Hepatitis E virus (HEV) causes high mortality specifically in which population group, and what is the approximate case-fatality rate in that group?

• A Elderly men over 70 years; CFR 15–20%
• B Infants under 6 months; CFR 5–10%
• C Immunocompromised individuals; CFR 30–40%
• D Pregnant women in the third trimester; CFR 15–25% ✓

Explanation

HEV is uniquely lethal in pregnant women, particularly in the third trimester, where the CFR reaches 15–25% (some reports up to 30%), compared to less than 1% in the general population. The mechanism is thought to involve immune tolerance changes during pregnancy, hormonal milieu, and impaired viral clearance. Fulminant hepatic failure is the main cause of death. HEV genotype 1 (prevalent in India) is particularly virulent in pregnancy. Chronic HEV infection occurs in immunocompromised individuals (organ transplants) with genotype 3 infection, but acute high mortality is characteristic of pregnant women.

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

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