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Population Seroprevalence of Hepatitis E Virus Antibodies in Rural Bangladesh

Hepatitis E virus (HEV) causes a substantial burden of sporadic and epidemic disease worldwide. HEV infections result in serious morbidity and mortality, especially among pregnant women, and have significant economic costs. Few population-based studies have characterized the epidemiology of HEV. A rural Bangladeshi population was studied to determine the age- and gender- specific population seroprevalence of antibodies to HEV. Of 1,134 specimens tested from a representative, random population sample, 255 (22.5%) were anti-HEV IgG seropositive. Seroprevalence was lower among women (19.7%) than among men (25.8%). We found anti-HBc (hepatitis B core) in 380 of 1080(35.2%) tested, anti-HCV (hepatitis C) in 14 of 917(1.5%) tested, and anti-HAV (hepatitis A) in 116 of 124(93.5%) tested individuals. Our data suggest that viral hepatitis, especially HEV, remains an under-recognized and significant public health problem in rural Bangladeshi populations, warranting further attention.

Received June 22, 2009. Accepted for publication July 20, 2009.

Acknowledgments: The authors thank Dr. Tim Endy, Dr. Mammen P. Mammen Jr, Dr. Khin Saw Aye Myint, and the laboratory team (Kittinun Hussem and Permpanich JibPattama) of the Armed Forces Research Institute of Medical Sciences (AFRIMS) for their generous hepatitis testing support. We also thank the dedication and hard work of the HEV-Matlab field team (Bashiruddin Ahmad, S. R. Paul, A. B. M. Borhan Uddin, Nasrin Akter, Nurunnahar Lina, and Sabina Akhter) and the ICDDR,B and Matlab Health Research Center administration and staff for their support.

Financial support: This study was conducted under an R01 Grant AI51/31/2004 from the National Institutes of Health. Additional support was provided in kind (HAV, HBV, HCV, and HEV antibody testing of study specimens) by the Armed Forces Research Institute of Medical Sciences (AFRIMS), a special foreign activity of the Walter Reed Army Institute of Research (WRAIR) in Bangkok, Thailand.

^* Address correspondence to Alain B. Labrique, Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, E5543, Baltimore, MD 21205. E-mail: alabriqu{at}jhsph.edu

Conflict of interest: None of the authors have any associations that might be deemed a conflict of interest to the publication of this manuscript.

This study was presented in part at the 13th International Symposium on Viral Hepatitis and Liver Disease, March 20–24, 2009, Washington, DC; and the 11th Asian Conference on Diarrhoeal Diseases and Nutrition, March 8–10, 2006, Bangkok, Thailand.

Authors’ addresses: Alain B. Labrique, John Ticehurst, and Kenrad E. Nelson, Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, E5543, Baltimore, MD 21205. K. Zaman, Zahid Hossain, Parimalendu Saha, Mohammad Yunus, and Anowar Hossain, ICDDR,B, Centre for Health and Population Research, Mohakhali, GPO Box 128, Dhaka 1000, Dhaka 1212, Bangladesh.

Reprint requests: Alain B. Labrique, Global Disease Epidemiology and Control Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, E5543, Baltimore, MD 21205.