title: Acute hepatitis E virus in pregnant women in Israel and in other industrialized countries.
abstract: OBJECTIVE
  Acute hepatitis E virus (HEV) is the most common etiology of viral hepatitis in adults in developing countries. HEV is rare in industrialized countries but its incidence is rising both in returning travelers and through autochthonous infection. In developing countries HEV is associated with a high rate of fulminant hepatitis and mortality during pregnancy and contributes to poor obstetric and fetal outcomes. There are no reliable data on the outcome of HEV during pregnancy in industrialized countries.
  
  
  METHODS
  A retrospective analysis of acute HEV cases diagnosed in Israel were examined. The clinical course of the disease among pregnant women was retrieved. A systematic review of the literature was performed for cases of HEV and pregnancy, originating or treated in industrialized countries
  
  
  RESULTS
  Between the years 1993-2013, 68 cases of acute HEV were diagnosed in Israel, including 9 pregnant women (13%). An additional 6 reported cases were found from a literature search. From the 15 women (10 autochthonous cases and 5 imported cases), the outcome was favorable in 10 cases, however, 5 cases (33%) resulted in fulminant hepatitis and two women underwent an urgent liver transplantation. No fatality occurred in the mothers and all babies were born alive and healthy.
  
  
  CONCLUSIONS
  This is the first case series of acute HEV infection in pregnant women in industrialized countries. Acute HEV infection poses a significant risk in pregnancy, irrespective of patients' country of origin. In contrast to reports from developing countries, all babies and mothers survived.
authors.affiliation: The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel. Electronic address: lachisht@yahoo.com.
authors.forename: Tamar
authors.initials: T
authors.lastname: Lachish
authors.affiliation: The Hebrew University, Hadassah Medical School, Jerusalem, Israel. Electronic address: ortaler@gmail.com.
authors.forename: Ortal
authors.initials: O
authors.lastname: Erez
authors.affiliation: The Liver Unit, The Hebrew University-Hadassah Medical School, Jerusalem, Israel. Electronic address: daudin@hadassah.org.il.
authors.forename: Nili
authors.initials: N
authors.lastname: Daudi
authors.affiliation: The Liver Unit, The Hebrew University-Hadassah Medical School, Jerusalem, Israel. Electronic address: shouval@hadassah.org.il.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shouval
authors.affiliation: The Center for Geographic Medicine and Department of Medicine C, Sheba Medical Center, Tel Hashomer and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: elischwa@post.tau.ac.il.
authors.forename: Eli
authors.initials: E
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D019049:Developed Countries; D005260:Female; D016751:Hepatitis E / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D007557:Israel / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000821:virology*; D011256:Pregnancy Outcome
keywords: Fetal outcome; Fulminant hepatitis; HEV; Pregnancy