Burden of acute hepatitis E virus in South Asia: Insights from Global Burden of Disease study 2021

Satapathy P 1 , Gaidhane S 2 , Bishoyi AK 3 , Ganesan S 4 , V K 5 , Mishra S 6 Show all authors , Kaur M 7 , Bushi G 8 , Shabil M 9 , Syed R 10 , Puri S 11 , Kumar S 12 , Ansar S 13 , Sah S 14 , Jena D 15 , Zahiruddin QS 16 , Goh KW 17

Affiliations 

  • 1 Centre of Research Impact and Outcome, Chitkara University, Rajpura- 140417, Punjab, India; Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia. Electronic address: prakasini.satapathy@gmail.com
  • 2 One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India. Electronic address: shilpa.gaidhane@dmiher.edu.in
  • 3 Marwadi University Research Center, Department of Microbiology, Faculty of Science, Marwadi University, Rajkot-360003, Gujarat, India. Electronic address: ashokkumar.bishoyi@marwadieducation.edu.in
  • 4 Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India. Electronic address: g.subbulakshmi@jainuniversity.ac.in
  • 5 Department of Chemistry, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India. Electronic address: kavitha.chemistry@sathyabama.ac.in
  • 6 Department of Pharmacology, IMS and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha-751003, India. Electronic address: swatimishra@soa.ac.in
  • 7 Department of Pharmacy, Chandigarh Pharmacy College, Chandigarh Group of Colleges-Jhanjeri, Mohali 140307, Punjab, India. Electronic address: Manpreet.J3137@cgcjhanjeri.in
  • 8 School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India; University of Cyberjaya, Persiaran Bestari, Cyber 11, 63000 Cyberjaya, Selangor Darul Ehsan, Malaysia. Electronic address: ganeshbushi313@gmail.com
  • 9 University Center for Research and Development, Chandigarh University, Mohali, Punjab, India; Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001 Hillah, Babil, Iraq. Electronic address: mohdshabil99@gmail.com
  • 10 IES Institute of Pharmacy, IES University, Bhopal, Madhya Pradesh 462044, India. Electronic address: Rukshar.research@iesuniversity.ac.in
  • 11 New Delhi Institute of Management, Tughlakabad Institutional Area, New Delhi, India. Electronic address: sonam.puri@ndimdelhi.org
  • 12 Department of Microbiology, Graphic Era (Deemed to be University), Clement Town, Dehradun-248002, India. Electronic address: sunilkumar.mb@geu.ac.in
  • 13 Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia. Electronic address: saansar@ksu.edu.sa
  • 14 Department of Paediatrics, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pimpri, Pune - 411018, Maharashtra, India; Department of Public Health Dentistry, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pimpri, Pune - 411018, Maharashtra, India; Department of Medicine, Korea Universtiy, Seoul, South Korea. Electronic address: sanjitsahnepal561@gmail.com
  • 15 Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India. Electronic address: diptismita.jena@gmail.com
  • 16 South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India. Electronic address: zahirquazi@dmiher.edu.in
  • 17 Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia; Faculty of Mathematics and Natural Sciences, Universitas Negeri Padang, Padang, Indonesia. Electronic address: khangwen.goh@newinti.edu.my
Diagn Microbiol Infect Dis, 2025 Mar 08;112(3):116767.
PMID: 40107226 DOI: 10.1016/j.diagmicrobio.2025.116767

Abstract

BACKGROUND: Despite global progress, South Asian countries account for a disproportionate burden of Acute hepatitis E (AHE). Understanding the burden of AHE in this region is crucial for targeted interventions.

METHODS: We used Global Burden of Disease (GBD) 2021 data to assess the burden of AHE across eight South Asian countries from 1990 to 2021. Joinpoint regression was used to analyze temporal trends and Estimated Annual Percentage Change (EAPC) was calculated to quantify trends. The relationship between age-standardized disability-adjusted life years rate (ASDR) and socio-demographic index (SDI) was assessed using smoothing spline model and Spearman rank correlation. Rates are expressed per 100,000 population.

RESULTS: Bangladesh had highest age-standardized prevalence rate (ASPR) [33.27 (95 % Uncertainty Interval: 27.64 to 39.95)] and age-standardized incidence rate (ASIR) [433.01 (359.61 to 519.76)], while India had highest ASDR [9.52 (4.33 to 18.42)]. Males had higher ASIR and ASPR than females in most South Asian countries, except Bhutan and India, and higher ASDR except in Nepal and Pakistan. Bhutan had the highest EAPC for both sexes in ASPR and ASIR, while India had the highest EAPC in ASDR, closely followed by Bhutan for both sexes. Age group 5-9 had the highest ASPR and ASIR whereas <1-year age group had the highest ASDR. There was an inverse relationship between ASDR and SDI (R = -0.49, p < 0.01).

CONCLUSION: South Asia bears a high burden of AHE, with variations across countries. Improvements in Water Sanitation and Hygiene (WASH) services are needed to achieve Sustainable Development Goals 3 and 6.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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