Hepatitis E virus infection during pregnancy

Abstract

Background: Hepatitis E virus (HEV) generally causes self-limiting viral hepatitis. However, in pregnant women, HEV infection can be severe and has been associated with up to 30% mortality in the third trimester. Additionally, HEV infection in pregnancy is also associated with high rates of preterm labor and vertical transmission. Main body: HEV is now recognized as a global health problem in both developing and industrialized countries. HEV can be transmitted via the fecal-oral route, zoonotic route, and blood transfusion route. An altered immune status, hormonal levels, and viral factors may be related to the severity of the disease. Currently, no established treatment is available for HEV in pregnant women. A Chinese vaccine has been demonstrated to be protective against HEV in the general population and seems to be safe in pregnancy; however, its safety and efficacy in a large population of pregnant women remain to be determined. Conclusion: This review summarizes the current knowledge about HEV infection during pregnancy and focuses on the epidemiology, clinical manifestations, mechanisms underlying severe liver injury, and management and prevention of HEV infection during pregnancy. Considering that HEV infection during pregnancy may result in poor outcomes, screening for and monitoring HEV infection early in pregnancy should be taken into account. In addition, a better understanding of the pathogenesis will help to develop potential treatment strategies targeting HEV infection in pregnancy.

The global trends and regional differences in incidence of HEV infection from 1990 to 2017 and implications for HEV prevention

“…46 Although HEV infection is self-limiting, a safe and effective antiviral is still important for HEV elimination. 46 Moreover, ribavirin is strictly prohibited in pregnant women, 47 so novel therapies to treat HEV in pregnancy are substantially needed to prevent the significant mortality rates for both mother and child. 46,47 The epidemiology and transmission of hepatitis A virus (HAV) is similar to that of HEV.…”

“…46 Moreover, ribavirin is strictly prohibited in pregnant women, 47 so novel therapies to treat HEV in pregnancy are substantially needed to prevent the significant mortality rates for both mother and child. 46,47 The epidemiology and transmission of hepatitis A virus (HAV) is similar to that of HEV. Being a vaccine-preventable disease, as the success of childhood vaccination in United States, HAV infection has decreased dramatically, and temporal and geographic variability have disappeared.…”

Autoimmune Hepatitis: Tolerogenic Immunological State During Pregnancy and Immune Escape in Post-partum

“…In addition, patients with AIH are already on immunosuppressive medications including steroid, azathioprine and mycophenolate mofetil ( 1 ). Enhanced immune tolerance during pregnancy sometimes may lead to susceptibility to pathogens thus these patients are prone to acquire viral infections including hepatitis E infection ( 44 ). Pregnant AIH patients who are cirrhotic may also be prone to spontaneous bacterial peritonitis.…”

Ectopic Expression of Genotype 1 Hepatitis E Virus ORF4 Increases Genotype 3 HEV Viral Replication in Cell Culture

“…The virus is transmitted by eating raw or undercooked infected meat, causing acute and chronic hepatitis [ 7 , 8 , 9 , 10 , 11 ]. Although typically self-limiting with a 2% mortality rate, the virus is highly detrimental to pregnant women during the third trimester, leading to a 30% mortality rate [ 12 ]. Ribavirin and IFN-α (PEGIFN-α) are contraindicated in pregnant women, thus limiting the therapeutic measures against HEV infection [ 13 , 14 ].…”