138. Incidence of intrapartum hepatitis E virus infections in two large prospective cohorts of pregnant Bangladeshi women between 2001 and 2010
Session: Oral Abstract Session: Clinical Virology and Treatment
Friday, October 21, 2011: 8:45 AM
Room: 156ABC
Background: Hepatitis E virus (HEV) is the leading cause of acute viral hepatitis globally and results in severe morbidity and mortality in pregnant women, especially in South Asia and Sub-Saharan Africa. There is a paucity of longitudinal data examining the incidence of HEV in cohorts of pregnant women in endemic areas. 
Methods: We studied serial sera collected within two prospective cohorts totaling 110,473 incident pregnancies enrolled as part of large randomized trials in rural northwestern Bangladesh, between 2001 – 2007 (cohort A)  and 2007 – 2010 (cohort B). An NIH research immunoassay was used to identify anti-HEV IgG status in early pregnancy, late pregnancy and 3 month postpartum venous blood specimens, drawn on a subsample of the larger cohorts. A multiplex MSD platform was used to characterize the pro- and anti-inflammatory cytokines in infected and uninfected women. Micronutrient status was determined using HPLC or EIA methods at the JHSPH molecular nutrition laboratory. 
Results: Of the 1,127 specimens available for testing in cohort A, 72 were anti-HEV seropositive at baseline, indicating a seroprevalence of ~6.4%. During this period, 63 women were identified as potential seroconverters, suggesting an incidence rate of ~56 infections per 1000 person-years. In the more recent cohort B, 1100 were available for testing, revealing a ~6.1% seroprevalence in anti-HEV IgG at early pregnancy. Within this cohort, 40 women were identified as putative seroconverters, or 46 infections per 1000 person-years.  In the cohort A, 4 pregnant seroconverters with high antibody titers were evaluated for cytokine profiles, revealing elevated levels of pro-inflammatory cytokines compared to unifected controls and women who were seropositive at baseline.  Seroconverters seem to have lower baseline serum Zinc, Copper and vitamin D levels than non-infected controls. 
Conclusion: Between these two cohorts, the incidence of intrapartum HEV infections seems to be declining in rural Bangladesh. This data elucidates population-based rates of HEV infection rates in pregnancy within a non-epidemic context, where this pathogen is ubiquitous, and identifies putative micronutrient and immunologic risk factors for infection and hepatitis E disease.

Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Alain Labrique, PhD, MHS, MSc, MACE1, Brittany Kmush, MS1, Ronald E. Engle, PhD2, Kerry Schulze, PhD1, Keith West, DrPH, RD1, Robert Purcell, PhD3 and Kenrad Nelson, MD4, (1)International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (2)Hepatitis Viruses Section, NIAID, National Institutes of Health, DHHS, Rockville, MD, (3)Hepatitis Viruses Section, NIAID, NIH, Rockville, MD, (4)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Disclosures:

A. Labrique, None

B. Kmush, None

R. E. Engle, None

K. Schulze, None

K. West, None

R. Purcell, None

K. Nelson, None

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