Viral hepatitis E in pregnant women in Belarus: clinical examples and molecular genetic characterization of the virus
https://doi.org/10.51523/2708-6011.2023-20-4-14
Abstract
Objective. To conduct a clinical and molecular genetic study of two cases of acute hepatitis E in pregnant women from Belarus.
Materials and methods. A total of 227 pregnant women with clinical symptoms of liver damage were included in the study. Blood serum samples were used for detection of antibodies to hepatitis E virus by enzyme-linked immunosorbent assay, virus nucleic acid was detected from fecal samples by reverse transcription nested polymerase chain reaction. The nucleotide sequence was determined on an automated sequencer using the Sanger method. Nucleotide sequences were analyzed, genotyped and evolutionary distances calculated using MEGA X software.
Results. Out of 227 sera tested, immunoglobulins of class G to hepatitis E virus were detected in 15, which is 6.61%. M immunoglobulins were also detected in the blood of six pregnant women, which is 2.6%. Two clinically evident cases of acute hepatitis E were identified. One of the two patients ended her pregnancy with antenatal fetal death. Virus nucleic acid was isolated from another woman diagnosed with hepatitis E, who had an episode of nutritional contact with raw minced pork. The virus RNA sequence isolated from this patient’s body is clustered into a common phylogenetic branch with the sequence obtained from the body of a patient from Belarus with a history of kidney transplantation and sequences isolated from the body of a domestic pig in the Republic of Belarus.
Conclusion. Hepatitis E virus poses a significant threat to pregnant women. A set of preventive measures against hepatitis E in pregnant women has been proposed.
About the Authors
V. V. DavydovBelarus
Vladimir V. Davydov, Candidate of Biological Sciences, Associate Professor, Head of the Department of Biology
Minsk
T. V. Znovets
Russian Federation
Tatyana V. Znovets, Candidate of Medical Sciences, Deputy Chief Physician for Obstetrics
Minsk
S. I. Marchuk
Belarus
Svetlana I. Marchuk, Researcher of the Laboratory of Biochemical Research Methods of the Scientific Part
Minsk
A. S. Babenka
Belarus
Andrey S. Babenka, Candidate of Chemical Sciences, Associate Professor, Associate Professor of the Department of Bioorganic Chemistry
Minsk
E. L. Gasich
Belarus
Elena L. Gasich, Doctor of Biology, Associate Professor, Head of the Laboratory for Diagnosis of HIV and Concomitant Infections
Minsk
S. V. Zhavoronok
Belarus
Sergey V. Zhavoronok, Doctor of Medical Sciences, Professor, Professor of the Department of Infectious Diseases
Minsk
References
1. Nimgaonkar I, Ding Q, Schwartz RE, Ploss A. Hepatitis E virus: advances and challenges. Nat Rev Gastroenterol Hepatol. 2018;15(2):96-110. DOI: https://doi.org/10.1038/nrgastro.2017.150
2. Hepatitis E: Information bulletin of the World Health Organization, 2023. [Electronic resource]. World Health Organization Global Website. [accessed 2023 May 05]. Access mode: https:// www.who.int/news-room/fact-sheets/detail/hepatitis-e (In Russ.).
3. Bazerbachi F, Haffar S, Garg SK, Lake JR. Extra-hepatic manifestations associated with hepatitis E virus infection: a comprehensive review of the literature. Gastroenterology Report. 2016;4(1):1-15. DOI: https://doi.org/10.1093/gastro/gov042
4. Khuroo NS, Khuroo MS, Khuroo MS. Hepatitis E: Discovery, global impact, control and cure. World Journal of Gastroenterology. 2016;22(31):7030-7045. DOI: https://doi.org/10.3748/wjg.v22.i31.7030
5. Wang B, Meng XJ. Hepatitis E virus: host tropism and zoonotic infection. Curr Opin Microbiol. 2021;59:8-15. DOI: https://doi.org/10.1016/j.mib.2020.07.004
6. Rivadulla E, Varela MF, Mesquita JR, Nascimento MSJ, Romalde JL. Detection of Hepatitis E Virus in Shellfish Harvesting Areas from Galicia (Northwestern Spain). Viruses. 2019;11(7):618. DOI: https://doi.org/10.3390/v11070618
7. Geng Y, Zhao C, Geng K, et al. High seroprevalence of hepatitis E virus in rabbit slaughterhouse workers. Transboundary and Emerging Diseases. 2019;66(2):1085-1089. DOI: https://doi.org/10.1111/tbed.13130
8. Tei S, Kitajima N, Takahashi K, Mishiro S. Zoonotic transmission of hepatitis E virus from deer to human beings. The Lancet. 2003;362(9381):371-373. DOI: https://doi.org/10.1016/S0140-6736(03)14025-1
9. Capai L, Charrel R, Falchi A. Hepatitis E in High-Income Countries: What Do We Know? And What Are the Knowledge Gaps? Viruses. 2018;10(6):285. DOI: https://doi.org/10.3390/v10060285
10. Domanović D, Tedder R, Blümel J, et al. Hepatitis E and blood donation safety in selected European countries: a shift to screening? Eurosurveillance. 2017;22(16):30514. DOI: https://doi.org/10.2807/1560-7917.ES.2017.22.16.30514
11. Kamar N, Abravanel F, Behrendt P. Ribavirin for Hepatitis E Virus Infection After Organ Transplantation: A Large European Retrospective Multicenter Study. Clinical Infectious Diseases. 2020;71(5):1204-1211. DOI: https://doi.org/10.1093/cid/ciz953
12. Shao Z, Tibi MA, Wakim-Fleming J. Update on viral hepatitis in pregnancy. CCJM. 2017;84(3):202-206. DOI: https://doi.org/10.3949/ccjm.84a.15139
13. GEV 239 for Hepatitis E and Immunization [Electronic resource] – Website of the Clinical Trials Registry ICH GCP. [Accessed: 2023 April 03]. Access mode: https://ichgcp.net/ru/clinical-trials-registry/NCT03827395 (In Russ.).
14. Pérez-Gracia MT, Suay-García B, Mateos-Lindemann ML. Hepatitis E and pregnancy: current state. Reviews in Medical Virology. 2017;27(3):e1929. DOI: https://doi.org/10.1002/rmv.1929
15. Khuroo MS, Khuroo MS, Khuroo NS. Transmission of Hepatitis E Virus in Developing Countries. Viruses. 2016;8(9):253. DOI: https://doi.org/10.3390/v8090253
16. Sinclair SM, Jones JK, Miller RK, Greene MF, Kwo PY, Maddrey WC. The Ribavirin Pregnancy Registry: An Interim Analysis of Potential Teratogenicity at the Mid-Point of Enrollment. Drug Saf. 2017;40(12):1205-1218. DOI: https://doi.org/10.1007/s40264-017-0566-6
17. Balayan MS, Andjaparidze AG, Savinskaya SS. Evidence for a Virus in Non-A, Non-B Hepatitis Transmitted via the Fecal-Oral Route. INT. 1983;20(1):23-31. DOI: https://doi. org/10.1159/000149370
18. Purdy MA, Drexler JF, Meng XJ, et al. ICTV Virus Taxonomy Profile: Hepeviridae 2022. Journal of General Virology. 2022;103(9):001778. DOI: https://doi.org/10.1099/jgv.0.001778
19. Himmelsbach K, Bender D, Hildt E. Life cycle and morphogenesis of the hepatitis E virus. Emerging Microbes & Infections. 2018;7(1):1-12. DOI: https://doi.org/10.1038/s41426-018-0198-7
20. Kar P, Sengupta A. A guide to the management of hepatitis E infection during pregnancy. Expert Review of Gastroenterology & Hepatology. 2019;13(3):205-211. DOI: https://doi.org/10.1080/17474124.2019.1568869
21. Jaiswal SPB, Jain AK, Naik G, Soni N, Chitnis DS. Viral hepatitis during pregnancy. International Journal of Gynecology & Obstetrics. 2001;72(2):103-108. DOI: https://doi.org/10.1016/ S0020-7292(00)00264-2
22. Lachish T, Erez O, Daudi N, Shouval D, Schwartz E. Acute hepatitis E virus in pregnant women in Israel and in other industrialized countries. Journal of Clinical Virology. 2015;73:20-24. DOI: https://doi.org/10.1016/j.jcv.2015.10.011
23. Chaudhry SA, Verma N, Koren G. Hepatitis E infection during pregnancy. Can Fam Physician. 2015;61(7):607-608.
24. Anty R, Ollier L, Péron JM, et al. First case report of an acute genotype 3 hepatitis E infected pregnant woman living in South-Eastern France. Journal of Clinical Virology. 2012;54(1):76-78. DOI: https://doi.org/10.1016/j.jcv.2012.01.016
25. Tabatabai J, Wenzel JJ, Soboletzki M, Flux C, Navid MH, Schnitzler P. First case report of an acute hepatitis E subgenotype 3c infection during pregnancy in Germany. Journal of Clinical Virology. 2014;61(1):170-172. DOI: https://doi.org/10.1016/j.jcv.2014.06.008
26. Navaneethan U, Al Mohajer M, Shata MT. Hepatitis E and pregnancy: understanding the pathogenesis. Liver International. 2008;28(9):1190-1199. DOI: https://doi.org/10.1111/j.1478-3231.2008.01840.x
27. Wu C, Wu X, Xia J. Hepatitis E virus infection during pregnancy. Virology Journal. 2020;17(1):73. DOI: https://doi.org/10.1186/s12985-020-01343-9
28. El-Mokhtar MA, Othman ER, Khashbah MY. Evidence of the Extrahepatic Replication of Hepatitis E Virus in Human Endometrial Stromal Cells. Pathogens. 2020;9(4):295. DOI: https://doi.org/10.3390/pathogens9040295
29. Krasochko PA, Zhavoronok SV, Borisovets DS, Krasochko PP, Alatortseva GI, Prokopenkova TM. Development of test systems for semi-quantitative detection of antibodies to the hepatitis E virus in pigs in the Republic of Belarus. News of the National Academy of Sciences of Belarus Series of Agrarian Sciences. 2020;58(3):339-351. (In Russ.). DOI: https://doi.org/10.29235/1817-7204-2020-58-3-339-351
30. Alatortseva GI, Sidorov AV, Nesterenko LN, Lukhverchik LN, Amiantova II, Dotsenko VV, et al. Recombinant protein containing antigenically significant fragments of hepatitis E virus proteins, used in test systems for the serodiagnosis of hepatitis E (variants). Patent RU 2711907 C2, 2020 January 23. (In Russ.).
31. Arabey AA, Marchuk SI, Zhavoronok SV, Davydov VV, Kyuregyan KK, Mikhailov MI. Adapted polymerase chain reaction method for detecting hepatitis E virus in humans and animals. Military medicine. 2018;(3):86-92. (In Russ.).
32. Kumar S, Stecher G, Li M, Knyaz C, Tamura K. MEGA X: Molecular Evolutionary Genetics Analysis across Computing Platforms. Mol Biol Evol. 2018;35(6):1547-1549. DOI: https://doi.org/10.1093/molbev/msy096
33. Smith DB, Izopet J, Nicot F, et al. Update: proposed reference sequences for subtypes of hepatitis E virus (species Orthohepevirus A). Journal of General Virology. 2020;101(7):692-698. DOI: https://doi.org/10.1099/jgv.0.001435
34. Hasegawa M, Kishino H, Yano T. Dating of the human-ape splitting by a molecular clock of mitochondrial DNA. J Mol Evol. 1985;22(2):160-174. DOI:1 https://doi.org/10.1007/BF02101694
35. Davydov VV, Zhavoronok SV, Rogacheva TA. Prevalence of antibodies to the hepatitis E virus in the population of regions of the Republic of Belarus. Journal of Microbiology, Epidemiology and Immunobiology. 2022;99(2):160-171. (In Russ.). DOI: https://doi.org/10.36233/0372-9311-236
36. Su YY, Huang SJ, Guo M, et al. Persistence of antibodies acquired by natural hepatitis E virus infection and effects of vaccination. Clinical Microbiology and Infection. 2017;23(5):336. e1-336.e4. DOI: https://doi.org/10.1016/j.cmi.2016.10.029
37. Davydov VV, Zhavoronok SV, Zadora IS, Novak LV, Karpenko FN, Levandovskaya OV, Kudryavtseva AM. Prevalence of antibodies to the hepatitis E virus in the blood of Belarusian donors. Medical journal. 2022;(4):53-59. (In Russ.).
Review
For citations:
Davydov V.V., Znovets T.V., Marchuk S.I., Babenka A.S., Gasich E.L., Zhavoronok S.V. Viral hepatitis E in pregnant women in Belarus: clinical examples and molecular genetic characterization of the virus. Health and Ecology Issues. 2023;20(4):112–122. (In Russ.) https://doi.org/10.51523/2708-6011.2023-20-4-14