{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T18:08:48Z","timestamp":1784830128913,"version":"3.55.0"},"reference-count":217,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Dr. Khuroo\u2019s Medical Trust"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>(1) Background: Hepatitis E remains a major public health challenge in India. (2) Methods: In August 2025, the recombinant HEV 239 vaccine was approved in India for adults aged 18 to 65 years. To establish clinical guidelines tailored to the Indian setting, an expert panel consensus was conducted using a modified Delphi process in accordance with the ACCORD reporting guidelines. (3) Results: A steering committee put forth 18 statements covering vaccine safety, efficacy, and clinical indications, which were independently evaluated by 33 senior Indian hepatologists and epidemiologists. Consensus was assessed using the GRADE framework for level of evidence, balance of benefits and harms, and strength of recommendations. Of the 18 statements, 12 reached the 70% consensus threshold. The panel concluded that the vaccine, which is administered on a standard three-dose schedule, is safe and highly effective in healthy adults, providing protection for up to 10 years. Targeted vaccination was recommended for five high-risk populations: outbreak-affected groups, hyperendemic pockets, women of childbearing age, patients with CLD, and solid organ transplant recipients. Although derived from HEV genotype 1, the vaccine demonstrated cross-protective efficacy against HEV genotype 4. (4) Conclusions: This consensus report provides a framework for deploying the HEV vaccine to mitigate disease burden in India while emphasizing the need for real-world effectiveness and safety data from India.<\/jats:p>","DOI":"10.3390\/pathogens15080783","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:13:17Z","timestamp":1784826797000},"page":"783","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Guidelines for Hepatitis E Vaccination in India: An Expert Panel Consensus Report on the Recombinant Hepatitis E Vaccine, HEV 239"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2823-8814","authenticated-orcid":false,"given":"Mohammad Sultan","family":"Khuroo","sequence":"first","affiliation":[{"name":"Digestive Diseases Center, Dr. Khuroo\u2019s Medical Clinic, Kashmir, Srinagar 190010, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naira S.","family":"Khuroo","sequence":"additional","affiliation":[{"name":"Digestive Diseases Center, Dr. Khuroo\u2019s Medical Clinic, Kashmir, Srinagar 190010, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1111\/jvh.12445","article-title":"Hepatitis E: An emerging global disease\u2014From discovery towards control and cure","volume":"23","author":"Khuroo","year":"2016","journal-title":"J. Viral Hepat."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"a031880","DOI":"10.1101\/cshperspect.a031880","article-title":"Classification and Genomic Diversity of Enterically Transmitted Hepatitis Viruses","volume":"8","author":"Smith","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1111\/j.1440-1746.2010.06540.x","article-title":"Hepatitis E: Historical, contemporary and future perspectives","volume":"26","author":"Aggarwal","year":"2011","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"a032144","DOI":"10.1101\/cshperspect.a032144","article-title":"Transmission and Epidemiology of Hepatitis E Virus Genotype 3 and 4 Infections","volume":"8","author":"Dalton","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1053\/j.gastro.2015.10.048","article-title":"Chronic Infection with Camelid Hepatitis E Virus in a Liver Transplant Recipient Who Regularly Consumes Camel Meat and Milk","volume":"150","author":"Lee","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1002\/hep.31138","article-title":"Transmission of Rat Hepatitis E Virus Infection to Humans in Hong Kong: A Clinical and Epidemiological Analysis","volume":"73","author":"Sridhar","year":"2021","journal-title":"Hepatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.3201\/eid2006.140140","article-title":"New hepatitis E virus genotype in camels, the Middle East","volume":"20","author":"Woo","year":"2014","journal-title":"Emerg. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1016\/0002-9343(80)90200-4","article-title":"Study of an epidemic of non-A, non-B hepatitis. Possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type","volume":"68","author":"Khuroo","year":"1980","journal-title":"Am. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1159\/000149370","article-title":"Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route","volume":"20","author":"Balayan","year":"1983","journal-title":"Intervirology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1126\/science.2107574","article-title":"Isolation of a cDNA from the virus responsible for enterically transmitted non-A, non-B hepatitis","volume":"247","author":"Reyes","year":"1990","journal-title":"Science"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/0042-6822(91)90760-9","article-title":"Hepatitis E virus (HEV): Molecular cloning and sequencing of the full-length viral genome","volume":"185","author":"Tam","year":"1991","journal-title":"Virology"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Yarbough, P.O., Tam, A.W., Gabor, K., Garza, E., Moeckli, R.A., Palings, I., Simonsen, C., and Reyes, G.R. (1994). Assay Development of Diagnostic Tests for Hepatitis E. Proceedings of the Viral Hepatitis and Liver Disease, Springer.","DOI":"10.1007\/978-4-431-68255-4_92"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Khuroo, M.S. (2023). Discovery of Hepatitis E and Its Impact on Global Health: A Journey of 44 Years about an Incredible Human-Interest Story. Viruses, 15.","DOI":"10.3390\/v15081745"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1111\/liv.14468","article-title":"The global epidemiology of hepatitis E virus infection: A systematic review and meta-analysis","volume":"40","author":"Li","year":"2020","journal-title":"Liver Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.jceh.2013.05.010","article-title":"Hepatitis E: Epidemiology and natural history","volume":"3","author":"Aggarwal","year":"2013","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1002\/hep.25505","article-title":"The global burden of hepatitis E virus genotypes 1 and 2 in 2005","volume":"55","author":"Rein","year":"2012","journal-title":"Hepatology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"a031724","DOI":"10.1101\/cshperspect.a031724","article-title":"Hepatitis E Virus Genome Structure and Replication Strategy","volume":"9","author":"Kenney","year":"2019","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1111\/zph.12934","article-title":"Distribution and phylogenetics of hepatitis E virus genotype 4 in humans and animals","volume":"69","author":"Li","year":"2022","journal-title":"Zoonoses Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.3201\/eid2011.140791","article-title":"Foodborne transmission of hepatitis E virus from raw pork liver sausage, France","volume":"20","author":"Renou","year":"2014","journal-title":"Emerg. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"448","DOI":"10.3201\/eid0904.020351","article-title":"Hepatitis E virus epidemiology in industrialized countries","volume":"9","author":"Pina","year":"2003","journal-title":"Emerg. Infect. Dis."},{"key":"ref_21","first-page":"7","article-title":"Autochthonous Hepatitis E Virus Infection in Europe: A Matter of Concern for Public Health?","volume":"2","author":"Echevarria","year":"2014","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1056\/NEJMoa1215246","article-title":"Ribavirin for chronic hepatitis E virus infection in transplant recipients","volume":"370","author":"Kamar","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1056\/NEJMoa0706992","article-title":"Hepatitis E virus and chronic hepatitis in organ-transplant recipients","volume":"358","author":"Kamar","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.2147\/IDR.S449221","article-title":"Hepatitis E Virus (HEV) Infection Among Immunocompromised Individuals: A Brief Narrative Review","volume":"17","author":"Alexandrova","year":"2024","journal-title":"Infect. Drug Resist."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.cmi.2024.11.016","article-title":"Global vaccination against hepatitis E virus: Position paper from the European Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Study Group","volume":"31","author":"Dudman","year":"2025","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"The Lancet (2010). Hepatitis E vaccine: Why wait?. Lancet, 376, 845.","DOI":"10.1016\/S0140-6736(10)61393-1"},{"key":"ref_27","unstructured":"URIHK (2026, June 06). Hevrevac\u00ae\u2014Recombinant Hepatitis E Vaccine. India\u2019s First Hepatitis E Vaccine, Approved for Individuals Aged 18 to 65 Years. Available online: https:\/\/www.urihkpharma.com\/hevrevac."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"743","DOI":"10.21037\/hbsn-23-435","article-title":"Expert consensus-promoting clinical excellence and ultimately benefitting patients","volume":"12","author":"Chen","year":"2023","journal-title":"Hepatobiliary Surg. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1097\/SLA.0000000000005668","article-title":"An International Expert Delphi Consensus on Defining Textbook Outcome in Liver Surgery (TOLS)","volume":"277","author":"Pawlik","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.jcjd.2022.01.003","article-title":"Modified Delphi Process to Identify Research Priorities and Measures for Adult Lifestyle Programs to Address Type 2 Diabetes and Other Cardiometabolic Risk Conditions","volume":"46","author":"Brauer","year":"2022","journal-title":"Can. J. Diabetes"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s41073-022-00122-0","article-title":"ACCORD guideline for reporting consensus-based methods in biomedical research and clinical practice: A study protocol","volume":"7","author":"Gattrell","year":"2022","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_32","unstructured":"ACCORD (2026, June 06). EQUATOR (Enhancing the QUAlity and Transparency of Health Research) Network. ACCORD (Accurate Consensus Reporting Document): A Reporting Guideline for Consensus Methods in Biomedicine Developed via a Modified Delphi. Available online: https:\/\/www.ismpp.org\/accord."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3837","DOI":"10.1016\/j.arthro.2025.06.038","article-title":"Expert Consensus and Delphi Studies Require Listing of Consensus Groups for Contributing Authors Designated by Their Steering Committee","volume":"41","author":"Rossi","year":"2025","journal-title":"Arthroscopy"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Gattrell, W.T., Logullo, P., van Zuuren, E.J., Price, A., Hughes, E.L., Blazey, P., Winchester, C.C., Tovey, D., Goldman, K., and Hungin, A.P. (2024). ACCORD (ACcurate COnsensus Reporting Document): A reporting guideline for consensus methods in biomedicine developed via a modified Delphi. PLoS Med., 21.","DOI":"10.1371\/journal.pmed.1004326"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1002\/cld.1146","article-title":"Hepatitis E: Current Status in India","volume":"18","author":"Aggarwal","year":"2021","journal-title":"Clin. Liver Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s15010-025-02661-2","article-title":"The silent spread of Hepatitis E in India\u2014From epidemiological insight to public health action: A comprehensive review","volume":"54","author":"Maity","year":"2026","journal-title":"Infection"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"7030","DOI":"10.3748\/wjg.v22.i31.7030","article-title":"Hepatitis E: Discovery, global impact, control and cure","volume":"22","author":"Khuroo","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"116767","DOI":"10.1016\/j.diagmicrobio.2025.116767","article-title":"Burden of acute hepatitis E virus in South Asia: Insights from Global Burden of Disease study 2021","volume":"112","author":"Satapathy","year":"2025","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1002\/jgh3.12646","article-title":"Hepatitis E: Genotypes, strategies to prevent and manage, and the existing knowledge gaps","volume":"5","author":"Kamani","year":"2021","journal-title":"JGH Open"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Zhang, L., Wang, T., Zhou, S., Li, S., Mo, T., and Wu, S. (2025). Update on the global burden of acute viral hepatitis in 2021: Addressing health inequalities. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1580863"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.trstmh.2007.03.014","article-title":"Hepatitis E: A neglected threat","volume":"102","author":"Myint","year":"2008","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"The Lancet Gastroenterology & Hepatology (2016). Hepatitis E: A neglected virus. Lancet Gastroenterol. Hepatol., 1, 261.","DOI":"10.1016\/S2468-1253(16)30152-2"},{"key":"ref_44","first-page":"96","article-title":"Hepatitis E: The enterically transmitted non-A, non-B hepatitis","volume":"10","author":"Khuroo","year":"1991","journal-title":"Indian J. Gastroenterol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"203","DOI":"10.2991\/j.jegh.2018.04.101","article-title":"Hepatitis A and E Outbreak Surveillance during 2015\u20132017 in Kashmir, India: Is the Water to Blame?","volume":"8","author":"Kadri","year":"2018","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_46","unstructured":"IDSP (2026, June 02). Weekly Outbreaks. Available online: https:\/\/ghdx.healthdata.org\/record\/india-integrated-disease-surveillance-programme-idsp-weekly-outbreak-reports-2018."},{"key":"ref_47","unstructured":"Gupta, S.K. (2025). Hepatitis E in India: Outbreaks, Risks, and Vaccines, Continental Hospital. Blog."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1002\/cld.244","article-title":"Hepatitis E: The endemic perspective","volume":"2","author":"Aggarwal","year":"2013","journal-title":"Clin. Liver Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1046\/j.1365-2893.2003.00415.x","article-title":"Aetiology and prognostic factors in acute liver failure in India","volume":"10","author":"Khuroo","year":"2003","journal-title":"J. Viral Hepat."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1002\/hep.510230622","article-title":"Fulminant hepatitis in a tropical population: Clinical course, cause, and early predictors of outcome","volume":"23","author":"Acharya","year":"1996","journal-title":"Hepatology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1093\/oxfordjournals.aje.a113643","article-title":"Acute sporadic non-A, non-B hepatitis in India","volume":"118","author":"Khuroo","year":"1983","journal-title":"Am. J. Epidemiol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Khuroo, M.S. (2021). Hepatitis E and Pregnancy: An Unholy Alliance Unmasked from Kashmir, India. Viruses, 13.","DOI":"10.3390\/v13071329"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1046\/j.1365-2893.2003.00398.x","article-title":"Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy","volume":"10","author":"Khuroo","year":"2003","journal-title":"J. Viral Hepat."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/0002-9343(81)90758-0","article-title":"Incidence and severity of viral hepatitis in pregnancy","volume":"70","author":"Khuroo","year":"1981","journal-title":"Am. J. Med."},{"key":"ref_55","unstructured":"Sahni, A. (2026). Finally, a Vaccine for Hepatitis E: What Every Patient in North India Needs to Know, Fortis Hospital Mohali (Blog)."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.1111\/jgh.13340","article-title":"Acute-on-chronic liver failure in India: The Indian National Association for Study of the Liver consortium experience","volume":"31","author":"Shalimar","year":"2016","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.1053\/j.gastro.2009.02.050","article-title":"Efficacy of L-ornithine L-aspartate in acute liver failure: A double-blind, randomized, placebo-controlled study","volume":"136","author":"Acharya","year":"2009","journal-title":"Gastroenterology"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.jhep.2006.09.016","article-title":"Hepatitis E virus (HEV) infection in patients with cirrhosis is associated with rapid decompensation and death","volume":"46","author":"Singh","year":"2007","journal-title":"J. Hepatol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2719","DOI":"10.1007\/s10620-019-06005-7","article-title":"Acute-on-Chronic Liver Failure in Budd-Chiari Syndrome: Profile and Predictors of Outcome","volume":"65","author":"Shalimar","year":"2020","journal-title":"Dig. Dis. Sci."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"S196","DOI":"10.3350\/cmh.2024.0758","article-title":"Hepatitis E as a trigger for acute-on-chronic liver failure","volume":"31","author":"Buti","year":"2025","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12072-024-10773-4","article-title":"Acute-on-chronic liver failure (ACLF): The \u2018Kyoto Consensus\u2019-steps from Asia","volume":"19","author":"Choudhury","year":"2025","journal-title":"Hepatol. Int."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"141","DOI":"10.4103\/TG.TG_69_25","article-title":"Changing Epidemiology of Viral Hepatitis in India: Regional Trends and Public Health Implications","volume":"46","author":"Jasrotia","year":"2025","journal-title":"Trop. Gastroenterol."},{"key":"ref_63","first-page":"917","article-title":"Prevalence of Hepatitis A and Hepatitis E in Patients Presenting with Acute Viral Hepatitis at a Tertiary Care Hospital, Guntur, Andhra Pradesh","volume":"15","author":"Parameswari","year":"2025","journal-title":"Eur. J. Cardiovasc. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/s12664-025-01803-6","article-title":"Hepatitis A: A wake-up call!","volume":"44","author":"Anand","year":"2025","journal-title":"Indian J. Gastroenterol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1007\/s12664-025-01746-y","article-title":"Age-stratified prevalence of anti-hepatitis A virus antibodies in four metropolitan Indian cities and recent changes in Pune city","volume":"45","author":"Lalwani","year":"2025","journal-title":"Indian J. Gastroenterol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1038\/s12276-025-01431-2","article-title":"Redefining the immune landscape of hepatitis A virus infection","volume":"57","author":"Colasanti","year":"2025","journal-title":"Exp. Mol. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"103551","DOI":"10.1016\/j.jceh.2026.103551","article-title":"Hepatitis A Virus-related Acute Liver Failure-A Cause for Concern?","volume":"16","author":"Biswas","year":"2026","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"105","DOI":"10.25259\/IJMS_225_2023","article-title":"A declining trend of hepatitis A and hepatitis E at tertiary care hospital in South Gujarat","volume":"76","author":"Gandhi","year":"2024","journal-title":"Indian J. Med. Sci."},{"key":"ref_69","unstructured":"Kumar, S., Kataria, R., and Iqbal, M. (2026, June 06). Swachh Bharat Mission Successfully Transforms India\u2019s Sanitation Landscape, Available online: https:\/\/static.pib.gov.in\/WriteReadData\/specificdocs\/documents\/2024\/sep\/doc202496389901.pdf."},{"key":"ref_70","unstructured":"Khuroo, M.S. (2026, June 06). Hand Hygiene and Swachh Bharat Abhiyaan. Researchgate. Available online: https:\/\/www.researchgate.net\/publication\/268871843."},{"key":"ref_71","unstructured":"Kapoor, A., and Anand, M. (2026, June 06). Available online: https:\/\/eacpm.gov.in\/wp-content\/uploads\/2024\/05\/Addressing_Groundwater_Depletion_in_India.pdf."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.virusres.2011.02.007","article-title":"Discovery of hepatitis E: The epidemic non-A, non-B hepatitis 30 years down the memory lane","volume":"161","author":"Khuroo","year":"2011","journal-title":"Virus Res."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1007\/s12072-009-9159-5","article-title":"Seroepidemiology of a second epidemic of hepatitis E in a population that had recorded first epidemic 30 years before and has been under surveillance since then","volume":"4","author":"Khuroo","year":"2010","journal-title":"Hepatol. Int."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1007\/s12664-018-0819-z","article-title":"Acute hepatitis E in India appears to be caused exclusively by genotype 1 hepatitis E virus","volume":"37","author":"Gupta","year":"2018","journal-title":"Indian J. Gastroenterol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1111\/j.1365-2893.2006.00815.x","article-title":"Hepatitis E virus infection among animals in northern India: An unlikely source of human disease","volume":"14","author":"Shukla","year":"2007","journal-title":"J. Viral Hepat."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e25367","DOI":"10.5812\/hepatmon.25367v2","article-title":"Genotype 4 Hepatitis E Virus Prevalent in Eastern China Shows Diverse Subtypes","volume":"15","author":"Tian","year":"2015","journal-title":"Hepat. Mon."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Nan, Y., Wu, C., Zhao, Q., and Zhou, E.M. (2017). Zoonotic Hepatitis E Virus: An Ignored Risk for Public Health. Front. Microbiol., 8.","DOI":"10.3389\/fmicb.2017.02396"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"e2002324118","DOI":"10.1073\/pnas.2002324118","article-title":"Ranking the risk of animal-to-human spillover for newly discovered viruses","volume":"118","author":"Grange","year":"2021","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s12560-021-09461-5","article-title":"The Foodborne Transmission of Hepatitis E Virus to Humans","volume":"13","author":"Treagus","year":"2021","journal-title":"Food Environ. Virol."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Rajkhowa, S., Sonowal, J., Pegu, S.R., Deb, R., and Gupta, V.K. (2025). Epidemiology and Emerging Trends of Zoonotic Viral Diseases of Pigs in India. Viruses, 17.","DOI":"10.20944\/preprints202501.0268.v1"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"723","DOI":"10.4254\/wjh.v13.i7.723","article-title":"Hepatitis E virus in professionally exposed: A reason for concern?","volume":"13","author":"Mrzljak","year":"2021","journal-title":"World J. Hepatol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.3201\/eid1809.120241","article-title":"Hepatitis E, a vaccine-preventable cause of maternal deaths","volume":"18","author":"Labrique","year":"2012","journal-title":"Emerg. Infect. Dis."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1016\/j.jhep.2023.03.024","article-title":"The pressing need for a global HEV vaccine","volume":"79","author":"Peron","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Fu, R.M., Decker, C.C., and Dao Thi, V.L. (2019). Cell Culture Models for Hepatitis E Virus. Viruses, 11.","DOI":"10.3390\/v11070608"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.addr.2021.01.001","article-title":"Recombinant protein vaccines, a proven approach against coronavirus pandemics","volume":"170","author":"Pollet","year":"2021","journal-title":"Adv. Drug Deliv. Rev."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"33175","DOI":"10.1074\/jbc.M110.106336","article-title":"Structure of Hepatitis E Virion-sized Particle Reveals an RNA-dependent Viral Assembly Pathway","volume":"285","author":"Xing","year":"2010","journal-title":"J. Biol. Chem."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1006\/viro.1999.0005","article-title":"Recombinant Hepatitis E Capsid Protein Self-Assembles into a Dual-Domain T = 1 Particle Presenting Native Virus Epitopes","volume":"265","author":"Xing","year":"1999","journal-title":"Virology"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Yin, X., Li, X., and Feng, Z. (2016). Role of Envelopment in the HEV Life Cycle. Viruses, 8.","DOI":"10.3390\/v8080229"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"e00817","DOI":"10.1128\/JVI.00822-17","article-title":"Characterization of the Quasi-Enveloped Hepatitis E Virus Particles Released by the Cellular Exosomal Pathway","volume":"91","author":"Nagashima","year":"2017","journal-title":"J. Virol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"e43983","DOI":"10.7554\/eLife.43983","article-title":"Cellular entry and uncoating of naked and quasi-enveloped human hepatoviruses","volume":"8","author":"Das","year":"2019","journal-title":"eLife"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1016\/j.csbj.2021.03.038","article-title":"Structural and molecular biology of hepatitis E virus","volume":"19","author":"Wang","year":"2021","journal-title":"Comput. Struct. Biotechnol. J."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.1038\/emi.2012.7","article-title":"Molecular biology and replication of hepatitis E virus","volume":"1","author":"Cao","year":"2012","journal-title":"Emerg. Microbes Infect."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"12992","DOI":"10.1073\/pnas.0904848106","article-title":"Structure of the hepatitis E virus-like particle suggests mechanisms for virus assembly and receptor binding","volume":"106","author":"Guu","year":"2009","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/B978-0-12-800947-5.00002-8","article-title":"Virus Structure and Classification","volume":"Volume 19","author":"Louten","year":"2016","journal-title":"Essential Human Virology"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"2457","DOI":"10.1007\/s00705-022-05575-8","article-title":"Structural aspects of hepatitis E virus","volume":"167","author":"Cancela","year":"2022","journal-title":"Arch. Virol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1128\/JVI.00657-10","article-title":"Spatial Configuration of Hepatitis E Virus Antigenic Domain","volume":"85","author":"Xing","year":"2011","journal-title":"J. Virol."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Zhou, Z., Xie, Y., Wu, C., and Nan, Y. (2021). The Hepatitis E Virus Open Reading Frame 2 Protein: Beyond Viral Capsid. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.739124"},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Hervouet, K., Ferrie, M., Ankavay, M., Montpellier, C., Camuzet, C., Alexandre, V., Dembele, A., Lecoeur, C., Foe, A.T., and Bouquet, P. (2022). An Arginine-Rich Motif in the ORF2 capsid protein regulates the hepatitis E virus lifecycle and interactions with the host cell. PLoS Pathog., 18.","DOI":"10.1371\/journal.ppat.1010798"},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Ju, X., and Ding, Q. (2019). Hepatitis E Virus Assembly and Release. Viruses, 11.","DOI":"10.3390\/v11060539"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1056\/NEJMoa061847","article-title":"Safety and efficacy of a recombinant hepatitis E vaccine","volume":"356","author":"Shrestha","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Huang, X., Lu, J., Liao, M., Huang, Y., Wu, T., and Xia, N. (2024). Progress and Challenges to Hepatitis E Vaccine Development and Deployment. Vaccines, 12.","DOI":"10.3390\/vaccines12070719"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"5073","DOI":"10.1016\/j.vaccine.2017.05.072","article-title":"A phase 1 randomized open-label clinical study to evaluate the safety and tolerability of a novel recombinant hepatitis E vaccine","volume":"35","author":"Cao","year":"2017","journal-title":"Vaccine"},{"key":"ref_103","unstructured":"Zydus (2023, August 14). Clinical Trials Registry\u2014India (CTRI) 2007. Available online: https:\/\/www.ctri.nic.in\/Clinicaltrials\/pmaindet2.php?EncHid=ODAwMjg=&Enc=&userName=Adsorbed."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1080\/21645515.2015.1008870","article-title":"The development of a recombinant hepatitis E vaccine HEV 239","volume":"11","author":"Li","year":"2015","journal-title":"Hum. Vaccin Immunother."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"S805","DOI":"10.1093\/infdis\/jiab446","article-title":"Hepatitis E in Bangladesh: Insights from a National Serosurvey","volume":"224","author":"Azman","year":"2021","journal-title":"J. Infect. Dis."},{"key":"ref_106","unstructured":"URIHK (2026, June 06). Summary of Product Characteristics (SmPC). Recombinant Hepatitis E Vaccine (E. coli). Manufacturer: Xiamen Innovax Biotech Co. Ltd. Marketer\/Importer: Urihk Pharmaceutical Private Limited, Available online: https:\/\/www.cdsco.gov.in\/opencms\/resources\/UploadCDSCOWeb\/2018\/UploadSmPC\/115.%20Hepatitis%20E%20Urhik.pdf."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1016\/j.vaccine.2008.12.061","article-title":"Randomized-controlled phase II clinical trial of a bacterially expressed recombinant hepatitis E vaccine","volume":"27","author":"Zhang","year":"2009","journal-title":"Vaccine"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1093\/infdis\/jiae148","article-title":"A Phase 1, Double-Blinded, Placebo-Controlled Clinical Trial to Evaluate the Safety and Immunogenicity of HEV-239 (Hecolin) Vaccine in Healthy US Adults","volume":"230","author":"Kao","year":"2024","journal-title":"J. Infect. Dis."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"2474","DOI":"10.4161\/hv.25814","article-title":"Immunogenicity and safety of hepatitis E vaccine in healthy hepatitis B surface antigen positive adults","volume":"9","author":"Wu","year":"2013","journal-title":"Hum. Vaccin Immunother."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"S24","DOI":"10.1016\/S0168-8278(26)00337-5","article-title":"OS-027 A prospective, randomized, double-blind, placebo-controlled, phase III, multicenter study to evaluate the immunogenicity and safety of recombinant hepatitis E vaccine in healthy adults & adolescents","volume":"84","author":"Kar","year":"2026","journal-title":"J. Hepatol."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1056\/NEJMoa1406011","article-title":"Long-term efficacy of a hepatitis E vaccine","volume":"372","author":"Zhang","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/S0140-6736(23)02234-1","article-title":"Long-term efficacy of a recombinant hepatitis E vaccine in adults: 10-year results from a randomised, double-blind, placebo-controlled, phase 3 trial","volume":"403","author":"Huang","year":"2024","journal-title":"Lancet"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/S0140-6736(10)61030-6","article-title":"Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: A large-scale, randomised, double-blind placebo-controlled, phase 3 trial","volume":"376","author":"Zhu","year":"2010","journal-title":"Lancet"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"e033702","DOI":"10.1136\/bmjopen-2019-033702","article-title":"HEV study protocol: Design of a cluster-randomised, blinded trial to assess the safety, immunogenicity and effectiveness of the hepatitis E vaccine HEV 239 (Hecolin) in women of childbearing age in rural Bangladesh","volume":"10","author":"Zaman","year":"2020","journal-title":"BMJ Open"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"e1288","DOI":"10.1016\/S2214-109X(24)00192-X","article-title":"Safety and effectiveness of a recombinant hepatitis E vaccine in women of childbearing age in rural Bangladesh: A phase 4, double-blind, cluster-randomised, controlled trial","volume":"12","author":"Zaman","year":"2024","journal-title":"Lancet Glob. Health"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"e1881","DOI":"10.1016\/S2214-109X(24)00321-8","article-title":"Safety of hepatitis E vaccine in pregnancy: An emulated target trial following a mass reactive vaccination campaign in Bentiu internally displaced persons camp, South Sudan","volume":"12","author":"Nesbitt","year":"2024","journal-title":"Lancet Glob. Health"},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Jotautis, V., and Sarantaki, A. (2025). Evaluating the Efficacy and Safety of Hepatitis E Vaccination in Reproductive-Age Women: A Systematic Review and Meta-Analysis. Vaccines, 13.","DOI":"10.3390\/vaccines13010053"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1002\/hep.25522","article-title":"Safety of the hepatitis E vaccine for pregnant women: A preliminary analysis","volume":"55","author":"Wu","year":"2012","journal-title":"Hepatology"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"2185456","DOI":"10.1080\/22221751.2023.2185456","article-title":"Safety of hepatitis E vaccination for pregnancy: A post-hoc analysis of a randomized, double-blind, controlled phase 3 clinical trial","volume":"12","author":"Zhong","year":"2023","journal-title":"Emerg. Microbes Infect."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"e1300","DOI":"10.1016\/S2214-109X(24)00193-1","article-title":"Receipt of hepatitis E vaccine and fetal loss in rural Bangladesh: Further analysis of a double-blind, cluster-randomised, controlled trial","volume":"12","author":"Aziz","year":"2024","journal-title":"Lancet Glob. Health"},{"key":"ref_121","unstructured":"WHO (2026, June 06). Safety of Hepatitis E Vaccines. Extract from Report of GACVS Meeting of 15\u201317 May 2024, Published in the WHO Weekly Epidemiological Record on 9 August 2024. Available online: https:\/\/www.who.int\/groups\/global-advisory-committee-on-vaccine-safety\/topics\/hepatitis-e-vaccines."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1016\/j.cmi.2025.02.027","article-title":"Safety and immunogenicity of hepatitis E vaccine in compensated liver cirrhosis with chronic hepatitis B","volume":"31","author":"Liao","year":"2025","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1038\/s41467-025-57021-3","article-title":"Effectiveness of a hepatitis E vaccine against medically attended symptomatic infection in HBsAg-positive adults from a test-negative design study","volume":"16","author":"Zhuang","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_124","unstructured":"Zurowska, A. (2025). Breakthrough Study Confirms Hepatitis E Vaccine Works in High-Risk Groups. EMJ Eur. Med. J., Available online: https:\/\/www.emjreviews.com\/hepatology\/news\/breakthrough-study-confirms-hepatitis-e-vaccine-works-in-high-risk-groups\/."},{"key":"ref_125","doi-asserted-by":"crossref","unstructured":"Azam, B., Marti, M., Goel, A., and Aggarwal, R. (2025). Immunogenicity, Efficacy, and Effectiveness of Two-Dose and Shorter Schedules of Hepatitis E Vaccine: A Systematic Review. Vaccines, 13.","DOI":"10.3390\/vaccines13010028"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.vaccine.2022.12.064","article-title":"Immunogenicity and safety of a two-dose regimen with hepatitis E virus vaccine in healthy adults in rural Bangladesh: A randomized, double-blind, controlled, phase 2\/pilot trial","volume":"41","author":"Overbo","year":"2023","journal-title":"Vaccine"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1038\/s41541-024-01041-5","article-title":"Persistence of hepatitis E vaccine-induced antibody response across different dosage schedules and baseline serostatus","volume":"9","author":"Zhu","year":"2024","journal-title":"npj Vaccines"},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Nesbitt, R.C., Asilaza, V.K., Gignoux, E., Koyuncu, A., Gitahi, P., Nkemenang, P., Duncker, J., Antier, Z., Haile, M., and Gakima, P. (2024). Vaccination coverage and adverse events following a reactive vaccination campaign against hepatitis E in Bentiu displaced persons camp, South Sudan. PLoS Negl. Trop. Dis., 18.","DOI":"10.1371\/journal.pntd.0011661"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1016\/j.cmi.2019.01.015","article-title":"Immunogenicity and safety of an accelerated hepatitis E vaccination schedule in healthy adults: A randomized, controlled, open-label, phase IV trial","volume":"25","author":"Chen","year":"2019","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/S1473-3099(24)00657-1","article-title":"The effectiveness of two doses of recombinant hepatitis E vaccine in response to an outbreak in Bentiu, South Sudan: A case-control and bias indicator study","volume":"25","author":"Nesbitt","year":"2025","journal-title":"Lancet Infect. Dis."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"2254","DOI":"10.1080\/21645515.2018.1469591","article-title":"Development of new hepatitis E vaccines","volume":"14","author":"Cao","year":"2018","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.jhep.2025.06.015","article-title":"Antibodies elicited by hepatitis E vaccination in humans confer cross-genus protection against rat hepatitis E virus","volume":"83","author":"Chen","year":"2025","journal-title":"J. Hepatol."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1038\/cr.2015.34","article-title":"Structural basis for the neutralization of hepatitis E virus by a cross-genotype antibody","volume":"25","author":"Gu","year":"2015","journal-title":"Cell Res."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1002\/jmv.21140","article-title":"Cross-protection of hepatitis E virus genotypes 1 and 4 in rhesus macaques","volume":"80","author":"Huang","year":"2008","journal-title":"J. Med. Virol."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1053\/j.gastro.2011.02.040","article-title":"A vaccine for hepatitis e: Has it finally arrived?","volume":"140","author":"Sarin","year":"2011","journal-title":"Gastroenterology"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.virusres.2013.05.013","article-title":"Rabbit and human hepatitis E virus strains belong to a single serotype","volume":"176","author":"Wang","year":"2013","journal-title":"Virus Res."},{"key":"ref_137","first-page":"117","article-title":"Current Knowledge on Hepatitis E","volume":"3","author":"Garcia","year":"2015","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1002\/jmv.25370","article-title":"Hepatitis E virus seroprevalence among blood donors in Pune, India","volume":"91","author":"Tripathy","year":"2019","journal-title":"J. Med. Virol."},{"key":"ref_139","doi-asserted-by":"crossref","unstructured":"Mirzaev, U.K., Ouoba, S., Ko, K., Phyo, Z., Chhoung, C., Ataa, A.G., Sugiyama, A., Akita, T., and Tanaka, J. (2024). Systematic review and meta-analysis of hepatitis E seroprevalence in Southeast Asia: A comprehensive assessment of epidemiological patterns. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-09349-2"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"a032573","DOI":"10.1101\/cshperspect.a032573","article-title":"Immunization against Hepatitis E","volume":"8","author":"Innis","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"O397","DOI":"10.1111\/1469-0691.12419","article-title":"Protection against hepatitis E virus infection by naturally acquired and vaccine-induced immunity","volume":"20","author":"Zhang","year":"2014","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"336.e1","DOI":"10.1016\/j.cmi.2016.10.029","article-title":"Persistence of antibodies acquired by natural hepatitis E virus infection and effects of vaccination","volume":"23","author":"Su","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1016\/0140-6736(93)90873-F","article-title":"Hepatitis E and long-term antibody status","volume":"341","author":"Khuroo","year":"1993","journal-title":"Lancet"},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"11187","DOI":"10.1038\/s41467-025-66188-8","article-title":"Long-term protection from naturally acquired immunity against hepatitis E virus reinfection","volume":"16","author":"Liu","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"ofz144","DOI":"10.1093\/ofid\/ofz144","article-title":"Long-term Antibody Persistence After Hepatitis E Virus Infection and Vaccination in Dongtai, China","volume":"6","author":"Kmush","year":"2019","journal-title":"Open Forum Infect. Dis."},{"key":"ref_146","first-page":"597","article-title":"A large waterborne viral hepatitis E epidemic in Kanpur, India","volume":"70","author":"Naik","year":"1992","journal-title":"Bull. World Health Organ."},{"key":"ref_147","first-page":"49","article-title":"Infectious hepatitis in Delhi (1955\u20131956): A critical study: Epidemiology","volume":"45","author":"Viswanathan","year":"1957","journal-title":"Indian J. Med. Res."},{"key":"ref_148","doi-asserted-by":"crossref","unstructured":"Khuroo, M.S., Khuroo, M.S., and Khuroo, N.S. (2016). Transmission of Hepatitis E Virus in Developing Countries. Viruses, 8.","DOI":"10.3390\/v8090253"},{"key":"ref_149","first-page":"113","article-title":"Hepatitis E: Evidence for person-to-person transmission and inability of low dose immune serum globulin from an Indian source to prevent it","volume":"11","author":"Khuroo","year":"1992","journal-title":"Indian J. Gastroenterol."},{"key":"ref_150","doi-asserted-by":"crossref","unstructured":"Koyuncu, A., Asilaza, K.V., Rumunu, J., Wamala, J., Gitahi, P., Antier, Z., Duncker, J., Nkemenang, P., Gakima, P., and Haile, M. (2025). High confidence and demand for hepatitis E vaccine during an outbreak in Bentiu, South Sudan: A qualitative study. PLoS Glob. Public Health, 5.","DOI":"10.1371\/journal.pgph.0003482"},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"e250","DOI":"10.1093\/infdis\/jiaf436","article-title":"Diagnostic Performance and Kinetics of Hepatitis E Viral RNA and IgM Antibody Test Positivity in a Genotype 1 Outbreak in South Sudan","volume":"233","author":"Koyuncu","year":"2026","journal-title":"J. Infect. Dis."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/S0140-6736(95)90761-0","article-title":"Vertical transmission of hepatitis E virus","volume":"345","author":"Khuroo","year":"1995","journal-title":"Lancet"},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1111\/j.1365-2893.2009.01101.x","article-title":"Clinical course and duration of viremia in vertically transmitted hepatitis E virus (HEV) infection in babies born to HEV-infected mothers","volume":"16","author":"Khuroo","year":"2009","journal-title":"J. Viral Hepat."},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"28","DOI":"10.7326\/0003-4819-147-1-200707030-00005","article-title":"Maternal and fetal outcomes in pregnant women with acute hepatitis E virus infection","volume":"147","author":"Patra","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_155","first-page":"70","article-title":"Association of severity of hepatitis E virus infection in mother and vertically transmitted infection in feuts","volume":"13","author":"Khuroo","year":"2006","journal-title":"JK-Pract."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"e1758","DOI":"10.1016\/S2214-109X(24)00290-0","article-title":"Hepatitis E vaccination: Continued benefit for pregnant women in vulnerable settings","volume":"12","author":"Marti","year":"2024","journal-title":"Lancet Glob. Health"},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1186\/s12985-026-03205-2","article-title":"Safety of hepatitis E vaccine in pregnancy","volume":"23","author":"Zhang","year":"2026","journal-title":"Virol. J."},{"key":"ref_158","unstructured":"Khan, M.A., and Khuroo, M.S. (1996). Obstetric Outcome and Vertical Transmission in Pregnant Patients with Viral Hepatitis E (A Prospective Study). [Ph.D. Thesis, Sher-I-Kashmir Institute of Medical Sciences]."},{"key":"ref_159","unstructured":"Kamili, S., Khuroo, M., and Jameel, S. (1994). Hepatitis E: Studies on Transmission, Etiological Agent and Sero-Epidemiology, Universidad de Cachemira."},{"key":"ref_160","first-page":"33","article-title":"Association of severity of HEV infection in the mother and vertically transmitted infection in fetus","volume":"147","author":"Khuroo","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_161","first-page":"50","article-title":"Superimposed acute hepatitis E infection in patients with chronic liver disease","volume":"23","author":"Monga","year":"2004","journal-title":"Indian J. Gastroenterol."},{"key":"ref_162","doi-asserted-by":"crossref","unstructured":"Kamar, N., Abravanel, F., Marion, O., Couat, C., Esposito, L., Hebral, A.L., Lavayssi\u00e8re, L., Ribes, D., Guy, P., and Lhomme, S. (2026). Two decades of hepatitis E in solid organ transplantation: A retrospective monocentric analysis. Hepatology, Publish ahead of print.","DOI":"10.1097\/HEP.0000000000001762"},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"e0740","DOI":"10.1097\/HC9.0000000000000740","article-title":"The high burden of HEV infection in solid organ transplant recipients","volume":"9","author":"Li","year":"2025","journal-title":"Hepatol. Commun."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.3748\/wjg.v27.i12.1240","article-title":"Hepatitis E in solid organ transplant recipients: A systematic review and meta-analysis","volume":"27","author":"Hansrivijit","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1002\/hep.32455","article-title":"Immunocompromised rabbit model of chronic HEV reveals liver fibrosis and distinct efficacy of different vaccination strategies","volume":"76","author":"He","year":"2022","journal-title":"Hepatology"},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1016\/j.jceh.2014.02.058","article-title":"Acute Hepatitis E in India appears to be caused Exclusively by Genotype 1 Hepatitis E Virus","volume":"4","author":"Aggarwal","year":"2014","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"e138","DOI":"10.1111\/jvh.12027","article-title":"Lack of evidence of hepatitis E virus infection among renal transplant recipients in a disease-endemic area","volume":"20","author":"Naik","year":"2013","journal-title":"J. Viral Hepat."},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1016\/S0140-6736(14)61034-5","article-title":"Hepatitis E virus in blood components: A prevalence and transmission study in southeast England","volume":"384","author":"Hewitt","year":"2014","journal-title":"Lancet"},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"20812","DOI":"10.2807\/1560-7917.ES2014.19.21.20812","article-title":"Transfusion-transmitted hepatitis E in Germany, 2013","volume":"19","author":"Huzly","year":"2014","journal-title":"Eurosurveillance"},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"482","DOI":"10.4254\/wjh.v14.i3.482","article-title":"Hepatitis E in immunocompromised individuals","volume":"14","author":"Damiris","year":"2022","journal-title":"World J. Hepatol."},{"key":"ref_171","doi-asserted-by":"crossref","unstructured":"Wang, M., Fu, P., Yin, Y., He, M., and Liu, Y. (2016). Acute, Recent and Past HEV Infection among Voluntary Blood Donors in China: A Systematic Review and Meta-Analysis. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0161089"},{"key":"ref_172","doi-asserted-by":"crossref","unstructured":"Denner, J., Pischke, S., Steinmann, E., Blumel, J., and Glebe, D. (2019). Why all blood donations should be tested for hepatitis E virus (HEV). BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4190-1"},{"key":"ref_173","unstructured":"GOV.UK, and HEV Working Group (2026, June 06). Hepatitis E Virus Transmission by Blood Transfusion\u2014Review of Current Screening Effectiveness, Available online: https:\/\/assets.publishing.service.gov.uk\/media\/6936a0e17b258b4b5257433d\/sabto-hepatitis-e-virus-transmission-by-blood-transfusion-review-of-current-screening-effectiveness.pdf."},{"key":"ref_174","first-page":"103","article-title":"Transfusion-transmitted hepatitis E in a patient with myelodysplastic syndromes","volume":"12","author":"Kimura","year":"2014","journal-title":"Blood Transfus."},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/trf.17696","article-title":"Universal nucleic acid donor screening revealed epidemiological features of hepatitis E and prevented transfusion-transmitted infection in Japan","volume":"64","author":"Tanaka","year":"2024","journal-title":"Transfusion"},{"key":"ref_176","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1111\/j.1440-1746.2004.03437.x","article-title":"Hepatitis E virus infection may be transmitted through blood transfusions in an endemic area","volume":"19","author":"Khuroo","year":"2004","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/tme.12760","article-title":"Risk of hepatitis-E virus infections among blood donors in a regional blood transfusion centre in western India","volume":"31","author":"Mishra","year":"2021","journal-title":"Transfus. Med."},{"key":"ref_178","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1111\/j.1440-1746.2004.03454.x","article-title":"Hepatitis E: Is it a blood-borne pathogen?","volume":"19","author":"Aggarwal","year":"2004","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_179","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/S0377-1237(10)80037-1","article-title":"Incidence of Hepatitis E Virus Infection in Recipients of Blood or Blood Products Transfusion","volume":"66","author":"Anand","year":"2010","journal-title":"Med. J. Armed Forces India"},{"key":"ref_180","doi-asserted-by":"crossref","unstructured":"Rivero-Juarez, A., Lopez-Lopez, P., Frias, M., and Rivero, A. (2019). Hepatitis E Infection in HIV-Infected Patients. Front. Microbiol., 10.","DOI":"10.3389\/fmicb.2019.01425"},{"key":"ref_181","doi-asserted-by":"crossref","unstructured":"Kogias, D., Skeva, A., Smyrlis, A., Mourvati, E., Kantartzi, K., Romanidou, G., Kalientzidou, M., Rekari, V., Konstantinidou, E., and Kiorteve, P. (2023). Hepatitis E Virus (HEV) Infection in Hemodialysis Patients: A Multicenter Epidemiological Cohort Study in North-Eastern Greece. Pathogens, 12.","DOI":"10.3390\/pathogens12050667"},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"e23633","DOI":"10.5812\/hepatmon.23633","article-title":"Anti-Hepatitis E Antibody in Hemodialysis Patients in Isfahan, Iran: Prevalence and Risk Factors","volume":"15","author":"Alavian","year":"2015","journal-title":"Hepat. Mon."},{"key":"ref_183","first-page":"464","article-title":"Evaluation of safety and immunogenicity of hepatitis E vaccine in maintenance hemodialysis patients","volume":"56","author":"Wang","year":"2022","journal-title":"Zhonghua Yu Fang Yi Xue Za Zhi"},{"key":"ref_184","doi-asserted-by":"crossref","unstructured":"Wang, M., Duan, B., Liu, M., Zhang, Y., Wu, F., Li, G., and Ouyang, Y. (2025). Vaccination Strategies and Research Gaps in Hepatitis E Virus for Special Populations. Vaccines, 13.","DOI":"10.3390\/vaccines13060621"},{"key":"ref_185","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.1016\/S0140-6736(11)61849-7","article-title":"Hepatitis E","volume":"379","author":"Kamar","year":"2012","journal-title":"Lancet"},{"key":"ref_186","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.7205\/MILMED.172.11.1217","article-title":"Hepatitis E virus infection in Thai troops deployed with U.N. peacekeeping forces","volume":"172","author":"Myint","year":"2007","journal-title":"Mil. Med."},{"key":"ref_187","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S0924-8579(02)00290-X","article-title":"Viral hepatitis in international travellers: Risks and prevention","volume":"21","author":"Khuroo","year":"2003","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_188","doi-asserted-by":"crossref","first-page":"taaa132","DOI":"10.1093\/jtm\/taaa132","article-title":"Travel-related hepatitis E: A two-decade GeoSentinel analysis","volume":"27","author":"Nicolini","year":"2020","journal-title":"J. Travel Med."},{"key":"ref_189","doi-asserted-by":"crossref","first-page":"167","DOI":"10.2310\/7060.2000.00053","article-title":"Hepatitis E vaccine for travelers?","volume":"7","author":"Shlim","year":"2000","journal-title":"J. Travel Med."},{"key":"ref_190","unstructured":"Gibson, M. (2026, June 06). Search WikiDoc [Internet]. Available online: https:\/\/www.wikidoc.org\/index.php\/Traveller_vaccination_hepatitis_E."},{"key":"ref_191","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1002\/jmv.1890430316","article-title":"Spectrum of hepatitis E virus infection in India","volume":"43","author":"Khuroo","year":"1994","journal-title":"J. Med. Virol."},{"key":"ref_192","doi-asserted-by":"crossref","first-page":"554","DOI":"10.4269\/ajtmh.1996.54.554","article-title":"High seroprevalence of hepatitis A, B, C, and E viruses in residents in an Egyptian village in the Nile Delta: A pilot study","volume":"54","author":"Darwish","year":"1996","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_193","doi-asserted-by":"crossref","first-page":"e70136","DOI":"10.1002\/jgc4.70136","article-title":"An introduction to Delphi studies and consensus methods for genetic counselors","volume":"34","author":"MacFarlane","year":"2025","journal-title":"J. Genet. Couns."},{"key":"ref_194","doi-asserted-by":"crossref","first-page":"116","DOI":"10.5662\/wjm.v11.i4.116","article-title":"Delphi methodology in healthcare research: How to decide its appropriateness","volume":"11","author":"Nasa","year":"2021","journal-title":"World J. Methodol."},{"key":"ref_195","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.jarmac.2018.01.007","article-title":"When Expert Decision Making Goes Wrong: Consensus, Bias, the Role of Experts, and Accuracy","volume":"7","author":"Dror","year":"2018","journal-title":"J. Appl. Res. Mem. Cogn."},{"key":"ref_196","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s11739-014-1156-6","article-title":"Consensus development for healthcare professionals","volume":"10","author":"Kea","year":"2015","journal-title":"Intern. Emerg. Med."},{"key":"ref_197","doi-asserted-by":"crossref","unstructured":"Lynch, J.A., Lim, J.K., Asaga, P.E.P., Wartel, T.A., Marti, M., Yakubu, B., Rees, H., Talaat, K., Kmush, B., and Aggarwal, R. (2023). Hepatitis E vaccine-Illuminating the barriers to use. PLoS Negl. Trop. Dis., 17.","DOI":"10.1371\/journal.pntd.0010969"},{"key":"ref_198","unstructured":"SAGE (2026, June 06). Recommendations of the HEV Working Group on the Use of Hepatitis E Vaccine. A Document Prepared for the Strategic Advisory Group of Experts on Immunization (SAGE) by the Hepatitis E Vaccine Working Group. Available online: https:\/\/terrance.who.int\/mediacentre\/data\/sage\/SAGE_Docs_Ppt_Oct2014\/8_session_hepE\/Oct2014_Session8_HEV_recommendations.pdf."},{"key":"ref_199","unstructured":"SAGE (2026, June 06). Hepatitis E Vaccines Background Paper Strategic Advisory Group of Experts (SAGE) on Immunization Meeting 12 March 2024. Available online: https:\/\/cdn.who.int\/media\/docs\/default-source\/immunization\/sage\/2024\/march\/hepatitis_e_background_paper_sage_mar24.pdf?sfvrsn=e14438c4_1."},{"key":"ref_200","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1080\/14760584.2025.2543809","article-title":"Hepatitis E vaccine landscape update 2025","volume":"24","author":"Kim","year":"2025","journal-title":"Expert Rev. Vaccines"},{"key":"ref_201","unstructured":"SAGE (2026, June 06). Report of the SAGE Working Group on Vaccine Hesitancy. Available online: https:\/\/www.asset-scienceinsociety.eu\/sites\/default\/files\/sage_working_group_revised_report_vaccine_hesitancy.pdf."},{"key":"ref_202","unstructured":"Orenstein, P.O.W. (2023). Chapter 29: Hepatitis E Vaccines. Plotkin\u2019s Vaccines, Elsvier. [8th ed.]."},{"key":"ref_203","doi-asserted-by":"crossref","unstructured":"Hartley, C., Wasuwanich, P., Van, T., and Karnsakul, W. (2024). Hepatitis E Vaccines Updates. Vaccines, 12.","DOI":"10.3390\/vaccines12070722"},{"key":"ref_204","doi-asserted-by":"crossref","first-page":"e108170","DOI":"10.5812\/ijem.108170","article-title":"Common Limitations and Challenges of Dietary Clinical Trials for Translation into Clinical Practices","volume":"19","author":"Mirmiran","year":"2021","journal-title":"Int. J. Endocrinol. Metab."},{"key":"ref_205","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1017\/S0950268811002925","article-title":"Fatal outbreaks of jaundice in pregnancy and the epidemic history of hepatitis E","volume":"140","author":"Teo","year":"2012","journal-title":"Epidemiol. Infect."},{"key":"ref_206","unstructured":"Lama, M.P. (2024). Internal displacement in India: Causes, protection and dilemmas. Foreced Migration Review, University of Oxford. Available online: https:\/\/www.fmreview.org\/lama\/."},{"key":"ref_207","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12985-025-03027-8","article-title":"Seroprevalence of hepatitis E in general, hepatic, and pregnant populations in Nepal, Bangladesh, and Pakistan: A systematic review and meta-analysis","volume":"23","author":"Gupta","year":"2025","journal-title":"Virol. J."},{"key":"ref_208","doi-asserted-by":"crossref","first-page":"336","DOI":"10.3201\/eid1902.120670","article-title":"Imported Hepatitis E Virus, Central African Republic","volume":"19","author":"Bouscaillou","year":"2013","journal-title":"Emerg. Infect. Dis."},{"key":"ref_209","doi-asserted-by":"crossref","unstructured":"Goumba, A.I., Konamna, X., and Komas, N.P. (2011). Clinical and epidemiological aspects of a hepatitis E outbreak in Bangui, Central African Republic. BMC Infect. Dis., 11.","DOI":"10.1186\/1471-2334-11-93"},{"key":"ref_210","doi-asserted-by":"crossref","unstructured":"Kim, J.H., Nelson, K.E., Panzner, U., Kasture, Y., Labrique, A.B., and Wierzba, T.F. (2014). A systematic review of the epidemiology of hepatitis E virus in Africa. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-308"},{"key":"ref_211","doi-asserted-by":"crossref","unstructured":"de Marguerite Nombot-Yazenguet, M.P., Dote, J.W., Koyaweda, G.W., Zemingui-Bembete, P.A., Selekon, B., Vickos, U., Manirakiza, A., Nakoune, E., Gouandjika-Vasilache, I., and Komas, N.P.J. (2024). Hepatitis E outbreak in the health district of Bocaranga-Koui, Central African Republic, 2018\u20132019. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-09116-3"},{"key":"ref_212","doi-asserted-by":"crossref","first-page":"737","DOI":"10.3855\/jidc.15701","article-title":"The burden of Hepatitis E virus in the Middle East and North Africa region: A systematic review","volume":"16","author":"Saade","year":"2022","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_213","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.4161\/hv.24657","article-title":"Vaccine hesitancy: An overview","volume":"9","author":"Laberge","year":"2013","journal-title":"Hum. Vaccin Immunother."},{"key":"ref_214","unstructured":"Holt, D., Finnegan, G., Rath, B., Gimenez-Sanchez, F., Signorelli, C., Usonis, V., Weil-Olivier, C., and Evans, S. (2020). Vaccine Hesitancy Deconstructing the Challenge and Finding Solutions, Coilation for Life Course Immunization (LCI). Available online: https:\/\/www.cl-ci.org\/reports\/vaccine-hesitancy-deconstructing-the-challenge-and-finding-solutions\/."},{"key":"ref_215","doi-asserted-by":"crossref","first-page":"2508","DOI":"10.1080\/21645515.2019.1599675","article-title":"Countering vaccine hesitancy through immunization information systems, a narrative review","volume":"15","author":"Gianfredi","year":"2019","journal-title":"Hum. Vaccin Immunother."},{"key":"ref_216","doi-asserted-by":"crossref","unstructured":"Blasioli, E., and Hassini, E. (2026, June 06). Vaccine Hesitancy: How Social and Technological Issues Converged to Spawn Mistrust. A Complex Blend of Personal, Social, and Environmental Factors Fuels Vaccine Skepticism. GAVI The Vaccine Alliance. Available online: https:\/\/www.gavi.org\/vaccineswork\/vaccine-hesitancy-how-social-and-technological-issues-converged-spawn-mistrust.","DOI":"10.64628\/AAM.9qamtagvn"},{"key":"ref_217","doi-asserted-by":"crossref","first-page":"2623707","DOI":"10.1080\/22221751.2026.2623707","article-title":"Cost-effectiveness analysis of hepatitis E screening and vaccination: Targeting vulnerable populations in outbreak and sporadic settings in China","volume":"15","author":"Liu","year":"2026","journal-title":"Emerg. Microbes Infect."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/8\/783\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:26:58Z","timestamp":1784827618000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/8\/783"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":217,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["pathogens15080783"],"URL":"https:\/\/doi.org\/10.3390\/pathogens15080783","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]}}}