European Journal of Obstetrics & Gynecology and Reproductive Biology
Sero-prevalence and mother-to-infant transmission of hepatitis E virus among pregnant women in the United Arab Emirates
Introduction
Hepatitis E virus (HEV) is responsible for water-borne epidemics of acute hepatitis in Asia, Africa and Mexico as well as sporadic disease [1], [2]. Some distinct epidemiologic features of HEV are faecal-oral route transmission presumably through contaminated water supplies, a high attack rate among adults 15–40 years age and high mortality (15–20%) among pregnant women [3], [4].
Although transmission of HEV occurs primarily by the feco-oral route, the parenteral route has also been implicated. There is evidence to suggest vertical transmission of HEV via the intra-uterine and perinatal routes [2].
There is limited information regarding (a) sero-prevalence of hepatitis E among parturient women residing in the United Arab Emirates (UAE), and the value of risk factors in its prevalence, (b) mother-to-infant transmission of hepatitis E virus from infected pregnant women and the natural history of such an acquired infection. Thus, we studied these parameters.
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Material and methods
Consecutive serum samples from 469 pregnant women in the third trimester of pregnancy attending the routine ante-natal clinics of the UAE University teaching hospitals (Al-Ain), were screened for sero-prevalence to HEV, or for the presence of HEV-RNA, after obtaining ethical committee approval and written consent for this study. No patient declined to give consent to this study. All positive assays were done in duplicate. In the UAE, the hospital population is representative of the UAE
Results
Serum samples from 469 pregnant women were analysed. Out of 469 mothers 93 (20%) were anti-HEV positive and 28 (30%) of these 93 were HEV-RNA positive and symptomatic whilst 65 (70%) remained asymtomatic with no evidence of clinical infection at any time. Twelve of these 28 symptomatic women developed acute hepatic disease and two died undelivered, thus, were excluded from further study. Of the 469 serum samples, 87 women (19%) were concomitantly positive for anti-HAV IgG; but negative for
Discussion
Our data suggests a high prevalence of anti-HEV (20%; P<0.001) among pregnant women residing in the UAE; a significant majority being from Egypt and the Indian sub-continent (Table 1). Out of the 28 mothers 21 with on-going hepatic disease are from the eastern states of India and Bangladesh, were there was a rescent escalation of acute hepatitis, although not declared as an epidemic zone. Out of the 12 women 10 who developed acute hepatitis were from the Indian sub-continent, which was
Conclusion
There is a high rate of anti-HEV antibody in pregnant women of Asian and Egyptian origin, residing in the UAE, with a significantly low prevalence among UAE women. Our data revealed that (1) mother-to-infant transmission of the hepatitis E virus, occurred frequently in symptomatic HEV-RNA positive mothers, which contributed to appreciable neonatal morbidity and mortality, (2) HEV infected pregnant women can develop fulminant hepatitis with resultant maternal mortality. This study supports the
Acknowledgements
The authors are deeply grateful to Dr. Ianny Cornfield Consultant Maternal and Foetal Medicine and Consultant Obstetrician and Gynaecologist King Faisal Specialist Hospital and Research Centre Riyadh, for critically appraising this paper and also to Mr. F.A. Khartabeal (Roche Diagnostics) for the gift of PCR kits, and Abbott Laboratories for providing their kits, equipment and technical assistance. We thank Ms. Maureen Dawood for excellent assistance and sister Cynthia and the staff of the
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