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

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.