icddr,b, Dhaka, Bangladesh.
School of Public Health and Community Medicine, UNSW Medicine, Sydney, Australia.
PLoS Negl Trop Dis. 2020 Jan 21;14(1):e0007586. doi: 10.1371/journal.pntd.0007586. eCollection 2020 Jan.
In the absence of reliable data on the burden of hepatitis E virus (HEV) in high endemic countries, we established a hospital-based acute jaundice surveillance program in six tertiary hospitals in Bangladesh to estimate the burden of HEV infection among hospitalized acute jaundice patients aged ≥14 years, identify seasonal and geographic patterns in the prevalence of hepatitis E, and examine factors associated with death. We collected blood specimens from enrolled acute jaundice patients, defined as new onset of either yellow eyes or skin during the past three months of hospital admission, and tested for immunoglobulin M (IgM) antibodies against HEV, HBV and HAV. The enrolled patients were followed up three months after hospital discharge to assess their survival status; pregnant women were followed up three months after their delivery to assess pregnancy outcomes. From December'2014 to September'2017, 1925 patients with acute jaundice were enrolled; 661 (34%) had acute hepatitis E, 48 (8%) had hepatitis A, and 293 (15%) had acute hepatitis B infection. Case fatality among hepatitis E patients was 5% (28/589). Most of the hepatitis E cases were males (74%; 486/661), but case fatality was higher among females-12% (8/68) among pregnant and 8% (7/91) among non-pregnant women. Half of the patients who died with acute hepatitis E had co-infection with HAV or HBV. Of the 62 HEV infected mothers who were alive until the delivery, 9 (15%) had miscarriage/stillbirth, and of those children who were born alive, 19% (10/53) died, all within one week of birth. This study confirms that hepatitis E is the leading cause of acute jaundice, leads to hospitalizations in all regions in Bangladesh, occurs throughout the year, and is associated with considerable morbidity and mortality. Effective control measures should be taken to reduce the risk of HEV infections including improvements in water quality, sanitation and hygiene practices and the introduction of HEV vaccine to high-risk groups.
在缺乏高流行国家戊型肝炎病毒（HEV）负担可靠数据的情况下，我们在孟加拉国的六所三级医院建立了一个基于医院的急性黄疸监测计划，以估计住院的 14 岁及以上急性黄疸患者中 HEV 感染的负担，确定戊型肝炎的流行的季节性和地域性模式，并研究与死亡相关的因素。我们从纳入的急性黄疸患者中采集血液样本，定义为在过去三个月内住院期间新出现的眼睛发黄或皮肤发黄，并检测针对 HEV、HBV 和 HAV 的免疫球蛋白 M（IgM）抗体。对住院患者进行了三个月的随访，以评估其生存状况；对孕妇进行了三个月的随访，以评估妊娠结局。从 2014 年 12 月至 2017 年 9 月，共纳入了 1925 例急性黄疸患者；661 例（34%）为急性戊型肝炎，48 例（8%）为甲型肝炎，293 例（15%）为急性乙型肝炎感染。戊型肝炎患者的病死率为 5%（28/589）。大多数戊型肝炎患者为男性（74%；486/661），但女性病死率较高-孕妇中为 12%（8/68），非孕妇中为 8%（7/91）。一半死于急性戊型肝炎的患者合并感染 HAV 或 HBV。在存活至分娩的 62 名 HEV 感染母亲中，有 9 名（15%）发生流产/死产，而在那些活产的儿童中，有 19%（10/53）在出生后一周内死亡。本研究证实，戊型肝炎是急性黄疸的主要原因，在孟加拉国所有地区都可导致住院，全年发生，并伴有相当高的发病率和死亡率。应采取有效的控制措施，包括改善水质、环境卫生和个人卫生习惯，以及向高危人群接种戊型肝炎疫苗，以降低 HEV 感染的风险。
