Population-based estimates of hepatitis E virus associated mortality in Bangladesh

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Copyright: Paul, Repon
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Abstract
Hepatitis E virus (HEV) is a significant public health problem in many resource-poor countries. China has produced and licensed an effective HEV vaccine, but there are limited population-based data on HEV-associated mortality to make informed decisions about introducing the vaccine. The overarching aim of the research in this thesis was to estimate the population-based rate of HEV-associated mortality in Bangladesh. To address this aim, we set up acute jaundice surveillance in six hospitals to estimate the prevalence of HEV infection among patients admitted with acute jaundice. We conducted a mortality survey in the hospitals’ catchment areas to identify deaths associated with acute jaundice. In the rural communities, we applied a novel survey method to identify jaundice-associated deaths and estimated the method’s sensitivity and cost-savings compared to the established house-to-house survey method. The population-based estimates of HEV-specific mortality were then estimated by combining the hospital data with the mortality survey. In the six study hospitals, the prevalence of acute HEV was 34% among patients aged ≥14 years admitted with acute jaundice. The case fatality rate of all acute HEV patients was 5%, but was 12% in pregnancy. The sensitivity of the community knowledge method in identifying maternal deaths was 100% and jaundice-associated deaths aged ≥14 years was 97%. The community knowledge approach required 36% of the staff time to undertake compared to the house-to-house survey. In the hospitals’ catchment area (population of 2.3 million), we identified 612 acute jaundice deaths aged ≥14 years, including 25 maternal deaths. HEV-associated mortality was 0.9 (95% CI: 0.7-1.9) per 100,000 population aged ≥14 years; the maternal mortality ratio associated with HEV was 4.7 (95% CI: 0.7-13.0) per 100,000 live births; the HEV-associated stillbirth rate was 8.1 (95% CI: 3.3-14.8), and the neonatal mortality rate was 22.5 (95% CI: 8.5-39.4) per 100,000 live births. This study provided a robust estimate of HEV-associated mortality in Bangladesh which can be used to determine the cost-effectiveness of HEV vaccination and other control measures to help prioritise public health interventions. The low-cost survey method could be a valuable tool for estimating the population-based burden of hepatitis in low-and middle-income countries.
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Author(s)
Paul, Repon
Supervisor(s)
Gidding, Heather
Hayen, Andrew
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Publication Year
2019
Resource Type
Thesis
Degree Type
PhD Doctorate
UNSW Faculty
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