Rates of Hepatitis E Virus Infection and Disease among Adolescents and Adults in Kathmandu, Nepal

Abstract

and Bruce L. InnisTo determine hepatitis E virus (HEV) infection and disease rates in the Kathmandu Valley of Nepal, serum was collected from 757 healthy Nepalese (ages 12 -48 years) during March and September 1992 and September 1993. At each visit, reports of interval illness were obtained. Sera were examined for IgG to HEV, using a commercially available kit. Seroconversion was used as a marker for HEV infection, and an episode of hepatitis E was defined as a history of jaundice with seroconversion. Seroprevalence ranged from 16% to 31% and increased with age, whereas both infection and disease rates decreased with age. Infection and disease rates were as high as 99/1000 and 45/1000 person-years, respectively. These results highlight the importance of sporadic hepatitis E as a public health problem among adolescents and young adults in this region. Hepatitis E virus (HEV) is believed to be the primary agentStudies to characterize the prevalence of IgG to HEV began as a result of the recent development of serologic assays for responsible for enterically transmitted non-A, non-B hepatitis. The most commonly reported signs and symptoms of this dis-HEV. Generally, the prevalence of antibody against HEV is low (0% -3%) in areas where no outbreaks have been reported ease include malaise, jaundice, dark urine, nausea, abdominal pain, fever, hepatomegaly, and vomiting [1]. The mortality rate and sporadic cases are rare (e.g., in the United States, Europe, Australia, Japan, New Zealand, South Africa, and Thailand) for hepatitis E is higher than for hepatitis A and ranges from 1% -3% among men and nonpregnant women to 12% -42% [5 -8]. By contrast, the prevalence of antibody against HEV is higher (10% -40%) in regions where outbreaks have been among pregnant women [2]. High rates of perinatal death are also associated with this disease [3,4]. Hepatitis E is an imreported and sporadic transmission occurs regularly, such as India, Nepal, and Tajikistan [6,7,9, 10]. Age-specific antibody portant health concern in nearly all under-developed regions of the world. No vaccines for hepatitis E have been developed, prevalence has been examined in India and Nepal [9, 10]. In both studies, antibody prevalence was found to increase with and prophylaxis with immune serum globulin appears to have little or no protective effect [2]. age until about age 30 years. No increase in antibody prevalence was apparent after age 30. No sex-dependent differences in antibody prevalence were observed; on the other hand, in older age groups, the numbers of women were too small to NOTE. Serum and medical histories were collected from 757 persons during March and September 1992 and September 1993. Case of hepatitis E was defined as episode of jaundice (self-reported during interview) along with acquisition of IgG to HEV during period examined. Infection was based on acquisition of HEV antibody during period examined. IgG to HEV was detected using ELISA developed by Diagnostic Biotechnology (Singapore). All 3 serum specimens from each individual were ...

Population Seroprevalence of Hepatitis E Virus Antibodies in Rural Bangladesh

“…7,30,31 The 66.7% peak in seroprevalence in the 81-to 85-year age category is likely an artifact of the small sample ( N = 6) for this age category. The paucity of infections in infancy and childhood, reported in other South Asian populations, was similar in our population despite a large representation of participants ≤ 15 years of age (402/1,134, 35.4%).…”

The socioeconomic impact of hepatitis E in Nepal.

“…Hepatitis E disease rates in the Kathmandu Valley have been estimated to be 20/1,000 person-years. 1 The estimated total burden of HE in the Kathmandu Valley for 1 year would be more than $1,238,676 U.S. and 32 healthy days lost for each of the estimated 24,000 individuals with HE, totaling 768,000 days (based on our results extrapolated to population estimates of 1.2 million from the Kathmandu Municipal City Office). This estimate may overestimate the impact of disease in individuals only mildly affected.…”

“…1,2 Hepatitis E disease (HE), formerly known as enterically transmitted non-A, non-B hepatitis, primarily afflicts populations in countries with poor environmental sanitation. 3,4 This disease is similar to hepatitis A disease (HA) with respect to transmission, clinical course, and absence of chronic disease.…”

“…3,6 Age-specific infection rates for persons 12-19 years of age have been estimated at 99/1,000 during sporadic transmission and higher during outbreaks. 1 Use of immune serum globulin as prophylaxis does not provide protection. 1,4 No vaccines are currently available.…”

“…1 Use of immune serum globulin as prophylaxis does not provide protection. 1,4 No vaccines are currently available.…”