Hepatitis E – a preventable cause of one in five maternal deaths in Bangladesh?

icddr,b researchers have found that one in five maternal deaths in Bangladesh is associated with jaundice. Many of these cases are likely to be caused by hepatitis E virus, and icddr,b has launched an effectiveness trial of a vaccine that could protect pregnant women from this potentially deadly infection

Hepatitis E virus is principally transmitted through sewerage contamination of the municipal water system. The World Health Organization(WHO) estimates that 20 million people are infected with hepatitis E virus globally each year. The virus is typically fatal in less than 1% of cases, but it appears to pose a much greater risk to pregnant women.

In February 2012, icddr,b researchers published an analysis of causes of maternal and neonatal death in Bangladesh, showing that 19–25% of maternal deaths were associated with jaundice.

In a paper published in  The American Journal of Tropical Medicine and Hygiene in March 2016, Dr Emily Gurley, director of icddr,b’s,emerging infections programme, and her colleagues reported updated and nationwide estimates of the proportion of maternal deaths associated with jaundice using verbal autopsy data from the Bangladesh Maternal Mortality Health Surveys (BMMS).These data showed national rates of maternal deaths associated with jaundice remained basically unchanged between 2001 (19%) and 2010 (23%).

As ‘cause of death’ in the BMMS is determined by verbal autopsy, where household members are interviewed about a person’s symptoms shortly before death, it is not possible tell how many of these cases were caused by hepatitis E virus. However, in published literature, 58% of jaundice-related deaths in pregnant women have been linked to hepatitis E virus infection, suggesting that the virus could be responsible for a significant proportion of maternal deaths in Bangladesh. A new study currently being undertaken by Dr Gurley and her team is intended to confirm these figures. 

Given the existence of an effective hepatitis E vaccine, HEV 239 (Hecolin), maternal deaths caused by HEV are potentially preventable. In 2015, icddr,b senior scientist Dr K Zaman and collaborators at the Norwegian Institute of Public Health received a US$5.5 million grant to conduct an effectiveness trial evaluating the protection of pregnant women by this vaccine in Bangladesh. The study will be conducted at icddr,b’s Matlab field site. As well as assessing how well the vaccine protects pregnant women against jaundice, the study will enable a local vaccine producer, Incepta, to produce a low-cost version of the vaccine for use in Bangladesh.