# Population-Based Estimates of Hepatitis E Virus–Associated Mortality in Bangladesh

## TL;DR

This study estimates hepatitis E virus-related deaths in Bangladesh, showing higher mortality than global estimates and highlighting the need for vaccination.

## Contribution

The study provides the first population-based estimate of HEV-associated mortality in Bangladesh using direct data collection.

## Key findings

- Estimated 986 HEV-associated deaths annually in Bangladesh among individuals aged ≥14 years.
- Identified 163 maternal deaths and 780 neonatal deaths attributed to HEV infection annually.
- Findings suggest underreporting of HEV deaths compared to global estimates.

## Abstract

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.

During December 2014 to September 2017, we conducted surveillance in 6 tertiary hospitals in Bangladesh. Patients aged ≥14 years with acute jaundice were recruited, tested for IgM anti-HEV, and followed up postdischarge. A mortality survey in the hospital catchment areas identified deaths associated with acute jaundice, including maternal deaths, stillbirths, and neonatal deaths delivered by a mother with acute jaundice during pregnancy, as confirmed by 2 independent physicians reviewing verbal autopsy data.

Out of 1925 patients with acute jaundice 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, 365–1297) neonatal deaths were attributed to HEV infection annually.

Prior Global Burden of Disease studies presented wildly varying modeling estimates of HEV-associated annual deaths, ranging from 50 000 in 2013 to 1932 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.

This study provides the first population-based estimate of hepatitis E virus–associated mortality in Bangladesh, revealing higher mortality than global estimates. Findings suggest underreporting of hepatitis E virus deaths and inform the cost-effectiveness of vaccination and other public health interventions.