A Serological Approach to Determine the Burden of Hepatitis E in Pregnant Women in Karachi, Pakistan Open Access

Howa, Amanda (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/td96k255b?locale=en


Background: Hepatitis E virus (HEV) is a self-limiting disease in the general population that causes epidemics of acute, viral hepatitis. However, in pregnant women, HEV causes more severe systems leading to obstetric complications, such as maternal death, antepartum hemorrhage, poor fetal outcomes, preterm delivery, and stillbirth. 


Methods: A surveillance study conducted in Karachi, Pakistan from February 2015 to April 2016 recruited 221 mothers and their infants. Serum samples were collected from the mothers at delivery and their infants at birth, six weeks, and eighteen weeks and tested for the presence of IgG anti-HEV and IgM anti-HEV. 


Results: At delivery, 75.1% of mothers were IgG anti-HEV positive. At birth, 74.8% of infants were positive for IgG anti-HEV, at six-weeks 59.1% were IgG anti-HEV, and at eighteen-weeks, 29.8% were IgG anti-HEV positive. At delivery, 7.4% of mothers tested positive for IgM anti-HEV. At birth, less than one percent of infants were positive for IgM anti-HEV. IgM anti-HEV increased to 2.3% in infants at six-weeks and decreased again to 0.7% at eighteen-weeks. Out of 21 total IgM anti-HEV positive individuals, 15 were also IgG anti-HEV positive.  


Conclusion: The presence of IgG anti-HEV antibodies in infants decrease over time from birth to eighteen weeks. Coinciding IgG/IgM anti-HEV positivity signified acute HEV infection, which can have numerous implications and complications with pregnancy, including transfer of infection to the infant. 

Table of Contents

I. Background and Literature Review 1

A. Clinical, Microbiological, and Transmission Characteristics of Hepatitis E 1

B. Hepatitis E in Low Income Countries 3

C. Hepatitis E in Pakistan 3

D. Hepatitis E in Pregnant Women 4

II. Introduction 5

III. Data and Methods 6

IV. Results 8

V. Discussion 8

VI. Public Health Implications 10

VII. Tables and Figures 11

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