Hepatitis E Virus (HEV) Synopsis: General Aspects and Focus on Bangladesh

Abstract

HEV is the most common cause of acute hepatitis globally. This review summarizes the latest knowledge on the epidemiology, clinical characteristics, testing, and treatment of HEV infection. We also focused on Bangladesh to highlight the distinct challenges and the possible remedies. In low-income settings, the virus is mainly transmitted between people by fecal contamination of drinking water causing large outbreaks, and sporadic cases. The disease is usually mild and self-limiting acute hepatitis. Still, pregnant women and their offspring in low-income countries are at particular risk for severe disease, with up to 20% maternal mortality. Despite the high burden of the disease, HEV remains a relatively neglected virus, with detection hampered by costly tests and a lack of suitable treatments. Molecular PCR diagnostics, together with ELISA antibody tests, remain the preferred methods for diagnosis of HEV; however, rapid bedside diagnostics are available and could offer a practical alternative, especially in low-income countries. One vaccine (HEV 239) is only available in China and Pakistan, as efficacy against the other genotypes remains uncertain. The effectiveness trial conducted in Bangladesh might lead the way in gathering more efficacy data and could, together with improved surveillance and raised awareness, dramatically reduce the global burden of HEV.

Discovery of Hepatitis E and Its Impact on Global Health: A Journey of 44 Years about an Incredible Human-Interest Story

“…HEV-gt3 and 4 infections are the most successful zoonotic viral diseases in human history and cause zoonotic food-borne autochthonous infections in industrialized countries. With the availability and application of HEV diagnostics, the existence of hepatitis E in several other forms has been established including transfusion-transmitted infections, inducing screening programs by several countries, a large pool of HEV-gt3 chronic liver disease in solid organ transplant, HIV, and hematopoietic neoplasm patients, masquerading as drug-induced liver injury, and a series of syndromes caused by extrahepatic manifestations of HEV [136,146,147]. The development of accurate diagnostic assays for the detection of HEV infection remains challenging and many outstanding issues remain (Table 3) [150].…”

“…HEV in these regions is the most common cause of acute sporadic hepatitis, acute liver failure, and acute-on-chronic liver failure. There is an enormous load of hepatitis E in pregnancy and fetal/neonatal HEV infections [ 146 , 147 ]. Of late, there are declining trends in these figures due to improvements in sanitation in India.…”

Prevalence of Hepatitis E Virus and Its Associated Outcomes among Pregnant Women in China

“…HEV infection during pregnancy causes various adverse maternal and neonatal outcomes in low-income and middle-income countries where sanitation is poor and HEV infection frequently leads to outbreaks [ 8 , 10 , 12 , 13 , 14 , 15 , 16 ]. In this study, no severe disease or maternal mortality was observed in HEV-infected pregnant women.…”

“…Additionally, HEV infection in pregnant women can lead to adverse fetal outcomes, including preterm delivery, low birth weight, spontaneous abortions, and stillbirths [ 8 , 12 ]. These adverse outcomes of HEV infections in pregnant women and their fetuses or neonates have been well documented in relation to HEV-1 and HEV-2 in low-income and middle-income countries with poor sanitation, including Bangladesh [ 13 ], India [ 8 , 12 , 14 ], Chad [ 15 ], Niger [ 10 ], and Sudan [ 16 ].…”

First serological and molecular investigation of hepatitis E virus infection in dromedary camels in Algeria

“…Every year, 20 million new HEV infections, with 3.3 million acute clinical cases and over than 44.000 related deaths are reported worldwide (9). Hepatitis E virus-1 and HEV-2 are epidemic and endemic in developing countries in Asia and Africa, while HEV-3 and HEV-4 are sporadic in developed countries in Europe, North America and Japan (10)(11)(12)(13), causing a variety of hepatic and extrahepatic manifestations (14). Hepatitis E virus-3, 4 and 7 infections are zoonotic (15) transmitted between animals and humans by consumption of raw or undercooked meat (HEV3 and 4) and milk (HEV-7) or contact with infected animals (16).…”