Clinical features of sporadic hepatitis E virus infection in pregnant women in Shanghai, China

  • Fan Zhang
    Affiliations
    Department of Microbiology and Infectious Disease Centre, School of Basic Medical Sciences, Peking University Health Science Centre, No. 38 Xueyuan Road, Beijing 100191, China
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  • Jiefei Wang
    Affiliations
    Department of Severe Hepatology, Shanghai Public Health Clinical Centre, Fudan University, 2901 Caolang Road, Jin-Shan, Shanghai 201508, China
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  • Jilin Cheng
    Affiliations
    Department of Gastroenterology and Hepatology, Shanghai Public Health Clinical Centre, Fudan University, 2901 Caolang Road, Jin-Shan, Shanghai 201508, China
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  • Xiaohong Zhang
    Affiliations
    Department of Obstetrics and Gynecology, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China
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  • Qiyu He
    Affiliations
    Department of Microbiology and Infectious Disease Centre, School of Basic Medical Sciences, Peking University Health Science Centre, No. 38 Xueyuan Road, Beijing 100191, China
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  • Liang Zhaochao
    Affiliations
    Department of Microbiology and Infectious Disease Centre, School of Basic Medical Sciences, Peking University Health Science Centre, No. 38 Xueyuan Road, Beijing 100191, China
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  • Jingyi Shu
    Affiliations
    Department of Microbiology and Infectious Disease Centre, School of Basic Medical Sciences, Peking University Health Science Centre, No. 38 Xueyuan Road, Beijing 100191, China
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  • Li Yan
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Severe Hepatology, Shanghai Public Health Clinical Centre, Fudan University, 2901 Caolang Road, Jin-Shan, Shanghai 201508, China
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  • Ling Wang
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Microbiology and Infectious Disease Centre, School of Basic Medical Sciences, Peking University Health Science Centre, No. 38 Xueyuan Road, Beijing 100191, China
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  • Lin Wang
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Microbiology and Infectious Disease Centre, School of Basic Medical Sciences, Peking University Health Science Centre, No. 38 Xueyuan Road, Beijing 100191, China
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  • Jianliang Zhang
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Gastroenterology and Hepatology, Shanghai Public Health Clinical Centre, Fudan University, 2901 Caolang Road, Jin-Shan, Shanghai 201508, China
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Published:November 09, 2021DOI:https://doi.org/10.1016/j.jinf.2021.11.004

      Highlights

      • Clinical features in HEV-infected pregnant women in Shanghai, China are generally mild and no maternal mortality occurs.
      • In 42.99% of births adverse foetal/neonatal outcomes seen include preterm births and stillbirths.
      • Anti-HEV IgG may be passed from mother to child.
      • Universal vaccination of women of child-bearing age should be considered in the future to avoid HEV-associated adverse foetal/neonatal outcomes in pregnant women.

      Summary

      Objectives

      Hepatitis E virus (HEV) infection causes high mortality in pregnant women of developing regions during large outbreaks. The aim of this study was to investigate the clinical features of HEV-infected pregnant women in Shanghai, China where the epidemiology of HEV has shifted from large outbreaks to the sporadic form.

      Methods

      Clinical data of 516 pregnant and nonpregnant child-bearing age women diagnosed with HEV infection during 2009–2020 was collected at the Shanghai Public Health Clinical center. Patients’ data were analysed for clinical features and laboratory parameters accordingly.

      Results

      Most of the hospitalized HEV-infected pregnant women (85.23%, 127/149) showed no obvious clinical symptoms and the disease outcome was generally benign with no liver failure or maternal mortality observed in the patients. By comparison, fewer (37.21%, 32/86) of the HEV-infected nonpregnant women were asymptomatic, and five cases (5.81%, 5/86) of liver failure were observed among them. The levels of serum alanine aminotransferase, aspartate aminotransferase, total bilirubin (TBiL), direct bilirubin (DBiL) and total bile acids (TBA) were significantly higher (P < 0.05) in nonpregnant women than those of the pregnant women. We found 42.99% (46/107) births had adverse foetal/neonatal outcome. Mothers who presented with adverse foetal/neonatal outcome showed higher (P < 0.05) serum TBiL, DBiL and TBA levels than those without.

      Conclusion

      We found that the clinical features of sporadic HEV infection in pregnant women in Shanghai, China are generally mild and no maternal mortality occurred. However foetal/neonatal adverse outcomes including preterm births and stillbirths were observed in HEV-infected pregnant women.

      Keywords

      Abbreviations:

      HEV (Hepatitis E Virus), ALT (alanine aminotransferase), AST (aspartate aminotransferase), ALP (alkaline phosphatase), GGT (γ-glutamyl transpeptidase), TBil (total bilirubin), DBiL (direct bilirubin), ALB (albumin), TBA (total bile acids), INR (international normalized ratio), PTA (prothrombin activity)
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