Scholarly article on topic 'Low seroprevalence of hepatitis E virus infection in pregnant women in Yunnan, China'

Low seroprevalence of hepatitis E virus infection in pregnant women in Yunnan, China Academic research paper on "Health sciences"

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Academic research paper on topic "Low seroprevalence of hepatitis E virus infection in pregnant women in Yunnan, China"

The Brazilian Journal of

INFECTIOUS DISEASES

www.elsevier.com/locate/bjid

Letter to the Editor

Low seroprevalence of hepatitis E virus infection in pregnant women in Yunnan, China

Dear Editor,

Hepatitis E virus (HEV) is an important global public health concern, with particularly high mortality in pregnant women.1,2 HEV is highly endemic in China,3 but epidemiological data for HEV among pregnant women are lacking. In the present study, a serosurvey of HEV among pregnant women in Yunnan, China was conducted. Results revealed a low prevalence of HEV infection in pregnant women.

Serum samples from 293 pregnant women (asymptomatic, apparently healthy), 20-41 years old (mean ± S.D. = 27.9 ± 3.9) at 7-37 weeks of pregnancy, were collected. HEV RNA was detected by reverse transcription-nested PCR (RT-nPCR) according to the protocol of previous study,4 but we failed to detect RNA in some subjects.

Thirty serum samples (30/293, 10.24%) were positive for HEV IgG by enzyme-link immunosorbent assay (ELISA). The seropositivity of HEV in Yunnan was lower than that in the neighboring provinces, general population of Guizhou (35.7%)5 or people who keep pigs in Southern China (43%).3 Pregnant women aged 26-30 years had the highest positive rate (13.76%), but there was no correlation

between increasing age and HEV seropositivity (p = 0.169). The seroprevalence in their third trimester was the highest (11.54%, Table 1), although not statistically significant (p = 0.803). In these HEV IgG positive pregnant women, 63.33% were in their second trimester of pregnancy. Four women (4/293, 1.37%) were positive to HEV IgM, all older than 30 years and in their second or third trimester of pregnancy (Table 1). IgM antibody emerged during the acute stage of HEV infection, which is very dangerous considering the extremely high mortality rate during their second or third trimester of pregnancy.2,6 Interesting, all the pregnant women were asymptomatic with normal liver enzymes.

Although the pregnant women were asymptomatic, it indicated that the HEV circulates at low but significant levels. All patients were living in urban settings, but poor hygienic measures and public health conditions could not be excluded in Yunnan, where raw pork is consumed frequently during Spring Festival. Pregnant women in endemic areas in Yunnan need to be screened for HEV infection during their second or third trimester of pregnancy to decrease the high mortality.

Table 1 - Prevalence of anti-HEV IgG and IgM antibodies in pregnant women in Kunming city.

Anti-HEV IgG antibody Anti-HEV IgM antibody

Trimester of pregnancy Age (years) Trimester of pregnancy Age (years)

First Second Third 20-25 26-30 >30 First Second Third 20-25 26-30 >30

Women (n) 30 185 78 110 109 74 80 78 135 76 116 101

Positive (n) 2 19 9 13 15 2 0 2 2 0 0 4

Positive rate (%) 6.67 10.27 11.54 11.81 13.76 2.70 0 2.56 1.48 0 0 3.96

* This work was supported by Natural Science Foundation of Yunnan Province in China (Grant No. 2011FZ068) and Foundation of Yunnan Educational Committee, under Grant No. 2011Y382.

Conflicts of interest

The authors declare no conflicts of interest. references

1. Mushahwar IK. Hepatitis E virus: molecular virology, clinical features, diagnosis, transmission, epidemiology, and prevention. J Med Virol. 2008;80:646-58.

2. Aggarwal R. Clinical presentation of hepatitis E. Virus Res. 2011;161:15-22.

3. Li RC, Ge SX, Li YP, et al. Seroprevalence of hepatitis E virus infection, rural southern People's Republic of China. Emerg Infect Dis. 2006;12:1682-8.

4. Huang FF, Haqshenas G, Guenette DK, et al. Detection by reverse transcription-PCR and genetic characterization of field isolates of swine hepatitis E virus from pigs in different geographic regions of the United States. J Clin Microbiol. 2002;40:1326-32.

5. Dong C, Dai X, Liang J, Dong M, Meng J. Seroprevalence of hepatitis E virus varies considerably among Chinese Provinces. Hepat Mon. 2012;12:386-90.

6. Kumar RM, Uduman S, Rana S, Kochiyil JK, Usmani A, Thomas L. Sero-prevalence and mother-to-infant transmission of hepatitis E virus among pregnant women in the United Arab Emirates. Eur J Obstet Gynecol Reprod Biol. 2001;100:9-15.

Fen Huanga, Tianwu Maa, Li Lib, WeikunZenga, ShenrongJinga*

a Medical Faculty, Kunming University of Science and Technology, Kunming, China

b Kunming Maternal and Child Health Hospital, Kunming, China

* Corresponding author at: Medical Faculty, Kunming University of Science and Technology, Yunnan, China. E-mail address: jingshenrong@163.com (S. Jing).

Received 6 December 2012

Accepted 8 May 2013

Available online 19 September 2013

1413-8670/$ - see front matter

© 2013 Elsevier Editora Ltda. All rights reserved.

http://dx.doi.org/10.1016/j.bjid.2013.02.006