Viral Hepatitis in Pakistan: Past, Present, and Future

of acute hepatitis A are much lower than the actual rate existing in the population.11 Hepatitis E in Pakistan has been witnessed to occur as outbreaks and sporadic cases in circumstances involving clustering of large numbers of people in areas where the water supply was contaminated.12,13 Overcrowding reflects poor sanitation and lifestyle in this patient population.14 A total of 14 to 26% of the apparently healthy pediatric population was found to be exposed to hepatitis E (HEV IgG reactive).6,15 Variability was found in reported prevalence of HEV in various studies.However, up to 20 to 22% of adults and 2.4% of children were found to have acute hepatitis due to HEV (Table 1).This disease has produced catastrophic effects in pregnant women, resulting in maternal mortality rates ranging between 20 and 29.3% and perinatal mortality rate of up to 30.3 per 1,000 live births.16,17 It is also a significant cause of mortality in patients with preexisting chronic liver disease.18 A nosocomial outbreak of hepatitis E in a neurosurgery ward in Karachi, which was attributed to incorrect sharing of intravenous administration sets between patients, has led to speculation that this pathogen may also be parentally transmitted, an idea that is supported by a few similar reports in the literature.19 This possibility needs to be looked into, in order to strengthen the current preventive strategies in place.In light of the significant morbidity and mortality caused by HEV infection, it is imperative to have accurate means of detection, which would facilitate early diagnosis ABSTRACT Viral hepatitis is a major cause of morbidity and mortality worldwide and a rising cause for concern in Asian countries.Weather it is blood borne or water/food borne hepatotropic virus, increasing burden is alarming for Asian countries.In this review we have evaluated the existing data to estimate the burden of viral hepatitis in populations of all age groups nationwide, along with an assessment of the risk factors and preventive and management strategies currently employed in Pakistan.The aim of our work is to consolidate and supplement the present knowledge regarding viral hepatitis in light of past and present trends and to provide future direction to the existing health policies.