What is the HEV case fatality rate in the general population and in pregnant women?

• A. General 1%; Pregnant 10-30%
• B. General 5%; Pregnant 1-2%
• C. General 0.1%; Pregnant 50-60%
• D. General 10%; Pregnant 2-5%

Answer: (A)

HEV infection has a notably higher mortality in pregnant women than in the general population. In the general population the case fatality rate is relatively low, around about 1%. In pregnant women, the burden is much greater, typically reported in the range of 10% to 30%, with higher risk observed in the third trimester and during outbreaks in resource-limited settings. This stark difference arises from pregnancy-related physiological and immune changes that can worsen liver injury and lead to fulminant hepatitis in some cases. While many HEV infections are mild or asymptomatic, the severe course in pregnant women makes the higher CFR especially concerning.