Regarding hepatitis E infection, which of the following statements is correct regarding its peculiar severity in a specific population?

• A Hepatitis E is most severe in immunocompromised individuals who develop chronic infection with HEV genotype 1
• B Hepatitis E severity is equal across all age groups and no group-specific risk exists
• C Hepatitis E is most severe in neonates born to infected mothers due to vertical transmission
• D Hepatitis E causes case fatality rate of 20–25% in pregnant women, particularly in the third trimester ✓

Explanation

Hepatitis E virus (HEV genotype 1) causes disproportionately severe disease in pregnant women, with a case fatality rate (CFR) of 20–25% in the third trimester, compared with 1–3% in the general population. The mechanism is not fully established but may involve altered immune regulation in pregnancy and viral replication in placental tissue. Chronic HEV infection occurs with genotypes 3 and 4 (zoonotic, pork-associated) in immunocompromised hosts, not genotype 1. Neonatal risk exists but maternal mortality is the defining feature.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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