Background

Although Iran is reported to be an endemic country for hepatitis E virus (HEV), data on the prevalence of HEV infection among pregnant women are scarce and the epidemiology of HEV is unknown in most parts of the country. Therefore, this study was conducted to elucidate the prevalence, risk factors and genotypic pattern of HEV infection among pregnant women resident in the northern shores of Persian Gulf. This is the first report on the epidemiology of HEV infection among pregnant women in this territory.

Methods

From October 2016 to May 2017, 1331 pregnant women participated in this study. The mean age ± SD of participants was 27.93±5.7 years with a range of 14–45 years. Serum samples of pregnant women were screened for the presence of anti-HEV total antibodies, anti-HEV IgG and anti-HEV IgM using commercially available ELISA kits (DIA.PRO, Milan, Italy). All anti-HEV IgG and anti-HEV IgM positive samples were tested for HEV RNA using two independent reverse transcriptase polymerase chain reaction (RT-PCR) assays, targeting ORF2 and ORF3 of HEV genome. In addition, 92 anti-HEV seronegative samples as well as 50 pooled seronegative samples were evaluated by two independent RT-PCR assays for validation of results.

Results

Of the 1331 pregnant women, 84 women (6.3%, 95% CI: 5.1%-7.7%) were positive for anti-HEV antibodies, of which 83 women had anti-HEV IgG, and 11 women (0.83%, 95% CI: 0.47%-1.47%) had anti-HEV IgM. The highest rate of HEV seroprevalence was observed among Afghan immigrants (68.0%), uneducated pregnant women (46.51%) and those residents in Bushehr city (8.75%). All anti-HEV IgG and/or IgM positive samples were found to be negative for HEV RNA. In addition, all of the evaluated anti-HEV seronegative samples were negative for HEV RNA. HEV seropositivity among pregnant women was statistically associated with age, ethnicity, place of residence, number of pregnancies, and level of education. So that, low education levels, Afghan, residence in Bushehr city, age group >34 years, and more parities were risk factors for exposure to HEV. In contrast, HEV seropositivity was not associated with stage of gestation, history of abortion, and time of sampling.

Conclusion

The northern shores of Persian Gulf in Iran, with HEV seroprevalence of 6.3%, can be classified as an endemic geographical region for hepatitis E, and residents of Bushehr city, Afghan immigrants and uneducated women are the main at-risk populations in this territory.

中文翻译：

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伊朗波斯湾北岸孕妇的戊型肝炎病毒感染率，危险因素和分子评估

背景

尽管据报道伊朗是戊型肝炎病毒（HEV）的流行国家，但关于孕妇中戊型肝炎病毒感染率的数据仍然很少，该国大部分地区的戊型肝炎流行病学也不清楚。因此，本研究旨在阐明居住在波斯湾北岸孕妇的戊型肝炎病毒感染率，危险因素和基因型分布。这是该地区孕妇中戊型肝炎病毒感染流行病学的第一份报告。

方法

从2016年10月到2017年5月，有1 331名孕妇参加了这项研究。参与者的平均年龄±SD为27.93±5.7岁，范围为14-45岁。使用市售的ELISA试剂盒（DIA.PRO，意大利米兰），筛选孕妇血清样品中是否存在抗HEV总抗体，抗HEV IgG和抗HEV IgM。使用针对HEV基因组的ORF2和ORF3的两个独立的逆转录酶聚合酶链反应（RT-PCR）测定法，测试了所有抗HEV IgG和抗HEV IgM阳性样品的HEV RNA。此外，通过两个独立的RT-PCR分析评估了92份抗HEV血清阴性样品以及50份合并的血清阴性样品，以验证结果。

结果

在1331名孕妇中，有84名妇女（6.3％，95％CI：5.1％-7.7％）的抗HEV抗体呈阳性，其中83名妇女具有抗HEV IgG，有11名妇女（0.83％，95％CI） ：0.47％-1.47％）具有抗HEV IgM。在阿富汗移民（68.0％），未受教育的孕妇（46.51％）和布什尔市居民（8.75％）中，HEV血清阳性率最高。发现所有抗-HEV IgG和/或IgM阳性样品均为HEV RNA阴性。此外，所有评估的抗HEV血清阴性样品的HEV RNA均为阴性。孕妇中的戊型肝炎病毒阳性与年龄，种族，居住地，怀孕次数和受教育程度有关。因此，受教育程度低，阿富汗人，在布什尔市居住，年龄组> 34岁以及更多的同等收入是暴露于戊型肝炎病毒的危险因素。相比之下，

结论

戊型肝炎病毒血清感染率为6.3％的伊朗波斯湾北岸可被归类为戊型肝炎的流行地区，布什尔市的居民，阿富汗移民和未受教育的妇女是该地区的主要高危人群。