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Detection of Hepatitis E 
Antibodies in Kazakhstan: A Pilot 
Study 

Francesca Cainelli1; Gonzalo 
Hortelano2; Baurzhan 
Negmetzhanov3; Aigerim 
Ibrayeva1; Kulpash Kaliaskarova4; 
Denis Bulanin3; Sandro Vento1,5 

 
1Department of Medicine, 
School of Medicine, Nazarbayev 
University, Astana, Kazakhstan;  
2Department of Biology, 
School of Science and Technology, 
Nazarbayev University, Astana, 
Kazakhstan;  
3Department of Biomedical Sciences, 
School of Medicine, Nazarbayev 
University, Astana, Kazakhstan; 
4Hepatology Coordinating Center, 
Ministry of Health, Astana, Kazakhstan; 
5University Medical Center, 
Astana, Kazakhstan 

 Vol. 7, No. 1 (2018)   |   ISSN 2166-7403 (online)  
DOI 10.5195/cajgh.2018.324 |   http://cajgh.pitt.edu 

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CAINELLI 
 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 7, No. 1 (2018) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2018.324|http://cajgh.pitt.edu 

 
 

Abstract 

Introduction. Hepatitis E virus exposure is associated with sporadic cases of acute hepatitis and outbreaks in many countries 
worldwide. It is particularly dangerous for pregnant women, in whom the mortality rate is high. There are no previously published 
data reporting circulation of this virus in Kazakhstan. 
Methods. We tested blood samples for IgG anti-hepatitis E virus antibodies in 199 Kazakh participants; of  these 119 were workers 
at the EXPO 2017 building site in Astana, 35 were volunteers who got tested at the Astana City Hall on the World Hepatitis Day 
2017, and 45 were volunteers who presented for screening at the Hepatogastroenterology Outpatient Clinic of the Republican 
Diagnostic Center, University Medical Center. 
Results. 11 (5.5%) individuals were positive for IgG anti-HEV antibodies, with a higher seroprevalence in males (7; 6.8%) vs 
females (4; 4.5%). The highest number of positive samples was in the 32-46 years age group. 
Conclusions. This pilot study suggests that Hepatitis E virus has been circulating in Kazakhstan. Studies are needed to determine 
whether it continues to be present, which viral genotypes are involved and what are the best methodologies for preventing its 
spread. 

Keywords: Hepatitis E; anti-HEV antibodies; Kazakhstan 

 
Detection of Hepatitis E Antibodies in 
Kazakhstan: A Pilot Study 

Francesca Cainelli1; Gonzalo 
Hortelano2; Baurzhan 
Negmetzhanov3; Aigerim Ibrayeva1; 
Kulpash Kaliaskarova4; Denis 
Bulanin3; Sandro Vento1,5 

 
1Department of Medicine, 
School of Medicine, Nazarbayev University, 
Astana, Kazakhstan;  
2Department of Biology, 
School of Science and Technology, 
Nazarbayev University, Astana, Kazakhstan;  
3Department of Biomedical Sciences, 
School of Medicine, Nazarbayev University, 
Astana, Kazakhstan; 
4Hepatology Coordinating Center, 
Ministry of Health, Astana, Kazakhstan; 
5University Medical Center, 
Astana, Kazakhstan 

Research 

Hepatitis E virus (HEV) is the most recently 
discovered major hepatitis virus, which poses a 
significant threat to pregnant women. Its existence was 
first suggested in 1980 by Khuroo, who studied a non-A, 
non-B hepatitis outbreak in the Kashmir Valley (India),1 

and its genome was entirely cloned in 1991.2 HEV 
infection causes acute sporadic hepatitis and outbreaks 
worldwide. The virus has four genotypes. HEV 1 and 2 
infect humans, are found largely in low and middle-
income countries, and are transmitted through the fecal-
oral route (mainly through contaminated water). 
Genotypes 3 and 4 are found mainly in high-income 
countries, infect humans as well as animals, and cause 
sporadic cases of acute hepatitis. HEV constitutes an 
important health problem in low- and middle-income 
countries, as acute sporadic form of hepatitis E is 
nowadays likely the most frequent cause of acute viral 
hepatitis worldwide.3 The worldwide incidence of acute 
genotypes 1 and 2 HEV infection was estimated in 2005 

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 
 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
Central Asian Journal of Global Health 

Volume 7, No. 1 (2018) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2018.324|http://cajgh.pitt.edu 

 
 

to be around 20.1 million cases, with 3.4 million 
symptomatic cases, 70,000 deaths, and 3,000 stillbirths.4 

Although HEV infection usually causes self-
limiting acute hepatitis with a low mortality rate, 
fulminant hepatitis frequently develops in pregnant 
women, especially at late gestational stages, and leads to 
a high maternal mortality rate (up to 31%) in developing 
countries.5,6,7 HEV-infected pregnant women develop 
obstetric complications, including intrauterine fetal 
death, preterm delivery, and stillbirth much more 
frequently than non-HEV-infected pregnant women.8 

Interestingly, during community outbreaks of acute 
hepatitis E, clinical attack rates were higher among 
adolescents and young adults than among children or 
older adults.9 In patients with chronic liver disease of 
other etiology, acute HEV infection can determine flare 
ups of liver disease, and cause decompensation or liver 
failure in previously compensated cirrhotic patients.10 

HEV can also cause chronic hepatitis in 
immunosuppressed patients, including transplant 
recipients, human immunodeficiency virus-infected 
individuals with low CD4 cell count, and patients with 
hematological malignancies treated with 
chemotherapy.10  

Neurologic complications have been observed 
in large number of patients with HEV infection,11 as well 
as renal and rheumatologic manifestations in a smaller 
number of cases. 

Outbreaks of HEV infection can occur in 
community-based settings (villages, cities, or provinces), 
military units, colleges, prisons, factories, and cruise 
ships. Outbreaks have been reported in Central Asian 
countries, specifically in Kyrgyzstan,12 Uzbekistan,13 and 
Turkmenistan;14 the latter was particularly large, 
occurred in the Dashoguz province and affected over 
16,000 people.14 In  Kazakhstan,  a likely outbreak of 
acute hepatitis E occurred during the 1950s in the South, 
where case fatality rate reached 10% in hospitalized 
pregnant women.15 Currently, tests for IgM anti-HEV 

antibodies are performed in pregnant women in some 
Infectious Diseases Hospitals in Kazakhstan, but no 
results have been published to date. 

We have performed a cross sectional study and 
tested for anti-HEV antibodies (HEV IgG 3rd generation 
EIA, DIA.PRO, Sesto San Giovanni, Italy) 199 Kazakh 
participants who gave their informed consent. 
Participants included 119 workers at the EXPO 2017 
building site in Astana who presented consecutively in 
one day, 35 volunteers at the Astana City Hall on the 
World Hepatitis Day 2017, and 45 volunteers who 
presented consecutively for screening over a period of ten 
months at the Hepatogastroenterology Outpatient Clinic 
of the Republican Diagnostic Center, University Medical 
Center (UMC). The participants were identified to be 
Kazakh residents in the country either by their employer 
(in the case of the EXPO 2017 site) or by the personnel 
working at the City Hall who contributed to the event 
promotion or by the healthcare staff working at the 
Hepatogastroenterology Outpatient Clinic of the 
Republican Diagnostic Center, University Medical 
Center (UMC). Selection of these three sites were based 
on the idea of screening diverse representation of 
different population groups of Kazakhstan. All 
participants were briefed about the voluntary nature of 
the study and its objectives. The Institutional Review 
Boards of both Nazarbayev University and UMC granted 
approval for this study. 

5 mL of blood were collected from each 
individual; serum was separated and stored at -80°C until 
used in the ELISA test. Specimens were considered 
positive at a cut off value ≥ 1, as per manufacturer’s 
instructions. 

We collected information about age, gender, 
place (city, town, or village) of residence, history of 
jaundice, any previous diagnosis of hepatitis (if yes type 
was recorded as A, B, C, D or E), and alcohol 
consumption (current and past) using paper surveys. 103 
participants were men and 89 women; in seven cases the 
gender was unreported (i.e. not indicated in the data 

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CAINELLI 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 7, No. 1 (2018) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2018.324|http://cajgh.pitt.edu 

 
 

sheets filled by the tested individuals). Age was available 
for 194 individuals (mean 39.3 years, range 9 - 77).  

Overall, 11 (5.5%) individuals sampled were 
positive for anti-HEV antibodies; with higher prevalence 
among males (7 individuals; 6.8%) compared to females 
(4 individuals; 4.5%). No positivity was observed in the 
oldest age groups (over 60 years of age), while the 
highest number of positive samples were identified in the 
group between 32 and 46 years of age.  

In the future, we plan to test all patients with 
acute and fulminant hepatitis admitted to hospitals in 
Astana to verify whether HEV is the etiological factors 
of some of these cases. Should this be the case, we will 
establish the genotypes of HEV that are found in 
Kazakhstan. The identification of genotypes will allow 
characterizing whether only genotypes HEV-1 and HEV-
2 or also genotypes HEV-3 and HEV-4 circulate in 
Kazakhstan. Preventive measures can then eventually be 
instituted to limit the possible circulation of the hepatitis 
E virus in the country and nearby regions. 

 

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 
 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
Central Asian Journal of Global Health 

Volume 7, No. 1 (2018) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2018.324|http://cajgh.pitt.edu 

 
 

Jan-Feb;36(1):66-9. 

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	Detection of Hepatitis E Antibodies in Kazakhstan: A Pilot Study
	Abstract
	Keywords: Hepatitis E; anti-HEV antibodies; Kazakhstan
	Detection of Hepatitis E Antibodies in Kazakhstan: A Pilot Study
	Research

