Hepatitis e virus infection in fulminant hepatitis patients and an apparently healthy population in Bangladesh.

Abstract

Abstract. This is the first study comparing hepatitis E virus (HEV) infection in Bangladesh in fulminant hepatitis (FH) patients presumed to have a viral cause and in the apparently healthy population. Sera from 22 FH patients were analyzed for antibodies to hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C and D viruses, and HEV and for hepatitis B surface antigen (HBsAg). Anti-HEV immunoglobulin M (IgM) was detected in the sera of 63.6% of patients, whereas 35.7% were positive for HBsAg. A high prevalence of HEV infection (83.3%) was noted in the HBV carriers. Serum samples from 273 apparently healthy individuals were tested for antibodies to HAV and HEV. Anti-HEV IgM was detected in 7.3% of the samples. The seroprevalence of HAV differed from that of HEV in the same population because all samples were negative for anti-HAV IgM. These data indicate that HEV infection is highly endemic in Bangladesh.

Population Seroprevalence of Hepatitis E Virus Antibodies in Rural Bangladesh

“…26 These findings confirm recent clinical studies identifying HEV as an etiologic agent contributing to substantial hepatitis morbidity in Bangladesh. 18,27,28 The rural population prevalence is lower than the 60.1% proposed by a recent urban study of 273 apparently healthy adults, 19 but similar to the 27% estimates of anti-HEV IgG prevalence in a study of 105 Bangladeshi peacekeepers participating in the United Nations Mission in Haiti in 1996. 17 A 1992 population serosurvey in southern India found an overall anti-HEV seroprevalence of 26%, 29 whereas other India estimates range from 4% to 64%, with varying sample sizes and age ranges using different assays.…”

“…29,35 This discrepancy between the age-specific distributions of the two enterically transmitted hepatitis viruses has been noted in a recent HEV study of healthy urban residents of the capital city of Bangladesh (Dhaka). 19 The increase in evidence of infection around age 15, peaking roughly around 30, is somewhat difficult to explain. Other infectious agents with similar epidemiologic patterns have clear sexual risk factors, but this has not been shown with HEV.…”

“…18,19 Despite the absence of recognized seasonal outbreaks, Bangladesh was suspected to be HEV endemic, with seroprevalence projections ranging from 27% to 60%. 17,19 This study represents the first rural community-based seroprevalence survey of HEV in rural Bangladesh, in a representative, random population sample to quantify the burden of HEV infection by age and sex. Our data confirm that HEV is endemic in Bangladesh and raise questions of whether seasonal epidemics occur, undetected, or whether population risk factors or HEV genotypic differences contribute to a different epidemiology from neighboring countries.…”

Nucleotide Substitutions of Hepatitis E Virus Genomes Associated with Fulminant Hepatitis and Disease Severity

“…HEV is a major cause of fulminant hepatitis in endemic areas of Asia such as India and Bangladesh (Sheikh et al 2002). To date, 7 of 9 HEV isolates obtained from fulminant hepatitis patients in Japan belonged to genotype 4, although a larger number of hepatitis E patients in Japan are infected with genotype 3 HEV in Japan , and the association of genotype 4 HEV with fulminant hepatitis was suggested.…”

Surveillance at Private Laboratories Identifies Small Outbreaks of Hepatitis E in Urban Bangladesh

“…3 Hepatitis E virus (HEV) infection is endemic in Bangladesh where occasional outbreaks are reported. [4][5][6] Drinking fecally contaminated water has been repeatedly implicated as a risk factor for hepatitis E outbreaks in south Asia, where HEV genotype 1 has been frequently identified in large outbreaks. 7 In Bangladesh, drinking water is often contaminated by fecal pathogens 8 ; hence, many people may be exposed to HEV by drinking contaminated water.…”