Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 2  |  Page : 582-586

Seroprevalence of hepatitis A virus and hepatitis E virus among the patients presenting with acute viral hepatitis admitted in a tertiary care center located in Central India


1 Department of Microbiology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
2 Department of Biochemistry, IGNOU, New Delhi, India
3 KEM Medical College Hospital, Mumbai, Maharashtra, India
4 Gagrani Hospital, Dewas, Madhya Pradesh, India

Date of Submission15-May-2020
Date of Decision29-May-2020
Date of Acceptance31-May-2020
Date of Web Publication30-Jun-2021

Correspondence Address:
Trupti Bajpai
Department of Microbiology, Sri Aurobindo Institute of Medical Sciences Medical College and PG Institute, MR-10 Crossing, Indore-Ujjain Highway, Indore, Madhya Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_153_20

Rights and Permissions
  Abstract 


Objective
To determine the seroprevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) among the patients admitted to a hospital on presenting the symptoms of acute viral hepatitis.
Background
HAV and HEV are enterically transmitted viruses responsible for causing acute viral hepatitis. They pose a heavy burden on the health care system of developing nations.
Patients and methods
A hospital-based study was conducted for a period of 18 months from September 2019 to February 2020. A total of 170 patients were considered for the study. Overall, 3–5 ml of venous blood samples was collected from patients presenting with the symptoms of acute viral hepatitis. Their serum was subjected to enzyme-linked immunosorbent assay test (DiaPro Diagnostic Bioprobes) for detection of anti-HAV and anti-HEV immunoglobulin M.
Results
Of the 170 serum samples tested, 35.8% samples were found to be positive for HAV and 51.7% samples were positive for HEV. Male preponderance was detected during both the infections. HAV was more common in pediatric population, whereas HEV was common among adult population. Coinfection was found to be 1.7%.
Conclusion
Our study mandates the screening of these enteric viruses so as to prevent the further complications associated with the disease. The data collected would essentially help in planning the vaccination strategies along with sanitation and hygiene in our geographical region.

Keywords: anti-hepatitis A virus and hepatitis E virus, enzyme-linked immunosorbent assay, hepatitis A virus, hepatitis E virus, viral hepatitis


How to cite this article:
Bajpai T, Shaw P, Pandey M, Meena J, Gagrani N. Seroprevalence of hepatitis A virus and hepatitis E virus among the patients presenting with acute viral hepatitis admitted in a tertiary care center located in Central India. Menoufia Med J 2021;34:582-6

How to cite this URL:
Bajpai T, Shaw P, Pandey M, Meena J, Gagrani N. Seroprevalence of hepatitis A virus and hepatitis E virus among the patients presenting with acute viral hepatitis admitted in a tertiary care center located in Central India. Menoufia Med J [serial online] 2021 [cited 2024 Mar 29];34:582-6. Available from: http://www.mmj.eg.net/text.asp?2021/34/2/582/319675




  Introduction Top


Enterically transmitted viral hepatitis is a major public health problem in developing nations. Hepatitis A and hepatitis E viruses (HAV and HEV) are responsible for causing communicable disease that are transmitted through ingestion of contaminated food or water and sometimes through direct contact with an infected person. Viruses have a very short incubation period [1],[2],[3]. They cause a self-limiting illness that rarely progresses to acute liver failure. Acute phases of illness include symptoms like jaundice, dark urine, nausea, vomiting, extreme fatigue, malaise, anorexia, right upper quadrant tenderness, and abdominal pain along with elevated liver enzymes [1],[2],[4],[5].

HAV is a member of genus Hepatovirus belonging to family Picornaviridae. It is a 27-nm nonenveloped ssRNA virus. It usually affects infants and young children in developing countries, thereby causing an asymptomatic and self-limiting infections, leading to lifelong immunity. The virus has a single serotype and 7 genotypes [2],[5],[6].

HEV is also a nonenveloped ssRNA virus, classified as a single member of genus Orthohepevirus and family Hepeviridae. It is restricted usually to older children and young adults and has been reported to cause fatal disease in pregnant women. The virus consists of a single serotype and four major genotypes [1],[2],[5],[6].

The humoral response against the viruses leads to the development of antibodies. Antibodies to HAV and HEV [antibodies of class immunoglobulin M (IgM)] are usually detected during acute phase of infection and usually persist for 6–12 months. Convalescence phase is marked by the presence of anti-HAV and anti-HEV (antibodies of class immunoglobulin G), which usually last throughout life, thereby providing a protection against re-infection [1],[2],[5],[6]. These play a pivotal role in the diagnosis of HAV and HEV. The aim of the study was to determine the seroprevalence of HAV and HEV in patients with acute viral hepatitis.


  Patients and methods Top


The present prospective study was conducted from September 2019 to February 2020 for a period of 18 months in the serology section of the Department of Microbiology of a teaching tertiary care hospital located in Central India. Overall, 3–5 ml of venous blood was collected from 170 patients presenting the symptoms of acute viral hepatitis during the study period. Study population included the patients of both the sexes and all age groups. Samples with request for both HAV and HEV IgM tests were included in the study. Hemolyzed and lipemic samples were excluded from the study. Serum was separated from the aforementioned collected blood samples through centrifugation at 1000 rpm for 5 min. The serum samples were further analyzed for anti-HAV IgM and anti-HEV IgM by commercially available enzyme-linked immunosorbent assay test (DiaPro Diagnostic Bioprobes, MI, Italy). All the tests were carried out as per manufacturer's protocol. Informed consent was obtained from the patients. The study was approved by the Institutional Ethical Committee. The data were statistically analyzed through c2 test, and P value less than 0.05 was defined as statistically significant [2],[3],[5],[6].

Statistical analysis

The collected data were transferred to a computer, and Microsoft Excel 2000 (version 9) Washington, United States. Analysis Tool Pack was used for analysis of data. c2 test was performed, and P value less than or equal to 0.05 was considered statistically significant.


  Results Top


A total of 170 serum samples were processed for detection of both HAV and HEV IgM antibodies. Among these samples, 101 were from male and 69 were from female patients. Of 170 samples, 61 (35.8%) samples were found to be positive only for HAV and 88 (51.7%) samples were positive only for HEV. The overall prevalence of HAV and HEV was found to be 85.8%. HAV–HEV coinfection was detected among 1.7% samples. Among the 61 HAV-positive samples, 39 (63.9%) were from male patients and 22 (36%) were from female patients. However, from the 88 HEV-positive samples, 52 (59%) were from males and 36 (40.9%) were from female patients [Table 1]. The P value detected in case of HAV was 0.59 and in case of HEV it was 0.97. Therefore, the differences were found to be statistically insignificant. Age-wise distribution of HAV and HEV IgM-positive cases has also been evaluated [Table 2] and [Table 3]. The differences were found to be highly significant statistically in case of HAV (P = 0.0005) and HEV (P = 0.0009).
Table 1: Seropositivity of hepatitis A virus and hepatitis E virus among male and female patients

Click here to view
Table 2: Age-wise seroprevalence of hepatitis E virus among different male and female patients

Click here to view
Table 3: Age-wise seroprevalence of hepatitis A virus among different male and female patients

Click here to view



  Discussion Top


HAV and HEV type of viral hepatitis appears to be a burning public health issue in developing nations, especially where there are inefficient waste management facilities and poor supply of safe drinking water.

Usually HAV is considered as a most common cause of viral hepatitis on global basis, but in our study, HEV (51.7%) has been identified as the major cause of acute viral hepatitis as compared with HAV (35.8%). Our results were concordant with those published by Samaddar et al. [2], Mittal et al. [3], Antony and Celine [4], Agarwal et al. [6], and Manmohan et al. [7]. Our results were also supported by Das et al. [8], Chadha et al. [9], and Khuroo et al. [10]. However, Sarangi et al. [5] and Rodriguez et al. [11] reported higher HAV prevalence as compared with HEV. Wide variations in the seroprevalence of both HAV and HEV in different regions may be owing to differences in the study population, hygiene, and sanitation. It may also occur owing to the type of diagnostic test kits used by the testing laboratory. Furthermore, antibodies against different strains may also vary in persistence [2]. Differences may also be owing to underreporting of cases and reluctance of patients in seeking medical advice. Comparatively greater seroprevalence of HEV in our study may be attributed to a higher prevalence of anti-HAV antibodies in the general population, improvement in living standards, and availability of vaccine against HAV [6]. Infection from variable strains of HEV, doubtful protection, and the gradual decline in the protective titers of anti-HEV antibodies may be again responsible for more cases of viral hepatitis owing to HEV during our study [2],[6]. Generally, higher incidences of HAV infection are also directly related to hygiene and sanitation.

In our study, coinfection was found in only three patients with a seroprevalence of 1.7%. It was almost similar to those reported by Samaddar et al. [2], Mittal et al. [3], Sarangi et al. [5], and Das et al. [8]. Our results were much lower as compared with those presented by Joon et al. [1], Agarwal et al. [6], Das et al. [8], Rodriguez et al. [11], Arora et al. [12], Radhakrishnan et al. [13], Vidsmiya et al. [14], Monika et al. [15], and Sarguna et al. [16]. Identical mode of transmission, doubtful immunity against both the viruses, and infection from divergent strains of viruses may be the possible reasons of coexistence of infection. Coinfections usually do not affect the prognosis of the patient and resolve through conservative treatment, but rarely, these may lead to severe form of disease like hepatic encephalopathy. Diagnosis of coinfection is not possible through clinical presentation or biochemical testing. Identification of causative agent should be done by either serology or PCR method. Timely detection of causative agent therefore prevents the chances of liver failure in children and adults [1],[6].

The sex-specific seroprevalence of antibody toward HAV and HEV was also determined in our study. The overall prevalence of both HAV and HEV was found to be higher among males in the present study. It has also been correlated with the studies from Joon et al. [1], Mittal et al. [3], Antony and Celine [4], Sarangi et al. [5], and Barrientos-Gutierrez et al. [17]. Male predominance was also supported by Manmohan et al. [7], Al-Naaimi et al. [18], Kamal et al. [19], Dhamdhere and Nadkarni [20], and Mishra et al. [21]. However, Samaddar et al. [2] and Agarwal et al. [6] also reported more males having HAV virus as compared with female patients and more females having HEV as compared with male patients. Almost equal number of male and female patients was found to be infected in the data presented by Kuntz and Kuntz [22]. Male predominance in case of our study may be attributed by their profession and outdoor activities [2],[3],[5],[6].

Regarding the age-wise prevalence of HAV and HEV in our study, we reported a high percentage of HAV in the age group more than 15 years of age and high percentage of HEV in the age group more than 30 years. Our results resembled the findings of Joon et al. [1], Mittal et al. [3], Sarangi et al. [5], Arora et al. [12], Chandra et al. [23], and Sebastian et al. [24]. However, studies by Antony and Celine [4], Davaalkham et al. [25], and Arankalle et al. [26] have noticed a shift of HAV infection from pediatric population to adults. On the basis of seroepidemiological data reported in developing countries, the infection of HAV is usually acquired in early life owing to overcrowding and poor sanitation, and by the age 10 years, 90% of the population possess antibody to the virus, thereby developing immunity toward the infection. Hence, HAV infection is less commonly seen in adults again, confirming the findings of our study [5]. However, recent studies are proposing the fact that HAV prevalence is trying to shift from children to adults owing to progress in availability of improved standards of living.

In the present study, of 170 patients with symptoms of acute viral hepatitis, 146 patients were positive for at least one viral marker. Our results resembled that of Sarangi et al. [5]. and were comparatively higher than the overall seropositivity detected by Joon et al. [1], Samaddar et al. [2], Agarwal et al. [6], Radhakrishnan et al. [13], and Al-Naaimi et al. [18]. This may be owing to the inclusion of clinical cases highly suspicious of acute viral hepatitis in our study. We assume that there could be many more cases of viral hepatitis than those reported in our area. This may be owing to the lack of awareness regarding disease complications. Patients try to treat jaundice-like symptoms by themselves or believe in tantric owing to superstitions.

HAV and HEV infections usually resolve without any sequela, but rarely, these may lead to liver failure. As such no specific treatment is available. As contaminated food and water are the main modes of transmission, emphasis should be given on the routes of transmission and focus should be on personal hygiene and sanitation practices within the region. Use of HAV vaccine should be proposed in high-risk population, travelers visiting endemic areas, and during onset of epidemics.


  Conclusion Top


Our study identifies a higher prevalence of HEV as compared with HAV infection. HAV was high among pediatric population and HEV among the adult population. However, the rate of coinfection is found to be low as compared with other studies. Male preponderance was seen throughout the study. Our results mandate the screening of these feco-orally transmitted viruses so as to reduce the burden imposed by them on our health system. This could be controlled by ensuring safe water supplies, better standard of sanitation and hygiene, and planning future vaccination strategies.

Acknowledgements

The authors wish to thank the Chairperson and Dean of the institute for providing laboratory facilities and healthy working atmosphere during the study period. The authors are also thankful to the technical staff of the institute for providing necessary helping hand during the endeavor.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Joon A, Rao P, Shenov SM, Baliga S. Prevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) in the patients presenting with acute viral hepatitis. Indian J Med Microbiol 2015; 33:102–105.  Back to cited text no. 1
    
2.
Samaddar A, Taklikar S, Kale P, Kumar CA, Baveja S. Infectious hepatitis: a 3-year retrospective study at a tertiary care hospital in India. Indian J Med Microbiol 2019; 37:230–234.  Back to cited text no. 2
    
3.
Mittal A, Bithu R, Vyas N, Maheshwari R. Prevalence of heptitis A virus and hepatitis E virus presenting with acute viral hepatitis at a tertiary care hospital, Jaipur, Rajasthan. N Niger J Clin Res 2016; 5:47–50.  Back to cited text no. 3
    
4.
Antony J, Celine TM. A hospital-based retrospective study on frequency and distribution of viral hepatitis. J Global Infect Dis 2014; 6:99–104.  Back to cited text no. 4
    
5.
Sarangi G, Dash M, Mahapatra D, Paty BP, Mohanty DP, Chayani N. Fecal-oral-transmitted hepatitis A and E prevalence in Eastern India: a 3-yesr retrospective study. J Med Soc 2019; 33:86–90.  Back to cited text no. 5
    
6.
Agarwal S, Shulania A, Duggal N. Seroprevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) co-infection in the patients presenting with acute viral hepatitis attending a tertiary care hospital in North India. J Comm Dis 2017; 49:57–60.  Back to cited text no. 6
    
7.
Manmohan G, Patil R, Khan MI, Gupta SK. Retrospective hospital based study of infective cases of jaundice in Tamil Nadu. India Calicut Med J 2011; 9:1–4.  Back to cited text no. 7
    
8.
Das K, Agarwal A, Andrew R, Frosner GG, Kar P. Role of hepatitis E and other hepatotrophic virus in aetiology of sporadic acute viral illness: a hospital based study from urban Delhi. Eur J Epidemiol 2000; 16:937–940.  Back to cited text no. 8
    
9.
Chadha MS, Walimbe AM, Chobe LP, Arankalle VA. Comparison of etiology of sporadic acute and fulminant viral hepatitis in hospitalized patients in Pune. During 1978-81 and 1994-97. Indian J Gastroenterol 2003; 22:11–15.  Back to cited text no. 9
    
10.
Khuroo MS, Kamili S, Dar MY, Moecklii R, Jameel S. Hepatitis E and long term antibody status. Lancet 1993; 341:1355.  Back to cited text no. 10
    
11.
Rodriguez L, Quintana A, Villalba MC, Lemos G, Corredor MB, Moreno AG, et al. Dual infection with hepatitis A and E viruses in outbreaks and in sporadic clinical cases: Cuba. 1998-2003. J Med Virol 2008; 80:798–802.  Back to cited text no. 11
    
12.
Arora D, Jindal N, Shukla RK, Bansal R. Waterborne hepatitis A and hepatitis E in Malwa region of Punjab, India. J Clin Diagn Res 2013; 7:2163–2166.  Back to cited text no. 12
    
13.
Radhakrishnan S, Raghuraman S, Abraham P, Kurian G, Chandy G, Sridharan G. Prevalence of enterically transmitted hepatitis viruses in patients attending a tertiary care hospital in South India. Indian J Pathol Microbiol 2000; 43:433–436.  Back to cited text no. 13
    
14.
Vidsmiya MG, Solanki HL, Chudasama V. Prevalence of HAV and HEV in the patients presenting with acute viral hepatitis. Int J Sci Res 2014; 3:333–334.  Back to cited text no. 14
    
15.
Monika A, Ruchi A, Ashish B. A study of seroprevalence nd co-infection of hepatitis A and E viruses in sporadic cases in an endemic area. J Med Sci Health 2016; 2:1–5.  Back to cited text no. 15
    
16.
Sarguna P, Rao A, Sudha RKN. Outbreak of acute viral hepatitis due to hepatitis E virus in Hyderabad. Indian J Med Microbiol 2007; 25:378–382.  Back to cited text no. 16
    
17.
Barrientos-Gutierrez T, Brizuela-Alcantara D, Chavez-Tapia NC. Hepatitis A virus infection in high risk subjects. Ann Hepatol 2011; 10:578–579.  Back to cited text no. 17
    
18.
Al-Naaimi AS, Turky AM, Khaleel HA, Jalil RW, Mekhlef OA, Kareem SA, et al. Predicting acute viral hepatitis serum markers (A and E) in patients with suspected acute viral hepatitis attending primary health care centers in Baghdad: a one year cros-sectional study. Global J Health Sci 2012; 4:172–183.  Back to cited text no. 18
    
19.
Kamal SM, Mahmoud S, Hafez T, El-Fouly R. Viral hepatitis A to E in South Mediterranean countries. Medit J Hemat Infect Dis 2010; 2:e2010001.  Back to cited text no. 19
    
20.
Dhamdhere MR, Nadkarni MG. Infectious hepatitis at Aurangabad. Report of an outbreak. Indian J Med Sci 1962; 16:1006–1015.  Back to cited text no. 20
    
21.
Mishra B, Srinivasa H, Muralidharan S, Charles S, Macaden RS. A hospital based study of hepatitis E by serology. Indian J Med Microbiol 2003; 21:115–117.  Back to cited text no. 21
    
22.
Kuntz E, Kuntz HD. Hepatology textbook and atlas. 3rd ed. Germany: Springer Medizin Verlag, Heidelberg.  Back to cited text no. 22
    
23.
Chandra NS, Sharma A, Rai RR, Malhotra B. Contribution of heptitis E virus in acute sporadic hepatitis in North western India. Indian J Med Res 2012; 136:477–482.  Back to cited text no. 23
    
24.
Sebastian B, Mathai S, Mathew G, Ouseph M, Balakrishnan P. An outbreak of hepatitis A in central India: changing patterns. Indian J Gastroenterol 2001; 20:132–135.  Back to cited text no. 24
    
25.
Davaalkham D, Enkhoyun T, Takahashi M, Nakamura Y, Okamoto H. Hepatitis A and E virus infections among children in Mongolia. Am J Trop Med Hygiene 2009; 81:248–251.  Back to cited text no. 25
    
26.
Arankalle VA, Sarada devi KL, Lole KS, Shenoy KT, Verma V, Haneephani M. Molecular characterization of hepatitis A virus from a large outbreak from Kerala, India. Indian J Med Res 2006; 123:760–769.  Back to cited text no. 26
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Patients and methods
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed1018    
    Printed14    
    Emailed0    
    PDF Downloaded119    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]