Development of an oral fluid immunoassay to assess past and recent hepatitis E virus (HEV) infection
Hepatitis E virus (HEV) is one of the leading global causes of acute viral hepatitis (Labrique et al., 1999; Emerson and Purcell, 2003). HEV infections result in serious morbidity and mortality, particularly among pregnant women (Tsega et al., 1992; Hamid et al., 1996), and have significant economic costs. Epidemics of hepatitis E are particularly problematic in areas of South Asia where seasonal floods lead to frequent contamination of drinking water supplies with HEV (Labrique et al., 2010; Ippagunta et al., 2007). Whereas case-fatality rates in the general population can vary from 0.1%–3.0% in South Asia, elevated mortality (10%–40%) in pregnant women infected with HEV genotype 1 has been demonstrated consistently. HEV infection during pregnancy frequently leads to miscarriage, preterm delivery and poor neonatal survival, stillbirth and neonatal death. Given its well-documented epidemic potential, with tens of thousands of hepatitis E cases reported annually, rapid, reliable diagnostic testing for hepatitis E is important. Rapid and reliable hepatitis E testing during outbreaks and epidemics could trigger preventive interventions (e.g., provision of safe drinking water, vaccination) to reduce the duration and severity of disease (Labrique et al., 2012; Krain et al., 2014).
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