveillance in Bangladesh [30]; therefore, it is possible that viral strains characterized in this study may include outbreak strains.…”

Section: Discussionmentioning

confidence: 99%

A tightly clustered hepatitis E virus genotype 1a is associated with endemic and outbreak infections in Bangladesh

et al. 2021

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Background Hepatitis E virus (HEV) infection is endemic in Bangladesh and there are occasional outbreaks. The molecular characteristics and pathogenesis of endemic and outbreak HEV strains are poorly understood. We compared the genetic relatedness and virulence associated mutations of endemic HEV strains with outbreak strains. Methods We analyzed systematically collected serum samples from HEV immunoglobulin M (IgM) positive patients attended at Bangabandhu Sheikh Mujib Medical University, Dhaka from August 2013 to June 2015. HEV RNA positive samples were subjected to whole genome sequencing. Genotype and subtype of the strains were determined by phylogenetic analysis. Virulence associated mutations e.g. acute viral hepatitis (AVH), fulminant hepatic failure (FHF), chronic hepatitis, ribavirin treatment failure (RTF), B and T cell neutralization epitopes were determined. Results 92 HEV immunoglobulin M (IgM) antibody positive plasma samples (43 in 2013–2014 and 49 in 2014–2015) were studied. 77.1% (70/92) of the samples were HEV RNA positive. A 279 bp open reading frame (ORF) 2 and ORF 3 sequence was obtained from 54.2% (38/70) of the strains. Of these 38 strains, whole genome sequence (WGS) was obtained from 21 strains. In phylogenetic analysis of 38 (279 bp) sequence all HEV sequences belonged to genotype 1 and subtype 1a. Further phylogenetic analysis of 21 HEV WGS, Bangladeshi HEV sequences clustered with genotype 1a sequences from neighboring countries. Within genotype 1a cluster, Bangladesh HEV strains formed a separate cluster with the 2010 HEV outbreak strains from northern Bangladesh. 80.9 to 100% of the strains had A317T, T735I, L1120I, L1110F, P259S, V1479I, G1634K mutations associates AVH, FHF and RTF. Mutations in T cell recognition epitope T3, T5, T7 was observed in 76.1%, 100% and 100% of the strains respectively. Conclusion Strains of HEV genotype 1a are dominant in Bangladesh and are associated with endemic and outbreak of HEV infection. HEV isolates in Bangladesh have high prevalence of virulence associated mutations and mutation which alters antigenicity to B and T cell epitopes.

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“…Cite this article as Cold Spring Harb Perspect Med 2019;9:a031732 use of untreated water from rivers or shallow wells for drinking, failure of water treatment plants, and inadequate chlorination of the water supply (Hakim et al 2017). A large commercial laboratory in Dhaka, Bangladesh has found HEV infection to be the most frequent etiology of clinical hepatitis throughout the year (Sazzad et al 2017). Surveillance of patients with acute jaundice in Northern Uganda has found most cases to be from HEV infection throughout the year (Gerbi et al 2015).…”

Section: Epidemiology Of Genotype 1 and 2 Hev Infectionsmentioning

confidence: 99%

Epidemiology of Genotype 1 and 2 Hepatitis E Virus Infections

Nelson

Labrique

Kmush

2018

Cold Spring Harb Perspect Med

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Hepatitis E virus (HEV) genotypes 1 and 2 are responsible for the majority of acute viral hepatitis infections in endemic areas in South Asia and sub-Saharan Africa. In addition to frequent sporadic illnesses throughout the year, these viruses often cause large epidemics in association with monsoon rains in Asia or during humanitarian crises in Africa. Clinical hepatitis commonly involves adults more often than young children, with an overall mortality of ∼1%. However, the mortality among pregnant women is often 30% or higher. HEV infection in pregnant women frequently leads to infant mortality or premature delivery. Hepatitis E is an important, yet largely neglected, global public health problem.

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Surveillance at Private Laboratories Identifies Small Outbreaks of Hepatitis E in Urban Bangladesh

Cited by 12 publications

References 24 publications

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

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

A tightly clustered hepatitis E virus genotype 1a is associated with endemic and outbreak infections in Bangladesh

Epidemiology of Genotype 1 and 2 Hepatitis E Virus Infections

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