title: The global burden of hepatitis E outbreaks: a systematic review.
abstract: Hepatitis E virus (HEV) is responsible for repeated water-borne outbreaks since the past century, representing an emerging issue in public health. However, the global burden of HEV outbreak has not been comprehensively described. We performed a systematic review of confirmed HEV outbreaks based on published literatures. HEV outbreaks have mainly been reported from Asian and African countries, and only a few from European and American countries. India represents a country with the highest number of reported HEV outbreaks. HEV genotypes 1 and 2 were responsible for most of the large outbreaks in developing countries. During the outbreaks in developing countries, a significantly higher case fatality rate was observed in pregnant women. In fact, outbreaks have occurred both in open and closed populations. The control measures mainly depend upon improvement of sanitation and hygiene. This study highlights that HEV outbreak is not new, yet it is a continuous global health problem.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.|Department of Microbiology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
authors.forename: Mohamad S
authors.initials: MS
authors.lastname: Hakim
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Wenshi
authors.initials: W
authors.lastname: Wang
authors.affiliation: Medical Library, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Wichor M
authors.initials: WM
authors.lastname: Bramer
authors.affiliation: Department of Infectious Diseases, The First People's Hospital of Yunnan Province, Kunming, China.
authors.forename: Jiawei
authors.initials: J
authors.lastname: Geng
authors.affiliation: Medical Faculty, Kunming University of Science and Technology, Kunming, China.
authors.forename: Fen
authors.initials: F
authors.lastname: Huang
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Robert A
authors.initials: RA
authors.lastname: de Man
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Maikel P
authors.initials: MP
authors.lastname: Peppelenbosch
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Qiuwei
authors.initials: Q
authors.lastname: Pan
mesh_terms: D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D000071219:Global Burden of Disease; D016751:Hepatitis E / Q000453:epidemiology*; D016752:Hepatitis E virus / Q000235:genetics; D006801:Humans; D011247:Pregnancy; D012367:RNA, Viral / Q000032:analysis
chemical_list: D012367:RNA, Viral
keywords: global burden; hepatitis E; outbreaks