Hepatitis E: Virus, Disease and Vaccine

A special issue of Pathogens (ISSN 2076-0817). This special issue belongs to the section "Viral Pathogens".

Deadline for manuscript submissions: 31 October 2026 | Viewed by 1832

Editors


E-Mail Website1 Website2
Guest Editor
Department of Pathology, Government Medical College, Srinagar 190010, Kashmir, J&K, India
Interests: hepatitis E; liver diseases; treatment

E-Mail Website1 Website2
Guest Editor
Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Srinagar, India
Interests: hepatitis; hepatitis E virus; ascariasis; biliary ascariasis; GI bleeding; liver disease; parasites; echinococcosis

Special Issue Information

Dear Colleagues,

The story of hepatitis E originated in the late 1970s with my extreme belief that there was a hidden saga in the relationship between jaundice and pregnancy in developing countries and the opportunity for a massive epidemic of viral hepatitis, which hit the Gulmarg Kashmir region in November 1978.  Hepatitis E is a global disease caused by infection with the hepatitis E virus (HEV).  HEV belongs to the family Hepeviridae and exhibits remarkable heterogeneity, comprising two subfamilies, five genera, and ten species, infecting a broad range of animal species.  Major animal reservoirs, including pigs, wild boar, rabbits, deer, camels, and rats, have a zoonotic potential. HEV is recognized as one of the most successful zoonotic viral infections in human history, with a high risk of pandemic emergence through zoonotic spillover. Based on a worldwide seroprevalence study, 12.5% of the world’s population, corresponding to 939 million individuals, have previously been exposed to HEV. Amongst these individuals, 15–110 million have current or ongoing infection. The epidemiology of human hepatitis E differs between developing and industrialized countries, primarily in the circulating HEV genotypes (HEV GTs).  HEV GT1 and GT2, widespread in Asia and Africa, are transmitted feco-orally via contaminated water supplies and poor sanitation. It causes massive waterborne epidemics with high morbidity and mortality and is the cause of around half of the acute sporadic hepatitis and acute liver failure cases in endemic zones. The disease has a high incidence and severity in pregnant women, and HEV superinfection in patients with cirrhosis sparks episodes of acute-on-chronic liver failure. HEV GT3 and GT4, prevalent in industrialized countries, cause autochthonous infection through the consumption of raw pig liver, sausages, and game meat. Chronic hepatitis E, caused by HEV GT3, leads to liver fibrosis and cirrhosis and occurs in patients with solid organ transplants, HIV, and hematopoietic neoplasms. Based on ORF2 expression and the self-assembly of virus-like particles (VLP) with neutralizing epitope (aa459-606 ORF2 capsid), four hepatitis E vaccines have entered the arena of human experimentation. Of these, HEV vaccine p239 Hecolin®️ (VLP, T=1, 230A, Xiamen Innovax Biotech Co., Ltd., gt1, aa368-606 ORF2 capsid) is the only vaccine available for clinical use and has undergone extensive studies in China, demonstrating safety, immunogenicity, and efficacy. Vaccine-induced antibodies persist for at least 8.5 years in the majority of participants, suggesting durable long-term protection.

Prof. Dr. Mehnaaz Sultan Khuroo
Prof. Dr. Mohammad S. Khuroo
Guest Editors

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Keywords

  • hepatitis E
  • hepatitis E virus
  • acute hepatitis
  • acute liver failure
  • pregnancy
  • acute-on-chronic liver failure
  • Hepatitis E vaccine
  • solid organ transplants

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Published Papers (2 papers)

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Research

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11 pages, 462 KB  
Article
Prevalence of Hepatitis E Virus Infection Among Pregnant Women in Tunisia: Findings from a Large Cohort Study
by Kaouther Ayouni, Mariem Gdoura, Rania Allègue, Majdi Ben Ameur, Henda Touzi, Nesrine Abderahmane, Khaoula Magdoud, Hiba Mkadmi, Rim Ben Hmid, Henda Triki and Anissa Chouikha
Pathogens 2026, 15(5), 549; https://doi.org/10.3390/pathogens15050549 - 19 May 2026
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Abstract
Hepatitis E is a liver inflammation caused by the hepatitis E virus (HEV). In pregnant women, the infection significantly increases the risk of acute liver failure, fetal loss, and maternal death. According to the World Health Organization, infection by HEV during the third [...] Read more.
Hepatitis E is a liver inflammation caused by the hepatitis E virus (HEV). In pregnant women, the infection significantly increases the risk of acute liver failure, fetal loss, and maternal death. According to the World Health Organization, infection by HEV during the third trimester of pregnancy may increase the risk of maternal mortality in 20–25% of cases. In Tunisia, little is known about HEV infection and its outcome, especially in pregnant women. This study aims to evaluate the prevalence of HEV infection in a large cohort of pregnant women in Tunisia. A total of 891 women who attended the Centre of Maternity and Neonatology of Tunis during 2021–2023 were included. Serum samples were screened to detect HEV-antibodies and RNA using commercial ELISA tests and molecular assays, respectively. Statistical analyses were conducted using SPSS 21.0 software and the EPISTAT package version 7.2.6. Seroprevalence of HEV infection was 3.82%, based on the detection of anti-HEV IgG. The distribution of the seroprevalence according to age was statistically significant (p < 0.05), showing a higher seroprevalence among women over 30 years. Among the 51 women with composite outcomes, viral RNA was detected in one case by real-time RT-PCR. Our findings indicate a low HEV prevalence among pregnant women in Tunisia. Expanding the study to other cohorts and to environmental surveillance would improve understanding of HEV burden in Tunisia and support hepatitis elimination efforts. Full article
(This article belongs to the Special Issue Hepatitis E: Virus, Disease and Vaccine)
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Review

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38 pages, 6310 KB  
Review
Clinical Guidelines for Hepatitis E Vaccination in India: An Expert Panel Consensus Report on the Recombinant Hepatitis E Vaccine, HEV 239
by Mohammad Sultan Khuroo and Naira S. Khuroo
Pathogens 2026, 15(8), 783; https://doi.org/10.3390/pathogens15080783 - 23 Jul 2026
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Abstract
(1) Background: Hepatitis E remains a major public health challenge in India. (2) Methods: In August 2025, the recombinant HEV 239 vaccine was approved in India for adults aged 18 to 65 years. To establish clinical guidelines tailored to the Indian setting, an [...] Read more.
(1) Background: Hepatitis E remains a major public health challenge in India. (2) Methods: In August 2025, the recombinant HEV 239 vaccine was approved in India for adults aged 18 to 65 years. To establish clinical guidelines tailored to the Indian setting, an expert panel consensus was conducted using a modified Delphi process in accordance with the ACCORD reporting guidelines. (3) Results: A steering committee put forth 18 statements covering vaccine safety, efficacy, and clinical indications, which were independently evaluated by 33 senior Indian hepatologists and epidemiologists. Consensus was assessed using the GRADE framework for level of evidence, balance of benefits and harms, and strength of recommendations. Of the 18 statements, 12 reached the 70% consensus threshold. The panel concluded that the vaccine, which is administered on a standard three-dose schedule, is safe and highly effective in healthy adults, providing protection for up to 10 years. Targeted vaccination was recommended for five high-risk populations: outbreak-affected groups, hyperendemic pockets, women of childbearing age, patients with CLD, and solid organ transplant recipients. Although derived from HEV genotype 1, the vaccine demonstrated cross-protective efficacy against HEV genotype 4. (4) Conclusions: This consensus report provides a framework for deploying the HEV vaccine to mitigate disease burden in India while emphasizing the need for real-world effectiveness and safety data from India. Full article
(This article belongs to the Special Issue Hepatitis E: Virus, Disease and Vaccine)
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