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Rahman M, Noor-E-Alam SM, Rahim MA, Das DC, Ahmed F, Mamun AA, Mahmud T, Mahmood T. Depression among Patients with Chronic Hepatitis B: A Cross-sectional Study in a Tertiary Hospital of Bangladesh. Euroasian J Hepatogastroenterol 2023; 13:79-83. [PMID: 38222954 PMCID: PMC10785126 DOI: 10.5005/jp-journals-10018-1406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/01/2023] [Indexed: 01/16/2024] Open
Abstract
Background Patients with chronic hepatitis B suffer not only from physical illness. Rather, they often present with the mental health consequences of this chronic disease. Objective The major objective was to assess the level of depression among patients having chronic hepatitis B. Method The Department of Hepatology of Bangabandhu Sheikh Mujib Medical University directed this study which was a comparative cross-sectional study during time duration from September 2021 to September 2022. Incidence and grading of depression between patients with chronic hepatitis B and HBsAg negative healthy volunteers were assessed and compared through this study. The association of different variables with depression among chronic hepatitis B (CHB) patients was also measured. Results Out of 90 patients having chronic hepatitis B, 52 (57.8%) were found to have some degree of depression; whereas among 90 HBsAg-negative healthy controls, 32 (35.6%) were found to have various degrees of depression. The dissimilarity between the two groups was significantly determined (p-value < 0.05). The majority of the depressed population from both groups had mild degrees of depression, however, the variance was not top the notch (p-value > 0.05). But the prevalence of moderate depression and moderately severe depression was statistically significant among CHB patients compared to their counterpart controls. Depression among CHB patients was found to be female-predominant. Conclusion The study has shown a higher prevalence of depression among patients with chronic hepatitis B compared to HBsAg-negative healthy controls. How to cite this article Rahman M, Noor-E-Alam SM, Rahim MA, et al. Depression among Patients with Chronic Hepatitis B: A Cross-sectional Study in a Tertiary Hospital of Bangladesh. Euroasian J Hepato-Gastroenterol 2023;13(2):79-83.
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Affiliation(s)
- Merina Rahman
- Department of Hepatology, Khulna Medical College and Hospital, Khulna, Dhaka, Bangladesh
| | | | - Md Abdur Rahim
- Interventional Hepatology Division, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Dulal Chandra Das
- Interventional Hepatology Division, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Faysal Ahmed
- Interventional Hepatology Division, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Ayub Al Mamun
- Interventional Hepatology Division, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Tasnim Mahmud
- Department of Epidemiology, North South University, Bashundhara, Dhaka, Bangladesh
| | - Tarim Mahmood
- Department of Maternal and Child Health, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
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Patterson J, Hussey HS, Silal S, Goddard L, Setshedi M, Spearman W, Hussey GD, Kagina BM, Muloiwa R. Systematic review of the global epidemiology of viral-induced acute liver failure. BMJ Open 2020; 10:e037473. [PMID: 32690747 PMCID: PMC7375632 DOI: 10.1136/bmjopen-2020-037473] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aetiology and burden of viral-induced acute liver failure remains unclear globally. It is important to understand the epidemiology of viral-induced ALF to plan for clinical case management and case prevention. PARTICIPANTS This systematic review was conducted to synthesize data on the relative contribution of different viruses to the aetiology of viral-induced acute liver failure in an attempt to compile evidence that is currently missing in the field. EBSCOhost, PubMed, ScienceDirect, Scopus and Web of Science were searched for relevant literature published from 2009 to 2019. The initial search was run on 9 April 2019 and updated via PubMed on 30 September 2019 with no new eligible studies to include. Twenty-five eligible studies were included in the results of this review. RESULTS This systematic review estimated the burden of acute liver failure after infection with hepatitis B virus, hepatitis A virus, hepatitis C virus, hepatitis E virus, herpes simplex virus/human herpesvirus, cytomegalovirus, Epstein-Barr virus and parvovirus B19. Data were largely missing for acute liver failure after infection with varicella-zostervirus, human parainfluenza viruses, yellow fever virus, coxsackievirus and/or adenovirus. The prevalence of hepatitis A-induced acute liver failur was markedly lower in countries with routine hepatitis A immunisation versus no routine hepatitis A immunisation. Hepatitis E virus was the most common aetiological cause of viral-induced acute liver failure reported in this review. In addition, viral-induced acute liver failure had poor outcomes as indicated by high fatality rates, which appear to increase with poor economic status of the studied countries. CONCLUSIONS Immunisation against hepatitis A and hepatitis B should be prioritised in low-income and middle-income countries to prevent high viral-induced acute liver failure mortality rates, especially in settings where resources for managing acute liver failure are lacking. The expanded use of hepatitis E immunisation should be explored as hepatitis E virus was the most common cause of acute liver failure. REGISTRATION PROSPERO registration number: CRD42017079730.
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Affiliation(s)
- Jenna Patterson
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Hannah Sophia Hussey
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Sheetal Silal
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Liz Goddard
- Department of Paediatrics, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Mashiko Setshedi
- Department of Medicine, Division of Gastroenterology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Wendy Spearman
- Department of Medicine, Division of Hepatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gregory D Hussey
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Benjamin M Kagina
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Rudzani Muloiwa
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Department of Pediatrics & Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Nationwide Hospital-Based Seroprevalence of Hepatitis A and Hepatitis E Virus in Bangladesh. Ann Glob Health 2020; 86:29. [PMID: 32211299 PMCID: PMC7082825 DOI: 10.5334/aogh.2574] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Hepatitis A virus (HAV) and hepatitis E virus (HEV) are transmitted by the fecal-oral route and are responsible for epidemic and sporadic outbreaks of acute hepatitis in low-income countries like Bangladesh. Objective: The purpose of this study was to describe the seroprevalence of acute hepatitis due to HAV and HEV infection in Bangladesh. Methods: The nationwide food-borne illness surveillance started in 2014 at 10 different hospitals which covered seven divisions of Bangladesh. Blood samples were collected from suspected acute hepatitis cases and screened for the anti-HAV IgM and anti-HEV IgM using enzyme-linked immunosorbent assay (ELISA). Participants’ socioeconomic status, clinical, sanitation and food history were recorded. Multivariate logistic regression was performed to determine the risk factors associated with HAV and HEV infection. Findings: A total of 998 patients were enrolled and tested for both HAV and HEV. Among these, 19% (191/998) were identified as HAV positive and 10% (103/998) were HEV positive. The median age was 12 years and 25 years for HAV and HEV positive patients, respectively. The prevalence of HAV was higher among the females (24.9%), whereas HEV was higher among males (11.2%). The highest occurrence of HAV was observed among children while HEV was most prevalent in the 15–60 years age group (12.4%). Conclusion: Through our nationwide surveillance, it is evident that hepatitis A and hepatitis E infection is common in Bangladesh. These data will be useful towards planning preventive and control measures by strengthening the sanitation programs and vaccination strategies in Bangladesh.
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Sarin SK, Kumar M, Eslam M, George J, Al Mahtab M, Akbar SMF, Jia J, Tian Q, Aggarwal R, Muljono DH, Omata M, Ooka Y, Han KH, Lee HW, Jafri W, Butt AS, Chong CH, Lim SG, Pwu RF, Chen DS. Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2020; 5:167-228. [PMID: 31852635 PMCID: PMC7164809 DOI: 10.1016/s2468-1253(19)30342-5] [Citation(s) in RCA: 287] [Impact Index Per Article: 71.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 07/20/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023]
Abstract
The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birth-dose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region.
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Affiliation(s)
- Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
| | - Mohammed Eslam
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sheikh M Fazle Akbar
- Department of Pathology, Ehime University Proteo-Science Center, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Qiuju Tian
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan; University of Tokyo, Tokyo, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology, Chiba University Hospital, Chiba, Japan
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Wasim Jafri
- Department of Medicine, Section of Gastroenterology, The Aga Khan University, Karachi, Pakistan
| | - Amna S Butt
- Department of Medicine, Section of Gastroenterology, The Aga Khan University, Karachi, Pakistan
| | - Chern H Chong
- Division of Gastroenterology & Hepatology, National University Health System, Singapore; Division of General Medicine, Woodlands Health Campus, Singapore
| | - Seng G Lim
- Division of Gastroenterology & Hepatology, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ding-Shinn Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Genomics Research Center, Academia Sinica, Taipei, Taiwan
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Paul RC, Nazneen A, Banik KC, Sumon SA, Paul KK, Akram A, Uzzaman MS, Iqbal T, Tejada-Strop A, Kamili S, Luby SP, Gidding HF, Hayen A, Gurley ES. Hepatitis E as a cause of adult hospitalization in Bangladesh: Results from an acute jaundice surveillance study in six tertiary hospitals, 2014-2017. PLoS Negl Trop Dis 2020; 14:e0007586. [PMID: 31961861 PMCID: PMC6994197 DOI: 10.1371/journal.pntd.0007586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/31/2020] [Accepted: 12/27/2019] [Indexed: 12/14/2022] Open
Abstract
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. In the absence of reliable surveillance data on the burden of hepatitis E in endemic countries, we conducted a hospital-based acute jaundice surveillance study over a two and a half year period in six tertiary hospitals in Bangladesh. The study confirms that HEV infections occur throughout the year, and is a major (34%) cause of acute jaundice in tertiary hospitals in Bangladesh. Three-quarters of the acute hepatitis E cases were male, and HEV infection was higher among patients residing in urban areas than patients in rural areas (41% vs 32%). The overall case fatality rate of acute HEV infections in hospitals was 5%, but was higher among pregnant women (12%). Hepatitis E patients who died were more likely to have co-infection with HAV or HBV than the HEV infected patients who did not die. Fifteen percent of HEV infected mothers had miscarriage/stillbirth. Of the children who were born alive, 19% died, all within one week of birth. Considering the high burden of hepatitis E among hospitalized acute jaundice patients, Bangladesh could take control measures to reduce this risk including improvements in water quality, sanitation and hygiene practices and the introduction of hepatitis E vaccine in high-risk areas.
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Affiliation(s)
- Repon C. Paul
- icddr,b, Dhaka, Bangladesh
- School of Public Health and Community Medicine, UNSW Medicine, Sydney, Australia
- * E-mail:
| | | | | | | | | | - Arifa Akram
- Institute of Epidemiology, Disease Control and Research, Government of the People’s Republic of Bangladesh
| | - M. Salim Uzzaman
- Institute of Epidemiology, Disease Control and Research, Government of the People’s Republic of Bangladesh
| | - Tahir Iqbal
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alexandra Tejada-Strop
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephen P. Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, United States of America
| | | | - Andrew Hayen
- Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, Australia
| | - Emily S. Gurley
- icddr,b, Dhaka, Bangladesh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Kilonzo SB, Gunda D, Ning Q, Han M. Where Hepatitis B and Hepatitis E Meet: Epidemiological and Clinical Aspects. HEPATITIS MONTHLY 2019; 19. [DOI: 10.5812/hepatmon.93840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/09/2019] [Indexed: 08/30/2023]
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Rashid HO, Khan MR, Rashid T, Rashid H, Mahtab MA. Variable Outcome of Acute Viral Hepatitis in Diabetic and Nondiabetic Patients in Bangladesh. Euroasian J Hepatogastroenterol 2019; 9:20-22. [PMID: 31988862 PMCID: PMC6969331 DOI: 10.5005/jp-journals-10018-1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Diabetes mellitus (DM) are common in Bangladesh, and this country is also well-known for frequent outbreaks of acute viral hepatitis (AVH). The study presented here was designed for the clinical courses of acute hepatitis with and without DM. A total of 300 patients with AVH were enrolled into two groups; group A; patients of AVH with DM (N = 140) and group B; patients with AVH without DM (N = 160). There was no significant difference regarding age, sex, and levels of alanine aminotransferase (ALT) between the two groups. The main cause of AVH was hepatitis E virus (HEV) in 100 and 112 patients of groups A and B, respectively. Jaundice persisted for more than 6 months in 68 of 140 (49%) patients of group A, whereas, this was found in only 11 of 160 patients of group B. Forty-two patients of group A showed evidence of esophageal varices; however, the endoscopic assessment did not reveal any abnormality in patients with group B. Moderate to several hepatic fibrosis was seen in 19 of 140 patients with group A, however, these were not detected in any patient of group B (patient with AVH without DM). Even more important is the fact that four patients of group A died of liver failure, whereas there was no mortality in any patient of group B. The study presented here indicates that all patients with DM with superimposed AVH should be carefully followed up with the possibility of development of severe liver diseases and even mortality. How to cite this article: Harun-or-Rashid, Khan MR, et al. Variable Outcome of Acute Viral Hepatitis in Diabetic and Nondiabetic Patients in Bangladesh. Euroasian J Hepatogastroenterol 2019;9(1): 20-22.
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Affiliation(s)
- Harun Or Rashid
- Department of Hepatology, Rajshahi Medical College Hospital, Rajshahi, Bangladesh
- Harun or Rashid, Department of Hepatology, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, Phone: 880-171-119 04778, e-mail:
| | - Mahbubur R Khan
- Department of Hepatology, Rajshahi Medical College Hospital, Rajshahi, Bangladesh
| | - Tasnova Rashid
- Department of Medicine, Medical College for Women and Hospital, Dhaka, Bangladesh
| | - Humaira Rashid
- Department of Pharmacy, Brac University, Dhaka, Bangladesh
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Abstract
Hydrologic disasters, including hurricanes, tsunamis, and severe flooding, have been associated with infectious diseases, particularly among vulnerable and displaced populations in resource-poor settings. Skin and soft tissue infections, gastrointestinal infections, respiratory infections, zoonotic infections, and vector-borne diseases each present unique threats to human health in this setting. Increased emergency physician awareness of these infectious diseases and their diagnosis and management helps optimize medical care for survivors after a hydrologic disaster and safeguard the health of disaster responders.
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Affiliation(s)
- Stephen Y Liang
- Division of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA; Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA.
| | - Nicole Messenger
- Division of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA
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Mamun-Al-Mahtab. Past, Present, and Future of Viral Hepatitis in Bangladesh. Euroasian J Hepatogastroenterol 2016; 6:43-44. [PMID: 29201723 PMCID: PMC5578557 DOI: 10.5005/jp-journals-10018-1164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 10/31/2015] [Indexed: 11/29/2022] Open
Abstract
Viral hepatitis poses huge burden to the health care delivery system as well as to the economy of Bangladesh. Hepatitis E virus is the leading cause of acute hepatitis in this country, however with the improvement of economic status and sanitation this seems to be on the decline. Hepatitis B virus remains the leading cause in all forms of chronic liver diseases in this country. This virus has been extensively studied in Bangladesh, including from epidemiology to pathogenosis. Clinical trials with innovative therapy conducted in Bangladesh have shown promise. Hepatitis C virus follows hepatitis B virus as the second commonest cause of chronic liver diseases here. However patients in Bangladesh have started benefitting from the local generic versions of the newly introduced direct acting anti-virals. HOW TO CITE THIS ARTICLE Al-Mahtab M. Past, Present, and Future of Viral Hepatitis in Bangladesh. Euroasian J Hepato-Gastroenterol 2016;6(1):43-44.
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Affiliation(s)
- Mamun-Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Joulaei H, Rudgari O, Motazedian N, Gorji-Makhsous S. Hepatitis E virus seroprevalence in HIV positive individuals in Shiraz, Southern Iran. IRANIAN JOURNAL OF MICROBIOLOGY 2015; 7:103-8. [PMID: 26622971 PMCID: PMC4662777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in the world. It is usually a self-limited disease but may leads to the deaths of about 20% of pregnant women in developing countries. This study was conducted to determine the prevalence of HEV infection among HIV individuals . MATERIALS AND METHODS This is a cross-sectional survey of HIV positive individuals in voluntary counselling and testing center of Shiraz in 2013 Using the systematic random sampling method, 158 patients enrolled for the research. They were asked about their age, gender, area of residence, marital status, number of children, education level, occupation, history of imprisonment, mode of HIV transmission, and viral hepatitis co-infection Three ml venous blood sample was drawn from each subject and transferred to the laboratory of voluntary counselling and testing center. RESULTS The overall seroprevalence of hepatitis E was 26 (16.4%), where it increased significantly with age ranging from zero in subjects less than 30 years of age to 47.4% in those aged 50 years or older. CONCLUSION Co-infection of HIV positive individuals with HEV is an issue that should be of concern to health care providers.
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Affiliation(s)
- Hassan Joulaei
- Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Rudgari
- Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Motazedian
- Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author: Nasrin Motazedian, MD. Address: Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, 2nd floor, Voluntary Counseling and Testing Center, Lavan Ave, Delavaran-e Basij Blvd, KhatounSq, Shiraz, Fars, Iran. Post Code: 71659-83885, Tel: +98-711-7386272, Fax: +98-711-7386272,
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Mahtab MA. Epidemiology of Viral Hepatitis and Liver Diseases in Bangladesh. Euroasian J Hepatogastroenterol 2015; 5:26-29. [PMID: 29201681 PMCID: PMC5578515 DOI: 10.5005/jp-journals-10018-1124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/19/2014] [Indexed: 12/19/2022] Open
Abstract
Bangladesh is a South Asian country with a homogeneous population. However, some difference has been demonstrated in the distribution of liver disease in different parts of the country. Hepatitis E remains the principal cause of acute hepatitis in Bangladesh, while chronic liver disease in Bangladesh, including hepatocelullar carcinoma, is predominantly due to hepatitis B virus. Hepatitis B has been extensively studied and characterized in Bangladesh, and some major clinical trials with HBV-related antigens have also been conducted.
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Affiliation(s)
- Mamun-Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
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Rashed-Ul Islam SM, Jahan M, Tabassum S. Evaluation of a Rapid One-step Real-time PCR Method as a High-throughput Screening for Quantification of Hepatitis B Virus DNA in a Resource-limited Setting. Euroasian J Hepatogastroenterol 2015; 5:11-15. [PMID: 29201678 PMCID: PMC5578512 DOI: 10.5005/jp-journals-10018-1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/26/2014] [Indexed: 11/30/2022] Open
Abstract
Virological monitoring is the best predictor for the management of chronic hepatitis B virus (HBV) infections. Consequently, it is important to use the most efficient, rapid and cost-effective testing systems for HBV DNA quantification. The present study compared the performance characteristics of a one-step HBV polymerase chain reaction (PCR) vs the two-step HBV PCR method for quantification of HBV DNA from clinical samples. A total of 100 samples consisting of 85 randomly selected samples from patients with chronic hepatitis B (CHB) and 15 samples from apparently healthy individuals were enrolled in this study. Of the 85 CHB clinical samples tested, HBV DNA was detected from 81% samples by one-step PCR method with median HBV DNA viral load (VL) of 7.50 × 103 lU/ml. In contrast, 72% samples were detected by the two-step PCR system with median HBV DNA of 3.71 × 103 lU/ml. The one-step method showed strong linear correlation with two-step PCR method (r = 0.89; p < 0.0001). Both methods showed good agreement at Bland-Altman plot, with a mean difference of 0.61 log10 IU/ml and limits of agreement of -1.82 to 3.03 log10 IU/ml. The intra-assay and interassay coefficients of variation (CV%) of plasma samples (4-7 log10 IU/ml) for the one-step PCR method ranged between 0.33 to 0.59 and 0.28 to 0.48 respectively, thus demonstrating a high level of concordance between the two methods. Moreover, elimination of the DNA extraction step in the one-step PCR kit allowed time-efficient and significant labor and cost savings for the quantification of HBV DNA in a resource limited setting. HOW TO CITE THIS ARTICLE Rashed-Ul Islam SM, Jahan M, Tabassum S. Evaluation of a Rapid One-step Real-time PCR Method as a High-throughput Screening for Quantification of Hepatitis B Virus DNA in a Resource-limited Setting. Euroasian J Hepato-Gastroenterol 2015;5(1):11-15.
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Affiliation(s)
- SM Rashed-Ul Islam
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Munira Jahan
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Shahina Tabassum
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
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Shinde N, Patil T, Deshpande A, Gulhane R, Patil M, Bansod Y. Clinical profile, maternal and fetal outcomes of acute hepatitis e in pregnancy. Ann Med Health Sci Res 2014; 4:S133-9. [PMID: 25184080 PMCID: PMC4145510 DOI: 10.4103/2141-9248.138033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Pregnant women are at increased risk of complications in hepatitis E virus (HEV) infection, with the risk increasing as the pregnancy progresses, often leading to fulminant hepatic failure and adverse fetal outcome. Aims: The primary objective of the following study is to evaluate the maternal and fetal complications of this infection and secondary aim is to compare the clinical features of hepatitis E in pregnant women to those in non-pregnant women. Subjects and Methods: This was a hospital based case-controls study, carried out from July 2008 to June 2010. Over a period of 2 years, cases were serologically confirmed pregnant women with hepatitis E, selected by screening in antenatal clinic. Controls were serologically confirmed non-pregnant women with hepatitis E, selected by screening in Medicine Outpatient Department. We studied 96 women with HEV infection, of which 52 were pregnant and 44 were non-pregnant. Clinical and laboratory profile of patients in both groups were studied. Patients were treated as per protocol and the outcome was studied in both groups. Pregnant women were followed-up for fetal and maternal outcome. We used t-test and z-test to compare normally distributed data and non-normally distributed data, respectively. Chi-square test was used to compare discrete values between groups. Results: Mean (standard deviation [SD]) age in pregnant patients was 24.1 (3.3) years while 32.6 (10.5) years in non-pregnant patients. 71.1% (37/52) of the patients were primigravida and 28.8% (15/52) patients were multigravida, by natural occurrence. Mean (SD) gestational age when infection occurred was 27.5 (7.2) weeks. Among pregnant women, 63.4% (33/52) were in 3rd trimester. Jaundice 1-5 days before presentation was seen in 51.9% (27/52) pregnant and 44.2% (23/44) non-pregnant women. Myalgia/arthralgia, fever, nausea/vomiting, right upper quadrant pain, jaundice, dark urine, light-colored stools, pruritus, diarrhea, altered sensorium and hematemesis/melena were presenting features. In pregnant group, 46.1% (24/52) patients developed encephalopathy while in non-pregnant group 34% (15/44) developed this complication. Among pregnant cases, 67.3% (35/52) survived and 32% (17/52) cases died. In non-pregnant group, nearly 90% (40/44) patients survived and only 9% (4/44) patients died. This difference was statistically significant (P < 0.01). Adverse fetal outcome was seen in 71.1% (37/52) pregnant women with acute hepatitis E, including pre-term delivery in 23% (12/52), stillbirth in 23% (12/52), abortion in 3.8% (2/52) and intra-uterine fetal death in 21.1% (11/52) patients. Conclusions: There is significantly higher occurrence of hepatitis E infection in pregnant women than in non-pregnant women, which increases with gestation, with associated fulminant hepatic failure, maternal mortality and worse fetal outcome.
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Affiliation(s)
- Nr Shinde
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - Tb Patil
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - As Deshpande
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - Rv Gulhane
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - Mb Patil
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - Yv Bansod
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
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Junaid SA, Agina SE, Abubakar KA. Epidemiology and associated risk factors of hepatitis e virus infection in plateau state, Nigeria. Virology (Auckl) 2014; 5:15-26. [PMID: 25512696 PMCID: PMC4251053 DOI: 10.4137/vrt.s15422] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 12/22/2022] Open
Abstract
A cross-sectional study in Nigeria was undertaken to determine the epidemiology, seroprevalence, and associated risk factors, of hepatitis E virus (HEV). A total of 462 subjects were used for the study, categorized into four groups: apparently healthy persons, pregnant women, HIV positive subjects, and animal handlers. Information was obtained from subjects using interviewer-administered questionnaire. Blood samples were collected and analyzed for HEV antibodies (IgG and IgM) using enzyme-linked immunosorbent assay (ELISA) technique. Results obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 17.0 statistical software. The overall seroprevalence of IgG and IgM was 42.7 and 0.9%, respectively. Animal handlers had the highest seroprevalence (66.7%). The associated risk factors for IgM seroprevalence were rural dwelling (P = 0.039, odds ratio (OR) 3.3, 95% confidence interval (CI) 0.7–15.4), blood transfusion (P < 0.001, OR 9.6, 95% CI 2.6–35.6), attending to animals (P = 0.032, OR 4.9, 95% CI 0.9–26.6), and waste disposal (P < 0.001). Factors associated with IgG were age (P = 0.044), location (P < 0.001), marital status (P < 0.001), formal education (P < 0.001), farming as occupation (P < 0.001), rural dwelling (P = 0.001), waste disposal (P < 0.001), alcohol consumption (P = 0.001, OR 2.4, 95% CI 1.4–4.0), open defecation (P < 0.001, OR 2.9, 95% CI 1.4–5.7), attending to animals (P < 0.001, OR 2.3, 95% CI 1.6–3.4), consuming unwashed fruits/vegetables (P < 0.001, OR 4.2, 95% CI 0.3–54.1), and stream/river as a source of drinking water (P < 0.001, OR 3.6, 95% CI 1.6–7.8). Preventive public health measures should be reinforced among all communities, particularly domestic animal handlers and pregnant women. Potable water should be provided for all communities. Data suggest that HEV remains an under-recognized and significant public health problem, warranting further attention and research.
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Affiliation(s)
- Surajudeen A Junaid
- Applied Microbiology Unit, Department of Plant Science and Technology, Faculty of Natural Sciences, University of Jos, Nigeria. ; Department of Medical Microbiology, Federal College of Veterinary and Medical Laboratory Technology, National Veterinary Research Institute (NVRI), Vom, Nigeria
| | - Samuel E Agina
- Applied Microbiology Unit, Department of Plant Science and Technology, Faculty of Natural Sciences, University of Jos, Nigeria
| | - Khadijah A Abubakar
- Department of Medical Virology, Federal College of Veterinary and Medical Laboratory Technology, National Veterinary Research Institute (NVRI), Vom, Nigeria
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Rahman S, Faroque Ahmed M, Jamshed Alam M, Ranjan Debnath C, Izazul Hoque M, Mahbub Hussain M, Shamsul Kabir A, Fazal Karim M, Ahmed Khondokar F, Mamun-Al-Mahtab AK, Golam Masud M, Uddin Mollick MK, Lutful Moben A, Mohammad Noor-E-Alam S, Kumar Podder P, Kumar Raha A, Abdur Rahim M, Harun Or Rashid M, Zaki K, Mohammad Fazle Akbar S. Distribution of Liver Disease in Bangladesh: A Cross-country Study. Euroasian J Hepatogastroenterol 2014; 4:25-30. [PMID: 29264315 PMCID: PMC5736952 DOI: 10.5005/jp-journals-10018-1092] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/30/2013] [Indexed: 12/05/2022] Open
Abstract
Introduction ‘Hepatology’, as an independent discipline of medical science, has recently been established in Bangladesh. The aim of this study was to formulate the distribution of pattern of liver diseases in this country. Materials and methods In this retrospective study, data regarding patients of liver diseases from the seven different administrative divisions of Bangladesh between January 2012 and 2013 were compiled. Results The study included 59,227 patients (age ranged 15-95 years). Majority of the patients were males (67.9%). Although all patients appeared at the department of hepatology, 13.2% were diagnosed with liver diseases, but a vast majority of patients (77.35%) were suffering from nonulcer dyspepsia or irritable bowel syndrome. Patients with liver diseases were mostly suffering from chronic liver diseases (CLDs) (37 -69%). Complication of CLD, like hepatic encephalopathy, was less frequent in regions with better healthcare system. Nonviral infections, like liver abscess and biliary ascarisis, were not uncommon. Acute hepatitis was another very common entity and contributed to approximately 20% cases. Conclusion This study provides insight about heterogeneous distribution pattern of liver diseases in different regions of Bangladesh. How to cite this article: Rahman S, Ahmed MF, Alam MJ, Debnath CR, Hoque MI, Hussain MM, Shamsul Kabir AKM, Karim MF, Khondokar FA, Mahtab MA, Masud MG, Mollick MKU, Moben AL, Noor-E-Alam SM, Podder PK, Raha AK, Rahim MA, Rashid MHO, Zaki KMJ, Akbar SMF. Distribution of Liver Disease in Bangladesh: A Cross-country Study. Euroasian J Hepato-Gastroenterol 2014;4(1):25-30.
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Affiliation(s)
- Salimur Rahman
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | | | | | | | | | - Akm Shamsul Kabir
- Department of Medicine, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
| | | | | | | | | | | | - Ahmed Lutful Moben
- Department of Hepatology, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh
| | | | | | - Aloke Kumar Raha
- Department of Hepatology, Chittagong Medical College, Chittagong, Bangladesh
| | | | | | - Kmj Zaki
- Department of Hepatology, Sylhet M.A.G. Osmani Medical College, Sylhet, Bangladesh
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Rahman S, Mamun-Al-Mahtab, Jahan M, Tabassum S, Fazle Akbar SM. Epidemiology of Hepatitis E Virus in an Urban Community in Dhaka City. Euroasian J Hepatogastroenterol 2014; 4:4-6. [PMID: 29264310 PMCID: PMC5736947 DOI: 10.5005/jp-journals-10018-1087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 01/05/2014] [Indexed: 12/03/2022] Open
Abstract
Introduction Hepatitis E virus (HEV) is endemic in Bangladesh and sporadic and epidemic outbreaks of acute hepatitis E occur in this country almost regularly. Although the real magnitude of HEV prevalence has not been documented in Bangladesh, HEV infections and HEV-related acute hepatitis of Bangladeshi origin have been reported from different parts of the world. Methods The study was conducted in Mirpur area of Dhaka city, which is a major residential area of the capital of Bangladesh. Three hundred adults were randomly included in the study. None had any history of jaundice or complains of liver diseases. Results The study revealed 30% prevalence of HEV in this population. The prevalence increased with age, but there was no gender difference. Conclusion HEV is a highly prevalent disease in Bangladesh as elsewhere in the developing world. Since there is no specific treatment for HEV, improvement of personal hygiene and ensuring supply of safe food and drinking water remain most important approach to sustain the virus. How to cite this article: Rahman S, Mahtab MA, Jahan M, Tabassum S, Akbar SMF. Epidemiology of Hepatitis E Virus in an Urban Community in Dhaka City. Euroasian J Hepato-Gastroenterol 2014; 4(1):4-6.
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Affiliation(s)
- Salimur Rahman
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Mamun-Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Munira Jahan
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shahina Tabassum
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Krain LJ, Nelson KE, Labrique AB. Host immune status and response to hepatitis E virus infection. Clin Microbiol Rev 2014; 27:139-65. [PMID: 24396140 PMCID: PMC3910912 DOI: 10.1128/cmr.00062-13] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatitis E virus (HEV), identified over 30 years ago, remains a serious threat to life, health, and productivity in developing countries where access to clean water is limited. Recognition that HEV also circulates as a zoonotic and food-borne pathogen in developed countries is more recent. Even without treatment, most cases of HEV-related acute viral hepatitis (with or without jaundice) resolve within 1 to 2 months. However, HEV sometimes leads to acute liver failure, chronic infection, or extrahepatic symptoms. The mechanisms of pathogenesis appear to be substantially immune mediated. This review covers the epidemiology of HEV infection worldwide, the humoral and cellular immune responses to HEV, and the persistence and protection of antibodies produced in response to both natural infection and vaccines. We focus on the contributions of altered immune states (associated with pregnancy, human immunodeficiency virus [HIV], and immunosuppressive agents used in cancer and transplant medicine) to the elevated risks of chronic infection (in immunosuppressed/immunocompromised patients) and acute liver failure and mortality (among pregnant women). We conclude by discussing outstanding questions about the immune response to HEV and interactions with hormones and comorbid conditions. These questions take on heightened importance now that a vaccine is available.
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Affiliation(s)
- Lisa J. Krain
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kenrad E. Nelson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alain B. Labrique
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Harun-Or-Rashid M, Akbar SMF, Takahashi K, Al-Mahtab M, Khan MSI, Alim MA, Ekram ARMS, Khan MMR, Arai M, Mishiro S. Epidemiological and molecular analyses of a non-seasonal outbreak of acute icteric hepatitis E in Bangladesh. J Med Virol 2013; 85:1369-76. [PMID: 23703666 DOI: 10.1002/jmv.23601] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Kazuaki Takahashi
- Department of Medical Sciences; Toshiba General Hospital; Tokyo Japan
| | - Mamun Al-Mahtab
- Department of Hepatology; Bangabandhu Sheikh Mujib Medical University; Dhaka Bangladesh
| | | | | | | | | | - Masahiro Arai
- Department of Medical Sciences; Toshiba General Hospital; Tokyo Japan
| | - Shunji Mishiro
- Department of Medical Sciences; Toshiba General Hospital; Tokyo Japan
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Labrique AB, Sikder SS, Krain LJ, West KP, Christian P, Rashid M, Nelson KE. Hepatitis E, a vaccine-preventable cause of maternal deaths. Emerg Infect Dis 2013; 18:1401-4. [PMID: 22931753 PMCID: PMC3437697 DOI: 10.3201/eid1809.120241] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hepatitis E virus (HEV) is a major cause of illness and of death in the developing world and disproportionate cause of deaths among pregnant women. Although HEV vaccine trials, including trials conducted in populations in southern Asia, have shown candidate vaccines to be effective and well-tolerated, these vaccines have not yet been produced or made available to susceptible populations. Surveillance data collected during 2001-2007 from >110,000 pregnancies in a population of ≈650,000 women in rural Bangladesh suggest that acute hepatitis, most of it likely hepatitis E, is responsible for ≈9.8% of pregnancy-associated deaths. If these numbers are representative of southern Asia, as many as 10,500 maternal deaths each year in this region alone may be attributable to hepatitis E and could be prevented by using existing vaccines.
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Affiliation(s)
- Alain B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Rm E5543, Baltimore, MD 21205, USA.
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Fatal outbreaks of jaundice in pregnancy and the epidemic history of hepatitis E. Epidemiol Infect 2012; 140:767-87. [PMID: 22273541 DOI: 10.1017/s0950268811002925] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Space-time clustering of people who fall acutely ill with jaundice, then slip into coma and death, is an alarming phenomenon, more markedly so when the victims are mostly or exclusively pregnant. Documentation of the peculiar, fatal predisposition of pregnant women during outbreaks of jaundice identifies hepatitis E and enables construction of its epidemic history. Between the last decade of the 18th century and the early decades of the 20th century, hepatitis E-like outbreaks were reported mainly from Western Europe and several of its colonies. During the latter half of the 20th century, reports of these epidemics, including those that became serologically confirmed as hepatitis E, emanated from, first, the eastern and southern Mediterranean littoral and, thereafter, Southern and Central Asia, Eastern Europe, and the rest of Africa. The dispersal has been accompanied by a trend towards more frequent and larger-scale occurrences. Epidemic and endemic hepatitis E still beset people inhabiting Asia and Africa, especially pregnant women and their fetuses and infants. Their relief necessitates not only accelerated access to potable water and sanitation but also vaccination against hepatitis E.
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