Symptoms typically last 1 to 2 weeks and include anorexia, dark urine, nausea and vomiting, abdominal pain, and eventually icterus.2 In rare instances, acute hepatitis E can result in fulminant liver failure and death among nonpregnant individuals. Among pregnant women, HEV substantially increases the risk of mortality among the infected pregnant women and also is associated with intrauterine fetal death, preterm delivery, and stillbirths.12 In this article we attempt to estimate the annual global burden of HEV associated with genotype 1 and 2 infections Tyrosine Kinase Inhibitor Library that occur in Africa and Asia (insufficient scientific study of the probability of illness following

infection precluded the inclusion of genotypes 3 and 4 in this analysis).13-15 The results from this study can be used to inform disease prevention policy and

to understand key areas of uncertainty in creating the burden estimates and to create estimates of disability adjusted life years (DALYs) lost due to HEV genotype 1 and 2 infections. DALY, disability Alectinib order adjusted life years; HAV, hepatitis A virus; HEV, hepatitis E virus; HIV, human immunodeficiency virus. We developed a simplified model of HEV infection and its outcomes based on expert opinion and clinical disease descriptions (Fig. 1).5 In the model, incident infections can occur in nonpregnant or pregnant individuals and infection can result in asymptomatic infection, symptomatic infection with icterus but without death, or symptomatic infection that results in death. All infections that occur in pregnancy also carry the additional risk of stillbirth.12 We

did not consider pregnancies terminated due to mortality to be learn more additional stillbirths. We applied the model to the nine Global Burden of Diseases, Injuries, and Risk Factors Study (the GBD Study) defined regions in Africa and Asia for which genotype 1 (and to a lesser extent genotype 2) HEV is dominant: Asia Central, Asia East, Asia South, Asia Southeast, North Africa and the Middle East, Sub-Saharan Africa Central, Sub-Saharan Africa East, Sub-Saharan Africa Southern, and Sub-Saharan Africa West.16, 17 Collectively, these nine regions contained approximately 4.7 billion people or 72.8% of the global population in 2005.18 Figure 2 illustrates the steps taken to convert our raw data into burden estimates. We modeled seroprevalence and incidence of HEV infection using data gathered from a systematic review of the prevalence of HEV disease and the DISMOD III v. 3.0 generic disease model (DISMOD), which was designed for the GBD Study.5, 19 We abstracted primary data on the age-specific prevalence of HEV from 37 articles published between 1990 and 2010 that we identified in an existing literature review of the prevalence of HEV antibodies.5 We used DISMOD to estimate the age, sex, and region-specific prevalence and incidence of HEV based on these data.