Hepatitis E and pregnancy: current state

Abstract

Hepatitis E virus (HEV) is responsible for more than 50% of acute viral hepatitis cases in endemic countries. Approximately 2 billion individuals live in hepatitis E-endemic areas and, therefore, are at risk of infection. According to World Health Organization, HEV causes about 20.1 million infections and 70 000 deaths every year. In developing countries with poor sanitation, this disease is transmitted through contaminated water and is associated with large outbreaks, affecting hundreds or thousands of people. In developed countries, autochthonous cases of HEV have been increasingly recognized in the past several years. Hepatitis E virus typically causes an acute, self-limiting illness similar to other acute viral hepatitis, such as hepatitis A or B, with about 0.2% to 1% mortality rate in the general population. However, the course of hepatitis E in pregnancy is different than the mild self-constraining infection described in other populations. During pregnancy, HEV infection can take a fulminant course, resulting in fulminant hepatic failure, membrane rupture, spontaneous abortions, and stillbirths. Studies from various developing countries have shown a high incidence of HEV infection in pregnancy with a significant proportion of pregnant women progressing to fulminant hepatitis with a fatality rate of up to 30%. The present review will highlight new aspects of the HEV infection and pregnancy.

Acute liver failure caused by hepatitis E virus genotype 3 and 4: A systematic review and pooled analysis

“…Several studies from highly endemic areas have shown high mortality rate in pregnant women who develop acute hepatitis E (up to 30% and especially in the third trimester) . The high mortality rate in pregnancy have not been reported in patients infected with genotypes 3 and 4 .…”

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].…”

Immunobiological aspects of vaccines in pregnancy: Maternal perspective

“…The incidence is increased in the second and third trimester as compared to the first trimester. Mortality has been estimated at 25-30% in pregnant women [29]. The mechanisms underlying the increased susceptibility of pregnant women to hepatitis E infection and not to other hepatitis viruses is not clear.…”