An outbreak of hepatitis E and high maternal mortality at Port Sudan, Eastern Sudan

Rayis, Duria A.; Jumaa, Ammar M; Gasim, Gasim I.; Karsany, Mubark S

doi:10.1179/2047773213y.0000000076

Cited by 64 publications

(63 citation statements)

References 31 publications

(35 reference statements)

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“…However, in our study there were only 2 neonatal deaths among HEV-infected mothers; 1 from IUD and another from miscarriage (10%), which was higher than those born to uninfected mothers (5%). In Sudan, among 39 pregnant women with HEV infection during an outbreak, there were 14 IUDs and 9 premature deliveries (18), and neonatal mortality was high compared to that in our study. A similarly high neonatal mortality has been reported in India, where 15-50% of live-born infants of HEV-infected mothers died within 1 week of birth (19).…”

Section: Discussioncontrasting

confidence: 63%

Hepatitis E virus seroprevalence in pregnant women in Pakistan: maternal and fetal outcomes

Javed

Ullah

Hussain

et al. 2017

East Mediterr Health J

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Séroprévalence de l'infection par le virus de l'hépatite E chez des femmes enceintes au Pakistan : conséquences sur la santé maternelle et foetale RÉSUMÉ Le virus de l'hépatite E (VHE) est endémique au Pakistan. Bien qu'asymptomatique dans la plupart des cas, le virus de l'hépatite E devient mortel lors d'une grossesse, contribuant de façon considérable à la morbidité et la mortalité maternelles et foetales. Une étude descriptive à été conduite entre avril et octobre 2015 dans 10 hôpitaux de soins tertiaires dans l'ensemble du Pakistan afin de déterminer la morbidité et la mortalité chez les femmes enceintes positives au virus de l'hépatite E avec ictère aigu ou présentant une élévation des tests hépatiques. Sur 135 femmes, 21 étaient positives au virus de l'hépatite E et se trouvaient au troisième trimestre de grossesse, exception faite de l'une d'entre elles qui en était au premier trimestre. La prévalence globale du virus de l'hépatite E durant la grossesse s'élevait à 0,19 %. Dix femmes avaient subi un accouchement déclenché, trois avaient eu un travail prématuré, quatre avaient accouché naturellement (à terme), trois femmes étaient décédées et on dénombrait un décès intra-utérin. Une femme avait avorté à domicile avant de se rendre à l'hôpital. Il y a eu sept cas de décès périnatals, dont quatre cas intra-utérins, trois mortinaissances et un avortement. La mortalité maternelle était significativement associée à l'accouchement puisque les 17 mères qui ont survécu avaient accouché naturellement ou avaient subi un accouchement déclenché, tandis que trois femmes avaient poursuivi leur grossesse sans accoucher, et étaient décédées. Le taux de létalité de l'infection par le virus de l'hépatite E durant la grossesse était de 14,2 %. ABSTRACT Hepatitis E virus (HEV) is endemic in Pakistan. Although otherwise asymptomatic, HEV infection becomes fatal in pregnancy, with considerable maternal and fetal morbidity and mortality. We conducted a descriptive study from April to October 2015 in 10 tertiary care hospitals throughout Pakistan to determine maternal and fetal morbidity and mortality in HEV-positive pregnant women with acute jaundice or raised liver function tests. Twenty-one of 135 women were HEV positive and in 3rd trimester except for 1 in 1st trimester. Overall prevalence of HEV in pregnancy was 0.19%. Ten women were artificially induced, 3 had premature labour, 4 delivered spontaneously (full term), 3 died and there was 1 intrauterine death. One woman had a home abortion before coming to hospital. There were 7 perinatal infant deaths: 4 intrauterine, 3 stillbirths and 1 abortion. Maternal mortality was significantly associated with delivery, as 17 mothers who lived went into labour spontaneously or were artificially induced, whereas 3 women who continued their pregnancy and did not deliver, died. Case fatality rate of HEV infection in pregnancy was 14.2%. ‫واألجنة‬ ‫األمهات‬ ‫عىل‬ ‫والعواقب‬ ‫باكستان:‬ ‫يف‬ ‫احلوامل‬ ‫بني‬ E ‫الكبد‬ ‫التهاب‬ ‫لفريوس‬ ‫املصيل‬ ‫االنتشار‬

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Section: Discussioncontrasting

confidence: 63%

Hepatitis E virus seroprevalence in pregnant women in Pakistan: maternal and fetal outcomes

Javed

Ullah

Hussain

et al. 2017

East Mediterr Health J

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“…In addition, increasing sensitivity of the surveillance system during the outbreak led to HEV cases being reported to the health facilities as well. The same phenomenon was reported from Port Sudan, the capital city of the Red Sea State, during 2010, which had been affected by a dual outbreak of HEV and dengue fever according to the disease surveillance system, Sudan Federal Ministry of Health [24,25]. Both dengue and YF are from the same virological family and are transmitted by the same means [1].…”

Section: Discussionmentioning

confidence: 52%

Concomitant outbreaks of yellow fever and hepatitis E virus in Darfur States, Sudan, 2012

Ahmed

Soghaier

Mohammed

et al. 2016

J Infect Dev Ctries

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Introduction: Yellow fever (YF) is a vector-borne disease transmitted to humans by infected Aedes mosquitoes, while hepatitis E virus (HEV) is a waterborne disease that is transmitted through the fecal-oral route. Both diseases have very close clinical presentation, namely fever, jaundice, malaise, and dark urine; they differ in severity and outcome. Methodology: In this cross-sectional, laboratory-based study, an attempt was made to measure the correlation of concomitant YF and HEV infection in Darfur States during the previous YF outbreak in 2012. Results: Results found concomitant outbreaks of YF and HEV at the same time with very weak statistical correlation between the two infections during the outbreak period, with Cramer's V correlation 0.05 and insignificant p value of 0.86. Conclusions: This correlation indicates that clinicians and care providers in tropical areas have to deal with clinical case definitions used for disease surveillance very carefully since prevalence of HEV infection is relatively common and this increases the possibility of misclassification and missing YF cases, particularly initial index cases, in a season or outbreak.

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“…Maternal mortality in HEV infection depends upon viral factors as well as maternal factors 17 . Researchers found.…”

Section: Discussionmentioning

confidence: 99%

Feto-Maternal Outcomes of Hepatitis E Virus Infection in Pregnancy of Bangladeshi women.

Sultana

Rozhana

Tabassum

et al. 2017

Bangladesh J Med Microbiol

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Hepatitis E virus (HEV) infection is responsible for more than half of acute viral hepatitis (AHV) with high feto-maternal complications. Bangladesh has high prevalence of HEV infection among pregnant women. This study was undertaken to observe fetal -maternal outcome of HEV infection in Bangladeshi pregnant women . For this purpose a total of 56 pregnant women with AVH were enrolled from two tertiary care hospitals of Dhaka, Bangladesh. Blood samples were collected and tested for HEV Ig-M, HBsAg and Anti HCV.Thirty one pregnant women were tested positive for HEV Ig-M, acted as case and rest 25 women had viral hepatitis other than HEV, acted as control group (non-HEV). Among the HEV infected pregnant women, 38.7% of the patients (12/31) were aged between 21-25 years with mean age of 23.7 + SD 4.5 years. Twelve (39%) AVH-E patient died due to fulminant hepatic failure (FHF), hepatic encephalopathy (HFE) and multiorgan dysfunction. Maternal mortality due to HEV was greater [ (RR), 9.6; 95% CI, 1.3 to 69.5] in HEV-infected women than in non-HEV infected women and it was higher in 2nd trimester (55.5%) then the 1st and 3rd trimester of pregnancy. Babies born to pregnant women with acute Hepatitis due to HEV (AHV-E) were more likely to have intrauterine death (RR 18.68; p = 0.03) and preterm delivery (RR 7.25; p = 0.05) than the non-HEV infected pregnant women. Only 23% (7/31) babies reached up to term maturity. In conclusion, his study reveals that comparing with non-HEV infection, pregnant women with AHV-E infection causes worse feto-maternal outcomes especially in the second trimester of pregnancy which needs special attention of healthcare providers to reduce bad obstetric outcome in HEV endemic countries.

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An outbreak of hepatitis E and high maternal mortality at Port Sudan, Eastern Sudan

Cited by 64 publications

References 31 publications

Hepatitis E virus seroprevalence in pregnant women in Pakistan: maternal and fetal outcomes

Hepatitis E virus seroprevalence in pregnant women in Pakistan: maternal and fetal outcomes

Concomitant outbreaks of yellow fever and hepatitis E virus in Darfur States, Sudan, 2012

Feto-Maternal Outcomes of Hepatitis E Virus Infection in Pregnancy of Bangladeshi women.

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