Population-based Estimates of Hepatitis E Virus Associated Mortality in Bangladesh

Background: Hepatitis E virus (HEV) is endemic in many resource-poor countries. Despite an available vaccine, data on HEV-associated mortality are scarce, hindering informed decisions. This study aims to estimate the population-based rate of HEV-specific mortality in Bangladesh.

Methods: During December 2014-September 2017, we conducted surveillance in six tertiary hospitals in Bangladesh. Patients aged ≥14 years with acute jaundice were recruited, tested for IgM anti-HEV, and followed up post-discharge. A mortality survey in the hospital catchment areas identified deaths associated with acute jaundice, including maternal, stillbirths and neonatal deaths delivered by a mother with acute jaundice during pregnancy, confirmed by two independent physicians reviewing verbal autopsy data.

Results: Out of 1,925 patients with acute jaundice identified and enrolled in the surveillance hospitals, 302 died, with 28 (9%) testing positive for IgM anti-HEV. In the hospital catchment areas, the team identified 587 jaundice-associated deaths, including 25 maternal deaths. Combining hospital-based surveillance and mortality survey data, the study estimated 986 (95% CI: 599-1338) HEV-associated deaths annually among individuals aged ≥14 years in Bangladesh, including 163 (95% CI: 57-395) maternal deaths. Additionally, 279 (95% CI: 101-664) stillbirths and 780 (95% CI: 365-1,297) neonatal deaths were attributed to HEV infection annually.

Conclusions: Prior Global Burden of Disease studies presented wildly varying modeling estimates of HEV-associated annual deaths, ranging from 50,000 in 2013 to 1,932 in 2019. This study is the first to directly measure population-based estimates of mortality in Bangladesh, which can be used to determine the cost-effectiveness of hepatitis E vaccination and other interventions.