Hepatitis E epidemiology and demographics: Difference between revisions
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==Overview== | ==Overview== | ||
An estimated 20 million [[HEV infection]]s and 3.3 million acute cases occur annually worldwide with an estimated 56 600 deaths.<ref name=WHO>{{cite web | title = Hepatitis E | url = http://www.who.int/mediacentre/factsheets/fs280/en/ }}</ref> [[HEV]] displays different epidemiological and clinical characteristics between developing and developed countries.<ref name=CDC>{{cite web | title = Hepatitis E Epidemiology | url = http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/hepatitis-e }}</ref> In the United States, studies show an [[incidence]] of 700 cases per 100,000 of the overall population, and a [[seroprevalence]] of 21,000 per 100,000 persons. Clinical manifestations of hepatitis E are more frequent among adult patients. When compared to men, women have a smaller rate of hepatitis E (20,4% vs 21,6%). Pregnant women are more prone to develop severe cases of the disease. In developed countries, the disease often occurs as small [[outbreaks]], commonly transmitted by [[ingestion]] of undercooked meat. In developing countries disease may occur as an [[epidemic]] | An estimated 20 million [[HEV infection]]s and 3.3 million acute cases occur annually worldwide with an estimated 56 600 deaths.<ref name=WHO>{{cite web | title = Hepatitis E | url = http://www.who.int/mediacentre/factsheets/fs280/en/ }}</ref> [[HEV]] displays different epidemiological and clinical characteristics between developing and developed countries.<ref name=CDC>{{cite web | title = Hepatitis E Epidemiology | url = http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/hepatitis-e }}</ref> In the United States, studies show an [[incidence]] of 700 cases per 100,000 of the overall population, and a [[seroprevalence]] of 21,000 per 100,000 persons. Clinical manifestations of hepatitis E are more frequent among adult patients. When compared to men, women have a smaller rate of hepatitis E (20,4% vs 21,6%). Pregnant women are more prone to develop severe cases of the disease. In developed countries, the disease often occurs as small [[outbreaks]], commonly transmitted by [[ingestion]] of undercooked meat. In developing countries, the disease may occur as an [[epidemic]], or as [[outbreaks]], and is often associated with [[genotype]]s 1 and 2, which are transmitted through the [[ingestion]] of contaminated water. | ||
==Prevalence== | ==Prevalence== | ||
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The rate of anti-[[HEV]] [[antibodies]] increases with age. According to a survey conducted in the US from 1988 to 1994, this rate can range from 10% (6 to 10 years) to 40% (>60 years).<ref name="pmid19473098">{{cite journal| author=Kuniholm MH, Purcell RH, McQuillan GM, Engle RE, Wasley A, Nelson KE| title=Epidemiology of hepatitis E virus in the United States: results from the Third National Health and Nutrition Examination Survey, 1988-1994. | journal=J Infect Dis | year= 2009 | volume= 200 | issue= 1 | pages= 48-56 | pmid=19473098 | doi=10.1086/599319 | pmc=PMC2762746 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19473098 }} </ref> | The rate of anti-[[HEV]] [[antibodies]] increases with age. According to a survey conducted in the US from 1988 to 1994, this rate can range from 10% (6 to 10 years) to 40% (>60 years).<ref name="pmid19473098">{{cite journal| author=Kuniholm MH, Purcell RH, McQuillan GM, Engle RE, Wasley A, Nelson KE| title=Epidemiology of hepatitis E virus in the United States: results from the Third National Health and Nutrition Examination Survey, 1988-1994. | journal=J Infect Dis | year= 2009 | volume= 200 | issue= 1 | pages= 48-56 | pmid=19473098 | doi=10.1086/599319 | pmc=PMC2762746 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19473098 }} </ref> | ||
==Gender== | ==Gender== | ||
Women have a | Women have a smaller rate of anti-HEV antibodies (20.4%) than men (21.6%).<ref name="pmid22549046">{{cite journal| author=Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J et al.| title=Hepatitis E. | journal=Lancet | year= 2012 | volume= 379 | issue= 9835 | pages= 2477-88 | pmid=22549046 | doi=10.1016/S0140-6736(11)61849-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22549046 }} </ref> | ||
===Pregnant Women=== | ===Pregnant Women=== | ||
Although pregnant women have the same exposure to the [[virus]] as other people, due to their [[micronutrient]] status and [[cytokine]] levels, they are more prone to the severe form of the disease. <ref name="pmid23013075">{{cite journal| author=Hoofnagle JH, Nelson KE, Purcell RH| title=Hepatitis E. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 13 | pages= 1237-44 | pmid=23013075 | doi=10.1056/NEJMra1204512 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23013075 }} </ref> | Although pregnant women have the same exposure to the [[virus]] as other people, due to their [[micronutrient]] status and [[cytokine]] levels, they are more prone to the severe form of the disease. <ref name="pmid23013075">{{cite journal| author=Hoofnagle JH, Nelson KE, Purcell RH| title=Hepatitis E. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 13 | pages= 1237-44 | pmid=23013075 | doi=10.1056/NEJMra1204512 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23013075 }} </ref> | ||
In [[outbreak]]-prone areas pregnant women (whether infected sporadically or during an [[epidemic]]) are at risk of progressing to [[liver failure]] and death after infection. [[Miscarriages]] and [[neonatal death]] | In [[outbreak]]-prone areas, pregnant women (whether infected sporadically or during an [[epidemic]]) are at risk of progressing to [[liver failure]] and death after infection. [[Miscarriages]] and [[neonatal death]] occur commonly as a result of [[HEV infection]].<ref name=CDC>{{cite web | title = Hepatitis E Epidemiology | url = http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/hepatitis-e }}</ref> | ||
==Race== | ==Race== | ||
After adjusting to age, the rate of anti-HEV antibodies was noted to be higher in non-hispanic whites (22.1%) than among blacks (14.5%).<ref name="pmid19473098">{{cite journal| author=Kuniholm MH, Purcell RH, McQuillan GM, Engle RE, Wasley A, Nelson KE| title=Epidemiology of hepatitis E virus in the United States: results from the Third National Health and Nutrition Examination Survey, 1988-1994. | journal=J Infect Dis | year= 2009 | volume= 200 | issue= 1 | pages= 48-56 | pmid=19473098 | doi=10.1086/599319 | pmc=PMC2762746 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19473098 }} </ref> | After adjusting to age, the rate of anti-HEV antibodies was noted to be higher in non-hispanic whites (22.1%) than among blacks (14.5%).<ref name="pmid19473098">{{cite journal| author=Kuniholm MH, Purcell RH, McQuillan GM, Engle RE, Wasley A, Nelson KE| title=Epidemiology of hepatitis E virus in the United States: results from the Third National Health and Nutrition Examination Survey, 1988-1994. | journal=J Infect Dis | year= 2009 | volume= 200 | issue= 1 | pages= 48-56 | pmid=19473098 | doi=10.1086/599319 | pmc=PMC2762746 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19473098 }} </ref> | ||
==Developed Countries== | ==Developed Countries== | ||
Small outbreaks and | Small [[outbreaks]] and individual cases of hepatitis E are often related to consumption of undercook pork, shellfish, as well as to [[blood transfusions]].<ref name="pmid23013075">{{cite journal| author=Hoofnagle JH, Nelson KE, Purcell RH| title=Hepatitis E. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 13 | pages= 1237-44 | pmid=23013075 | doi=10.1056/NEJMra1204512 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23013075 }} </ref><ref name="pmid16623913">{{cite journal| author=Boxall E, Herborn A, Kochethu G, Pratt G, Adams D, Ijaz S et al.| title=Transfusion-transmitted hepatitis E in a 'nonhyperendemic' country. | journal=Transfus Med | year= 2006 | volume= 16 | issue= 2 | pages= 79-83 | pmid=16623913 | doi=10.1111/j.1365-3148.2006.00652.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16623913 }} </ref><ref name="pmid18651907">{{cite journal| author=Matsubayashi K, Kang JH, Sakata H, Takahashi K, Shindo M, Kato M et al.| title=A case of transfusion-transmitted hepatitis E caused by blood from a donor infected with hepatitis E virus via zoonotic food-borne route. | journal=Transfusion | year= 2008 | volume= 48 | issue= 7 | pages= 1368-75 | pmid=18651907 | doi=10.1111/j.1537-2995.2008.01722.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18651907 }} </ref><ref name="pmid18983248">{{cite journal| author=Wichmann O, Schimanski S, Koch J, Kohler M, Rothe C, Plentz A et al.| title=Phylogenetic and case-control study on hepatitis E virus infection in Germany. | journal=J Infect Dis | year= 2008 | volume= 198 | issue= 12 | pages= 1732-41 | pmid=18983248 | doi=10.1086/593211 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18983248 }} </ref> The rate of anti-[[HEV]] [[antibodies]] is lower than in developing countries. <ref name="pmid23013075">{{cite journal| author=Hoofnagle JH, Nelson KE, Purcell RH| title=Hepatitis E. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 13 | pages= 1237-44 | pmid=23013075 | doi=10.1056/NEJMra1204512 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23013075 }} </ref> | ||
==Developing Countries== | ==Developing Countries== | ||
Hepatitis E may occur either as a sporadic case, or as an [[epidemic]] disease. It is often caused by [[genotype]]s 1 (Asia) and 2 (Central America and Africa).<ref name="pmid18192058">{{cite journal| author=Purcell RH, Emerson SU| title=Hepatitis E: an emerging awareness of an old disease. | journal=J Hepatol | year= 2008 | volume= 48 | issue= 3 | pages= 494-503 | pmid=18192058 | doi=10.1016/j.jhep.2007.12.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18192058 }} </ref> Anti-HEV antibodies were detected in 30 to 80% of adults.<ref name="pmid23013075">{{cite journal| author=Hoofnagle JH, Nelson KE, Purcell RH| title=Hepatitis E. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 13 | pages= 1237-44 | pmid=23013075 | doi=10.1056/NEJMra1204512 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23013075 }} </ref> | Hepatitis E may occur either as a sporadic case, or as an [[epidemic]] disease. It is often caused by [[genotype]]s 1 (Asia) and 2 (Central America and Africa).<ref name="pmid18192058">{{cite journal| author=Purcell RH, Emerson SU| title=Hepatitis E: an emerging awareness of an old disease. | journal=J Hepatol | year= 2008 | volume= 48 | issue= 3 | pages= 494-503 | pmid=18192058 | doi=10.1016/j.jhep.2007.12.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18192058 }} </ref> Anti-HEV antibodies were detected in 30 to 80% of adults.<ref name="pmid23013075">{{cite journal| author=Hoofnagle JH, Nelson KE, Purcell RH| title=Hepatitis E. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 13 | pages= 1237-44 | pmid=23013075 | doi=10.1056/NEJMra1204512 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23013075 }} </ref> | ||
The highest seroprevalence rates | The highest [[seroprevalence]] rates are observed in regions where low standards of sanitation increase the risk for [[transmission]] of the virus. Over 60% of all [[HEV]] infections and 65% of all hepatitis E deaths occur in East and South Asia, where [[seroprevalence]] rates of 25% are common in some age groups. In Egypt, half the population aged above five years is serologically positive for the [[hepatitis E virus]].<ref name=WHO>{{cite web | title = Hepatitis E | url = http://www.who.int/mediacentre/factsheets/fs280/en/ }}</ref> | ||
Men in developing countries manifest symptoms of hepatitis E 2 to 5 times more than women during [[outbreaks]].<ref name="pmid1909252">{{cite journal| author=Zhuang H, Cao XY, Liu CB, Wang GM| title=Epidemiology of hepatitis E in China. | journal=Gastroenterol Jpn | year= 1991 | volume= 26 Suppl 3 | issue= | pages= 135-8 | pmid=1909252 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1909252 }} </ref><ref name="pmid11871830">{{cite journal| author=Aggarwal R, Kumar R, Pal R, Naik S, Semwal SN, Naik SR| title=Role of travel as a risk factor for hepatitis E virus infection in a disease-endemic area. | journal=Indian J Gastroenterol | year= 2002 | volume= 21 | issue= 1 | pages= 14-8 | pmid=11871830 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11871830 }} </ref> | Men in developing countries manifest symptoms of hepatitis E 2 to 5 times more than women during [[outbreaks]].<ref name="pmid1909252">{{cite journal| author=Zhuang H, Cao XY, Liu CB, Wang GM| title=Epidemiology of hepatitis E in China. | journal=Gastroenterol Jpn | year= 1991 | volume= 26 Suppl 3 | issue= | pages= 135-8 | pmid=1909252 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1909252 }} </ref><ref name="pmid11871830">{{cite journal| author=Aggarwal R, Kumar R, Pal R, Naik S, Semwal SN, Naik SR| title=Role of travel as a risk factor for hepatitis E virus infection in a disease-endemic area. | journal=Indian J Gastroenterol | year= 2002 | volume= 21 | issue= 1 | pages= 14-8 | pmid=11871830 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11871830 }} </ref> | ||
Revision as of 02:08, 28 August 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
An estimated 20 million HEV infections and 3.3 million acute cases occur annually worldwide with an estimated 56 600 deaths.[1] HEV displays different epidemiological and clinical characteristics between developing and developed countries.[2] In the United States, studies show an incidence of 700 cases per 100,000 of the overall population, and a seroprevalence of 21,000 per 100,000 persons. Clinical manifestations of hepatitis E are more frequent among adult patients. When compared to men, women have a smaller rate of hepatitis E (20,4% vs 21,6%). Pregnant women are more prone to develop severe cases of the disease. In developed countries, the disease often occurs as small outbreaks, commonly transmitted by ingestion of undercooked meat. In developing countries, the disease may occur as an epidemic, or as outbreaks, and is often associated with genotypes 1 and 2, which are transmitted through the ingestion of contaminated water.
Prevalence
In the United States, the seroprevalence of hepatitis E is 21,000 per 100,000 (21%) of the overall population.[3]
Incidence
The estimated annual incidence of hepatitis E in the United States is 700 per 100,000 (0.7%) of the overall population.[4]
Age
Clinical manifestations of hepatitis E are highest in young adults aged 15 to 49 years.[2] The rate of anti-HEV antibodies increases with age. According to a survey conducted in the US from 1988 to 1994, this rate can range from 10% (6 to 10 years) to 40% (>60 years).[5]
Gender
Women have a smaller rate of anti-HEV antibodies (20.4%) than men (21.6%).[3]
Pregnant Women
Although pregnant women have the same exposure to the virus as other people, due to their micronutrient status and cytokine levels, they are more prone to the severe form of the disease. [6]
In outbreak-prone areas, pregnant women (whether infected sporadically or during an epidemic) are at risk of progressing to liver failure and death after infection. Miscarriages and neonatal death occur commonly as a result of HEV infection.[2]
Race
After adjusting to age, the rate of anti-HEV antibodies was noted to be higher in non-hispanic whites (22.1%) than among blacks (14.5%).[5]
Developed Countries
Small outbreaks and individual cases of hepatitis E are often related to consumption of undercook pork, shellfish, as well as to blood transfusions.[6][7][8][9] The rate of anti-HEV antibodies is lower than in developing countries. [6]
Developing Countries
Hepatitis E may occur either as a sporadic case, or as an epidemic disease. It is often caused by genotypes 1 (Asia) and 2 (Central America and Africa).[10] Anti-HEV antibodies were detected in 30 to 80% of adults.[6]
The highest seroprevalence rates are observed in regions where low standards of sanitation increase the risk for transmission of the virus. Over 60% of all HEV infections and 65% of all hepatitis E deaths occur in East and South Asia, where seroprevalence rates of 25% are common in some age groups. In Egypt, half the population aged above five years is serologically positive for the hepatitis E virus.[1]
Men in developing countries manifest symptoms of hepatitis E 2 to 5 times more than women during outbreaks.[11][12]
References
- ↑ 1.0 1.1 "Hepatitis E".
- ↑ 2.0 2.1 2.2 2.3 "Hepatitis E Epidemiology".
- ↑ 3.0 3.1 Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J; et al. (2012). "Hepatitis E." Lancet. 379 (9835): 2477–88. doi:10.1016/S0140-6736(11)61849-7. PMID 22549046.
- ↑ Kantala T, Maunula L, von Bonsdorff CH, Peltomaa J, Lappalainen M (2009). "Hepatitis E virus in patients with unexplained hepatitis in Finland". J Clin Virol. 45 (2): 109–13. doi:10.1016/j.jcv.2009.03.006. PMID 19376741.
- ↑ 5.0 5.1 Kuniholm MH, Purcell RH, McQuillan GM, Engle RE, Wasley A, Nelson KE (2009). "Epidemiology of hepatitis E virus in the United States: results from the Third National Health and Nutrition Examination Survey, 1988-1994". J Infect Dis. 200 (1): 48–56. doi:10.1086/599319. PMC 2762746. PMID 19473098.
- ↑ 6.0 6.1 6.2 6.3 Hoofnagle JH, Nelson KE, Purcell RH (2012). "Hepatitis E." N Engl J Med. 367 (13): 1237–44. doi:10.1056/NEJMra1204512. PMID 23013075.
- ↑ Boxall E, Herborn A, Kochethu G, Pratt G, Adams D, Ijaz S; et al. (2006). "Transfusion-transmitted hepatitis E in a 'nonhyperendemic' country". Transfus Med. 16 (2): 79–83. doi:10.1111/j.1365-3148.2006.00652.x. PMID 16623913.
- ↑ Matsubayashi K, Kang JH, Sakata H, Takahashi K, Shindo M, Kato M; et al. (2008). "A case of transfusion-transmitted hepatitis E caused by blood from a donor infected with hepatitis E virus via zoonotic food-borne route". Transfusion. 48 (7): 1368–75. doi:10.1111/j.1537-2995.2008.01722.x. PMID 18651907.
- ↑ Wichmann O, Schimanski S, Koch J, Kohler M, Rothe C, Plentz A; et al. (2008). "Phylogenetic and case-control study on hepatitis E virus infection in Germany". J Infect Dis. 198 (12): 1732–41. doi:10.1086/593211. PMID 18983248.
- ↑ Purcell RH, Emerson SU (2008). "Hepatitis E: an emerging awareness of an old disease". J Hepatol. 48 (3): 494–503. doi:10.1016/j.jhep.2007.12.008. PMID 18192058.
- ↑ Zhuang H, Cao XY, Liu CB, Wang GM (1991). "Epidemiology of hepatitis E in China". Gastroenterol Jpn. 26 Suppl 3: 135–8. PMID 1909252.
- ↑ Aggarwal R, Kumar R, Pal R, Naik S, Semwal SN, Naik SR (2002). "Role of travel as a risk factor for hepatitis E virus infection in a disease-endemic area". Indian J Gastroenterol. 21 (1): 14–8. PMID 11871830.