The death-rate from hepatitis in pregnant women in Libya is high. Of 922 hepatitis patients treated during 1975, 377 were males and 545 were females. The case fatality-rate was 0.53% for males and 7-67% for females. In 293 pregnant women it was 12-97% compared with 1-6% in 252 non-pregnant women. In pregnant women deaths occurred mainly in the last trimester. Although 18-4% of the male patients and 15-2% of the women were hepatitis B surface antigen (HBsAg) positive, no patient shown to be antigen-positive died. The frequency of hepatitis in the second half of the year fell both in pregnant women and in the general population, suggesting a warning hepatitis-A epidemic. The exact cause of the high mortality in pregnant women is not clear, but it may have a nutritional basis.
PIP: An outbreak of hepatitis especially virulent in pregnant women in Tripoli, Libya in 1975 is described. The case-fatality rate was 12.97% in 293 pregnant women, 1.6% in 252 nonpregnant women, and 0.53% in 377 men. Deaths in pregnant women usually occurred in 3rd trimester, often at the onset of labor. There was no evidence that pregnant women with jaundice were admitted in preference to non-pregnant women, or that age or parity was related to infection. Hepatitis B antigen was tested by counter immunoelectrophoresis and later by reverse passive hemagglutination and radioimmunoassay. The overall prevalence was 16.6%. In pregnant women it was 11.1%. None of the pregnant women who died were positive for HBsAg. Coma and an abrupt deterioration were often seen in the pregnant women who dies. The women ate a diet devoid in protein from meat, eggs or fish. The epidemic died down in the second half of the year. It was conjectured that virulent a non-A-non-B hepatitis virus caused this outbreak.