Hepatitis E Virus (HEV) Synopsis: General Aspects and Focus on Bangladesh

Abstract

HEV is the most common cause of acute hepatitis globally. This review summarizes the latest knowledge on the epidemiology, clinical characteristics, testing, and treatment of HEV infection. We also focused on Bangladesh to highlight the distinct challenges and the possible remedies. In low-income settings, the virus is mainly transmitted between people by fecal contamination of drinking water causing large outbreaks, and sporadic cases. The disease is usually mild and self-limiting acute hepatitis. Still, pregnant women and their offspring in low-income countries are at particular risk for severe disease, with up to 20% maternal mortality. Despite the high burden of the disease, HEV remains a relatively neglected virus, with detection hampered by costly tests and a lack of suitable treatments. Molecular PCR diagnostics, together with ELISA antibody tests, remain the preferred methods for diagnosis of HEV; however, rapid bedside diagnostics are available and could offer a practical alternative, especially in low-income countries. One vaccine (HEV 239) is only available in China and Pakistan, as efficacy against the other genotypes remains uncertain. The effectiveness trial conducted in Bangladesh might lead the way in gathering more efficacy data and could, together with improved surveillance and raised awareness, dramatically reduce the global burden of HEV.

Keywords: Bangladesh; endemic zones; epidemiology; hepatitis E virus (HEV); vaccine.

Figure 1

Map showing reported outbreak and refugee camp locations in Bangladesh.

Figure 2

Water source in Rohingya refugee camp (photo was taken with Permission).

Figure 3

Rohingya refugee camp Bangladesh.

Figure 4

Hepatitis E epidemiology in 4 distinctive zones.

Figure 5

Diagnostic algorithm of HEV infection [3].