Prevalence and co-infection of acute hepatitis A virus and hepatitis E virus infections in patients with acute viral hepatitis
DOI:
https://doi.org/10.18203/2320-6012.ijrms20252786Keywords:
Acute infection prevalence, Acute viral hepatitis, Co-infection, Hepatitis A virus, Hepatitis E virusAbstract
Background: Viral hepatitis constitutes a significant global health burden, with hepatitis A virus (HAV) and hepatitis E virus (HEV) causing approximately 1.34 million deaths annually. This study aimed to determine the prevalence of acute HAV and HEV infections, evaluate co-infection patterns, and assess liver dysfunction among suspected acute viral hepatitis cases.
Methods: This cross-sectional study was conducted from July 2023 to July 2024 at a tertiary care hospital. A total of 165 patients with clinically suspected acute viral hepatitis were included. Serum samples were tested for IgM antibodies against HAV and HEV using ELISA. Clinical severity was assessed using standardized grading criteria.
Results: Among 165 patients with suspected acute viral hepatitis, HAV IgM seropositivity was 23.6% (39/165), HEV IgM seropositivity was 10.9% (18/165), and co-infection rate was 2.4% (4/165). HAV mono-infections comprised 21.2% (35/165) and HEV mono-infections 8.5% (14/165). Co-infected patients were significantly younger (mean age 15.8±4.2 years) compared to HAV (30.2±13.8 years) and HEV (25.6±11.4 years) mono-infections (p=0.042). Severe disease occurred in 50% of co-infected patients compared to <9% in mono-infections. Seasonal clustering was highly significant (p < 0.001) with 47.2% of cases during monsoon period.
Conclusions: This study demonstrates significant HAV and HEV disease burden with young adults being most susceptible. Co-infected patients showed more severe clinical presentation requiring enhanced monitoring. Seasonal clustering emphasizes the environmental influence on transmission patterns.
Metrics
References
World Health Organization. Global hepatitis report, 2017. Available at: https://www.who.int/publications/ i/item/9789241565455. Accessed 01 January 2025.
Satsangi S, Chawla YK. Viral hepatitis: Indian scenario. Med J Armed Forces India. 2016;72(3):204-10. DOI: https://doi.org/10.1016/j.mjafi.2016.06.011
Kumar M, Sarin SK. Viral hepatitis eradication in India by 2080-gaps, challenges & targets. Ind J Med Res. 2014;140(1):1-4.
Arankalle VA, Chadha MS, Chitambar SD, Walimbe AM, Chobe LP, Gandhe SS, et al. Changing epidemiology of hepatitis A and hepatitis E in urban and rural India. J Viral Hepat. 2001;8(4):293-303. DOI: https://doi.org/10.1046/j.1365-2893.2001.00279.x
Deoshatwar AR, Gurav YK, Lole KS. Declining trends in Hepatitis A seroprevalence over two decades. Epidemiol Infect. 2020;148:e121. DOI: https://doi.org/10.1017/S0950268820000953
Acharya SK, Madan K, Dattagupta S, Panda SK. Viral hepatitis in India. Natl Med J India. 2006;19:203-17.
Puri P, Sharma PK, Nagpal AK. Viral hepatitis in India: Armed Forces perspective. Med J Armed Forces India. 2016;72(3):201-3. DOI: https://doi.org/10.1016/j.mjafi.2016.07.004
Kumar T, Shrivastava A, Kumar A, Laserson KF, Narain JP, Venkatesh S, et al. Viral hepatitis surveillance-India, 2011–2013. MMWR Morb Mortal Wkly Rep. 2015;64(28):758-62. DOI: https://doi.org/10.15585/mmwr.mm6428a3
Suresh K. Viral Hepatitis in India. Arch Hepat Res. 2020;6(1):003-6. DOI: https://doi.org/10.17352/ahr.000026
Anitha T, Sivagamasundari P, Jacob ES, Kumar PP, Thangavel A. A retrospective study on the prevalence of hepatitis a virus in patients with acute viral hepatitis at a tertiary care hospital. Cureus. 2025;17(2). DOI: https://doi.org/10.7759/cureus.78676
Gopinath R, Sundaram AM, Dhanasezhian A, Arundadhi M, Thangam GS, et al. Seroprevalence of Various Viral Diseases in Tamil Nadu, India. J Glob Infect Dis. 2023;15(4):144-8. DOI: https://doi.org/10.4103/jgid.jgid_101_23
Palewar MS, Joshi S, Choudhary G, Das R, Sadafale A, Karyakarte R. Prevalence of Hepatitis A virus (HAV) and Hepatitis E virus (HEV) in patients presenting with acute viral hepatitis: A 3-year retrospective study at a tertiary care Hospital in Western India. Journal of Family Medicine and Primary Care. 2022;11(6):2437-41. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1746_21
Kalita D, Paul M, Deka S, Badoni G, Gupta P. Simultaneous infection of Hepatitis A and E viruses amongst acute viral hepatitis patients. J Fam Med Prim Care. 2020;9(12):6130. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1373_20
Samaddar A, Taklikar S, Kale P, Kumar CA, Baveja S, et al. Infectious Hepatitis: A 3-Year Retrospective Study at a Tertiary Care Hospital. Indian J Med Microbiol. 2019;37(2):230-4. DOI: https://doi.org/10.4103/ijmm.IJMM_19_197
Bansal Y, Singla N, Garg K, Sharma G, Gill M, Chander J. Seroprevalence of hepatitis A and hepatitis E in patients at a teaching hospital. J Fam Med Prim Care. 2022;11(2):567-72. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1212_21
Franco E. Hepatitis A: Epidemiology and prevention in developing countries. World J Hepatol. 2012;4(3):68. DOI: https://doi.org/10.4254/wjh.v4.i3.68
Joon A, Rao P, Shenoy S, Baliga S. Prevalence of HAV and HEV in patients with acute viral hepatitis. Indian J Med Microbiol. 2015;33:S102-5. DOI: https://doi.org/10.4103/0255-0857.150908
Netra S, Bithu R, Maheshwari RK. Epidemiological Study of HAV and HEV infection in acute viral hepatitis. Int J Curr Microbiol App Sci. 2018;7:899-904. DOI: https://doi.org/10.20546/ijcmas.2018.705.109
Sarguna P, Rao A, Sudha Ramana K. Outbreak of acute viral hepatitis due to HEV in Hyderabad. Indian J Med Microbiol. 2007;25(4):378. DOI: https://doi.org/10.4103/0255-0857.37343