ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
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Shrestha MP , et al.2007. Safety and efficacy of a recombinant hepatitis E vaccine. N Engl J Med 356: 895–903.
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Bilak A , Cordona Fox G , Ginnetti J , Rushing EJ , Schere I , Swain M , Walicki N , Yonetani M , 2016. Global report on internal displacement. Geneva, Switzerland: Internal Displacement Monitoring Centre.
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Basnyat B , Dalton HR , Kamar N , Rein DB , Labrique A , Farrar J , Piot P , 2015. Nepali earthquakes and the risk of an epidemic of hepatitis E. Lancet 385: 2572–2573.
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Shrestha AC , Flower RLP , Seed CR , Rajkarnikar M , Shrestha SK , Thapa U , Hoad VC , Faddy HM , 2016. Hepatitis E virus seroepidemiology: a post-earthquake study among blood donors in Nepal. BMC Infect Dis 16: 707.
-
18.
Shrestha SM , Shrestha S , Tsuda F , Nishizawa T , Gotanda Y , Takeda N , Okamoto H , 2003. Molecular investigation of hepatitis E virus infection in patients with acute hepatitis in Kathmandu, Nepal. J Med Virol 69: 207–214.
-
19.
Clayson ET , Myint KS , Snitbhan R , Vaughn DW , Innis BL , Chan L , Cheung P , Shrestha MP , 1995. Viremia, fecal shedding, and IgM and IgG responses in patients with hepatitis E. J Infect Dis 172: 927–933.
-
20.
Innis BL , Seriwatana J , Robinson RA , Shrestha MP , Yarbough PO , Longer CF , Scott RM , Vaughn DW , Myint KS , 2002. Quantitation of immunoglobulin to hepatitis E virus by enzyme immunoassay. Clin Diagn Lab Immunol 9: 639–648.
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Seriwatana J , Shrestha MP , Scott RM , Tsarev SA , Vaughn DW , Myint KS , Innis BL , 2002. Clinical and epidemiological relevance of quantitating hepatitis E virus-specific immunoglobulin M. Clin Diagn Lab Immunol 9: 1072–1078.
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Gupta BP , Adhikari A , Chaudhary S , 2018. Hepatitis viruses in Kathmandu, Nepal: Hospital-based study. BMC Res Notes 11: 627.
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Shrestha SM , 2006. Hepatitis E in Nepal. Kathmandu Univ Med J 4: 530–544.
-
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Kmush B , Wierzba T , Krain L , Nelson K , Labrique AB , 2013. Epidemiology of hepatitis E in low- and middle-income countries of Asia and Africa. Semin Liver Dis 33: 15–29.
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Izopet J et al.2015. Hepatitis E virus seroprevalence in three hyperendemic areas: Nepal, Bangladesh and southwest France. J Clin Virol 70: 39–42.
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Shrestha P , Bhandari D , Sharma D , Bhandari BP , 2009. A study of viral hepatitis during pregnancy in Nepal Medical College Teaching Hospital. Nepal Med Coll J 11: 192–194.
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Shrestha NS , Saha R , Karki C , 2010. Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital. Kathmandu Univ Med J 8: 222–226.
-
32.
Rana A , Pradhan N , Manandhar B , Bitsta KD , Adhikari S , Gurung G , Amatya A , 2009. Maternal mortality over the last decade: a changing pattern of death due to alarming rise in hepatitis in the latter five-year period. J Obstet Gynaecol Res 35: 243–251.
-
33.
Bergløv A , Hallager S , Weis N , 2019. Hepatitis E during pregnancy: maternal and foetal case-fatality rates and adverse outcomes—a systematic review. J Viral Hepat 26: 1240–1248.
-
34.
Kumar A , Sharma S , Kar P , Agarwal S , Ramji S , Husain SA , Prasad S , Sharma S , 2017. Impact of maternal nutrition in hepatitis E infection in pregnancy. Arch Gynecol Obstet 296: 885–895.
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Historical Analysis of the Risk of Hepatitis E and Its Complications in Pregnant Women in Nepal, 1996–1998
Robert McNair Scott
Robert McNair Scott
Walter Reed/AFRIMS Research Unit—Nepal, Kathmandu, Nepal;
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Brittany L. Kmush
Brittany L. Kmush
Department of Public Health, Food Studies, and Nutrition, Syracuse University, Syracuse, New York;
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Kundu Norkye
Kundu Norkye
Walter Reed/AFRIMS Research Unit—Nepal, Kathmandu, Nepal;
Patan Hospital, Kathmandu, Nepal;
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Patan Hospital, Kathmandu, Nepal;
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Meera Hada
Meera Hada
Patan Hospital, Kathmandu, Nepal;
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Mrigendra Prasad Shrestha
Mrigendra Prasad Shrestha
Walter Reed/AFRIMS Research Unit—Nepal, Kathmandu, Nepal;
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David W. Vaughn
David W. Vaughn
Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand;
Integrated Clinical Vaccine Development, Bill & Melinda Gates Foundation, Seattle, Washington;
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Integrated Clinical Vaccine Development, Bill & Melinda Gates Foundation, Seattle, Washington;
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Khin Saw Aye Myint
Khin Saw Aye Myint
Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand;
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Timothy P. Endy
Timothy P. Endy
Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand;
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Sanjaya K. Shrestha
Sanjaya K. Shrestha
Walter Reed/AFRIMS Research Unit—Nepal, Kathmandu, Nepal;
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Bruce L. Innis
Bruce L. Innis
Department of Virus Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland;
Global Vaccine Development, GlaxoSmithKline Biologicals, King of Prussia, Pennsylvania
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ABSTRACT.
Hepatitis E (HE) during pregnancy can be fatal; there are no prospective risk estimates for HE and its complications during pregnancy. We followed 2,404 pregnant women for HE and pregnancy outcomes from 1996 to 1998. Subjects from Nepal were enrolled at an antenatal clinic with pregnancy of ≤ 24 weeks. Most women (65.1%) were anti-HE virus negative. There were 16 cases of HE (6.7 per 1,000); three mothers died (18.8%) having had intrauterine fetal death (IUFD). Thirteen mothers survived: five preterm and seven full-term deliveries, one IUFD. HE among seronegative women was the sole cause of maternal death and increased the risk of IUFD (relative risk [RR]: 10.6; 95% confidence interval [CI]: 4.29–26.3) and preterm delivery (RR: 17.1, 95% CI 7.56–38.5). HE vaccination of females in at-risk regions before or as they attain reproductive age would reduce their risk for preterm delivery, IUFD, and maternal death.
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Author Notes
Deceased.
Financial support: This study was funded by U.S. Army Medical Research and Materiel Command, Fort Detrick, MD, and GlaxoSmithKline Biologicals, Rixensart, Belgium. The funders played no role in the study design, collection, analysis, and interpretation of data, in the writing of the report, and in the decision to submit the paper for publication.
Disclaimer: The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Defense.
Disclosure: BLI reports employment by GSK 1999 to Jan 2017.
Authors’ addresses: Robert McNair Scott, Retired, Chevy Chase, MD, E-mail: scottrmcn@icloud.com. Brittany L. Kmush, Syracuse University, Syracuse, New York, E-mail: blkmush@syr.edu. Kundu Norkyel, Meera Hada, and Sanjaya K. Shrestha, Walter Reed/AFRIMS Research Unit Nepal (WARUN), Kathmandu, Nepal, E-mails: kunduyangzom@gmail.com, nipponshr@gmail.com, and shresthask.ca@afrims.org. Mrigendra Prasad Shrestha, deceased. David W. Vaughn, Bill & Melinda Gates Foundation, Seattle, WA, E-mail: david.vaugh@gatesfoundation.org. Khin Saw Aye Myint, Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia, E-mail: khinsawying@hotmail.com. Timothy P. Endy, SUNY Upstate Medical University, Syracuse, NY, E-mail: endyt@upstate.edu. Bruce L Innis, PATH Vaccines, Washington, DC, E-mail: binnis@path.org.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Rein DB , Stevens G , Theaker J , Wittenborn JS , Wiersma ST , 2011. 2012. The global burden of hepatitis E virus. Hepatology 55: 988–997.
-
2.
Clayson ET , Shrestha MP , Vaughn DW , Snitbhan R , Shrestha KB , Longer CF , Innis BL , 1997. Rates of hepatitis E virus infection and disease among adolescents and adults in Kathmandu, Nepal. J Infect Dis 176: 763–766.
-
3.
Bista BK , Rana A , 2006. Acute hepatitis E in pregnancy—study of 16 cases. JNMA J Nepal Med Assoc 45: 182–185.
-
4.
Kumar A , Beniwal M , Kar P , Sharma JB , Murthy NS , 2004. Hepatitis E in pregnancy. Int J Gynaecol Obstet 85: 240–244.
-
5.
Boccia D , Guthmann JP , Klovstad H , Hamid N , Tatay M , Ciglenecki I , Nizou JY , Nicand E , Guerin PJ , 2006. High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan. Clin Infect Dis 42: 1679–1684.
-
6.
Patra S , Kumar A , Trivedi SS , Puri M , Sarin SK , 2007. Maternal and fetal outcomes in pregnant women with acute hepatitis E virus infection. Ann Intern Med 147: 28–33.
-
7.
Kar P , Jilani N , Husain SA , Pasha ST , Anand R , Rai A , Das BC , 2008. Does hepatitis E viral load and genotypes influence the final outcome of acute liver failure during pregnancy? Am J Gastroenterol 103: 2495–2501.
-
8.
Singh S , Mohanty A , Joshi YK , Deka D , Mohanty S , Panda SK , 2003. Mother-to-child transmission of hepatitis E virus infection. Indian J Pediatr 70: 37–39.
-
9.
Jin H , Zhao Y , Zhang X , Wang B , Liu P , 2016. Case-fatality risk of pregnant women with acute viral hepatitis type E: A systematic review and meta-analysis. Epidemiol Infect 144: 2098–2106.
-
10.
Shrestha MP , et al.2007. Safety and efficacy of a recombinant hepatitis E vaccine. N Engl J Med 356: 895–903.
-
11.
Zhu FC et al.2010. Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: A large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet 376: 895–902.
-
12.
Park SB , 2012. Hepatitis E vaccine debuts. Nature 491: 21–22.
-
13.
SAGE Working Group on Hepatitis, E , 2015. Hepatitis E vaccine: WHO position paper, May 2015. Wkly Epidemiol Rec 90: 185–200.
-
14.
Innis BL , Lynch JA , 2018. Immunization against hepatitis E. Cold Spring Harb Perspect Med 8: a032573.
-
15.
Bilak A , Cordona Fox G , Ginnetti J , Rushing EJ , Schere I , Swain M , Walicki N , Yonetani M , 2016. Global report on internal displacement. Geneva, Switzerland: Internal Displacement Monitoring Centre.
-
16.
Basnyat B , Dalton HR , Kamar N , Rein DB , Labrique A , Farrar J , Piot P , 2015. Nepali earthquakes and the risk of an epidemic of hepatitis E. Lancet 385: 2572–2573.
-
17.
Shrestha AC , Flower RLP , Seed CR , Rajkarnikar M , Shrestha SK , Thapa U , Hoad VC , Faddy HM , 2016. Hepatitis E virus seroepidemiology: a post-earthquake study among blood donors in Nepal. BMC Infect Dis 16: 707.
-
18.
Shrestha SM , Shrestha S , Tsuda F , Nishizawa T , Gotanda Y , Takeda N , Okamoto H , 2003. Molecular investigation of hepatitis E virus infection in patients with acute hepatitis in Kathmandu, Nepal. J Med Virol 69: 207–214.
-
19.
Clayson ET , Myint KS , Snitbhan R , Vaughn DW , Innis BL , Chan L , Cheung P , Shrestha MP , 1995. Viremia, fecal shedding, and IgM and IgG responses in patients with hepatitis E. J Infect Dis 172: 927–933.
-
20.
Innis BL , Seriwatana J , Robinson RA , Shrestha MP , Yarbough PO , Longer CF , Scott RM , Vaughn DW , Myint KS , 2002. Quantitation of immunoglobulin to hepatitis E virus by enzyme immunoassay. Clin Diagn Lab Immunol 9: 639–648.
-
21.
Myint KS et al.2006. Hepatitis E antibody kinetics in Nepalese patients. Trans R Soc Trop Med Hyg 100: 938–941.
-
22.
Seriwatana J , Shrestha MP , Scott RM , Tsarev SA , Vaughn DW , Myint KS , Innis BL , 2002. Clinical and epidemiological relevance of quantitating hepatitis E virus-specific immunoglobulin M. Clin Diagn Lab Immunol 9: 1072–1078.
-
23.
Armitage P , Berry G , 1994. Statistical Methods in Medical Research. London: Blackwell, 131.
-
24.
Central Bureau of Statistics , 1995. Population Monograph of Nepal. Kathmandu, Nepal: National Planning Commission (NPC), Government of Nepal.
-
25.
Shrestha A et al.2015. Hepatitis E epidemic, Biratnagar, Nepal, 2014. Emerg Infect Dis 21: 711–713.
-
26.
Gupta BP , Adhikari A , Chaudhary S , 2018. Hepatitis viruses in Kathmandu, Nepal: Hospital-based study. BMC Res Notes 11: 627.
-
27.
Shrestha SM , 2006. Hepatitis E in Nepal. Kathmandu Univ Med J 4: 530–544.
-
28.
Kmush B , Wierzba T , Krain L , Nelson K , Labrique AB , 2013. Epidemiology of hepatitis E in low- and middle-income countries of Asia and Africa. Semin Liver Dis 33: 15–29.
-
29.
Izopet J et al.2015. Hepatitis E virus seroprevalence in three hyperendemic areas: Nepal, Bangladesh and southwest France. J Clin Virol 70: 39–42.
-
30.
Shrestha P , Bhandari D , Sharma D , Bhandari BP , 2009. A study of viral hepatitis during pregnancy in Nepal Medical College Teaching Hospital. Nepal Med Coll J 11: 192–194.
-
31.
Shrestha NS , Saha R , Karki C , 2010. Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital. Kathmandu Univ Med J 8: 222–226.
-
32.
Rana A , Pradhan N , Manandhar B , Bitsta KD , Adhikari S , Gurung G , Amatya A , 2009. Maternal mortality over the last decade: a changing pattern of death due to alarming rise in hepatitis in the latter five-year period. J Obstet Gynaecol Res 35: 243–251.
-
33.
Bergløv A , Hallager S , Weis N , 2019. Hepatitis E during pregnancy: maternal and foetal case-fatality rates and adverse outcomes—a systematic review. J Viral Hepat 26: 1240–1248.
-
34.
Kumar A , Sharma S , Kar P , Agarwal S , Ramji S , Husain SA , Prasad S , Sharma S , 2017. Impact of maternal nutrition in hepatitis E infection in pregnancy. Arch Gynecol Obstet 296: 885–895.
-
35.
Devi SG , Kumar A , Kar P , Husain SA , Sharma S , 2014. Association of pregnancy outcome with cytokine gene polymorphisms in HEV infection during pregnancy. J Med Virol 86: 1366–1376.
-
36.
Zhang J et al.2014. Protection against hepatitis E virus infection by naturally acquired and vaccine-induced immunity. Clin Microbiol Infect 20: 397.
-
37.
UNICEF , 2011. State of the World’s Children 2011. New York, NY: Hatteras Press.
-
38.
Ministry of Health Nepal, New Era, ICF , 2017. Nepal Demographic and Health Survey 2016. Kathmandu, Nepal: Ministry of Health, Nepal.
-
39.
Krishna SB, Pradhan A, Barnett S, Puri M, Chitrakar SR, Poudel P, Sharma S, Hulton L, 2009. Nepal Maternal Mortality and Morbidity Study 2008/2009: Summary of Preliminary Findings. Kathmandu, Nepal: Family Health division, Department of Health Services, Ministry of Health, Government of Nepal.
-
40.
Changede P , Chavan N , Raj N , Gupta P , 2019. An observational study to evaluate the maternal and foetal outcomes in pregnancies complicated with jaundice. J Obstet Gynaecol India 69: 31–36.
-
41.
Solanke D , Rathi C , Pandey V , Patil M , Phadke A , Sawant P , 2016. Etiology, clinical profile, and outcome of liver disease in pregnancy with predictors of maternal mortality: a prospective study from western India. Indian J Gastroenterol 35: 450–458.
-
42.
Singla A , Mehta S , Rajaram S , Shree S , 2016. Materno-fetal outcomes with viral hepatitis in pregnancy. J Obstet Gynaecol India 66: 166–169.
-
43.
Puri M , Patra S , Singh P , Malhotra N , Trivedi SS , Sharma S , Kumar A , Sarin SK , 2011. Factors influencing occurrence of postpartum haemorrhage in pregnant women with hepatitis E infection and deranged coagulation profile. Obstet Med 4: 108–112.
-
44.
Khuroo MS , Kamili S , 2003. Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy. J Viral Hepat 10: 61–69.
-
45.
United Nations Population Division , 2017. World population prospects 2017. Available at: https://population.un.org/wpp/Download/Standard/Fertility/. Accessed March 17, 2019.
-
46.
Shrestha AC , Flower RLP , Seed CR , Rajkarnikar M , Shrestha SK , Thapa U , Hoad VC , Faddy HM , 2016. Hepatitis E virus seroepidemiology: a post-earthquake study among blood donors in nepal. BMC Infect Dis 16: 707.
-
47.
Kmush BL et al.2016. The association of cytokines and micronutrients with hepatitis E virus infection during pregnancy and the postpartum period in rural Bangladesh. Am J Trop Med Hyg 94: 203–211.
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