Epidemiology and Risk Factors of Incident Hepatitis E Virus Infections in Rural Bangladesh

Abstract

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in the world. Most of South Asia is HEV endemic, with frequent seasonal epidemics of hepatitis E and continuous sporadic cases. This author group's epidemiologic work and clinical reports suggest that Bangladesh is HEV endemic, but there have been few population-based studies of this country's HEV burden. The authors calculated HEV infection rates, over an 18-month interval between 2003 and 2005, by following a randomly selected cohort of 1,134 subjects between the ages of 1 and 88 years, representative of rural communities in southern Bangladesh. Baseline prevalence of antibody to hepatitis E virus (anti-HEV) was 22.5%. Seroincidence was 60.3 per 1,000 person-years during the first 12 months and 72.4 per 1,000 person-years from >12 to 18 months (during the monsoon season), peaking by age 50 years and with low rates during childhood. Few of the seroconverting subjects reported hepatitis-like illness. Overall incidence was calculated to be 64 per 1,000 person-years, with 1,172 person-years followed. No significant associations were found between anti-HEV incidence and demographic or socioeconomic factors for which data were available. This is the first study to document annual HEV infection rates among "healthy" and very young to elderly subjects in a rural Bangladeshi population.

Human Hepatitis E Virus among Apparently Healthy Individuals in Ogbomoso, South-Western Nigeria

“…This disagrees with the reports of Labrique et al [8] and Junaid et al [6] where a higher prevalence was documented among married people than singles. This might be attributed to increased sexual activity among singles as compared to married in the study area, which can lead to sexual transmission.…”

“…The prevalence is the same with the prevalence recorded in United States [10]. However, it is lower than a prevalence of 22.5% in Rural Bangladesh [8], 14.3% in Austria [2], 5.38% in Italy [4], 5.8% in Ghana [11] 18.8% among schistosomiasis patients in Northeastern Brazil [12]. It is higher than a 2.6% prevalence recorded at Switzerland [13].…”

“…Since the discovery of HEV, several outbreaks of the infection have been reported among pregnant women [6], HIV positive individuals [1], sick individuals [3], animal handlers [7] as well as apparently healthy individuals [8]. Thus, apparently healthy individuals are considered a high risk group for HEV infection in endemic areas; however, this assumption is based on outbreak reports only, as no studies have been performed comparing exposure to HEV among this group.…”

Host Immune Status and Response to Hepatitis E Virus Infection

“…Clinically, patients suffering from acute hepatitis E typically present with combinations of symptoms such as fever, anorexia, nausea and/or vomiting, lassitude/weakness, dark urine, light (clay/ash-colored) stool, and jaundice (yellowing of the skin and sclera). Pruritus and/or upper right quadrant pain may also be present (22)(23)(24).…”

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

“…Epidemic and sporadic cases has been reported from these areas 4 . Bangladesh is one of the endemic countries for HEV infection 5 where sero-prevalence of HEV infection among the general population is 22.5% 6 . Viral hepatitis in pregnancy has been a subject of continuing interest and controversy.…”