Historical Analysis of the Risk of Hepatitis E and Its Complications in Pregnant Women in Nepal, 1996–1998

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  • 1 Walter Reed/AFRIMS Research Unit—Nepal, Kathmandu, Nepal
  • 2 Department of Public Health, Food Studies, and Nutrition, Syracuse University, Syracuse, New York
  • 3 Patan Hospital, Kathmandu, Nepal
  • 4 Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
  • 5 Integrated Clinical Vaccine Development, Bill & Melinda Gates Foundation, Seattle, Washington
  • 6 Department of Virus Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland
  • 7 Global Vaccine Development, GlaxoSmithKline Biologicals, King of Prussia, Pennsylvania

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

Address correspondence to Bruce L. Innis, PATH Vaccines, Washington, DC 20001. E-mail: binnis@path.org


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.