Hepatitis A and E: Prevalence, Epidemiology and Co-infection among Patients with Acute Viral Hepatitis

Abstract

Background and Objectives:

Hepatitis A and E present significant public health dilemmas contributing to high morbidity and mortality rates, particularly in developing nations. Both viruses spread through the fecal-oral route, resulting in a range of symptoms, from asymptomatic infections to severe acute viral hepatitis (AVH). Given the seriousness of these pathogens and the scarcity of available data, we undertook this study to determine the seroprevalence, epidemiological patterns, seasonal changes, and instances of coinfection involving hepatitis A virus (HAV) and hepatitis E virus (HEV) in patients with AVH.

Methods:

This retrospective study was conducted in a tertiary care hospital located in North India. Blood samples from patients exhibiting symptoms consistent with AVH were analyzed for anti-HAV and anti-HEV immunoglobulin M (IgM) using commercially available enzyme-linked immunosorbent assay (ELISA) kits. A total of 3,363 patient samples were analyzed.

Results:

The ELISA for anti-HAV IgM yielded a positivity rate of 20.3%, while only 0.6% tested positive for anti-HEV IgM. Among those with positive HAV serology, 41.2% were under 10 years old, followed by 30.9% in the 11–20-year age cohort. Conversely, the majority of HEV-positive cases (47.6%) were found within the 21–30-year age group. Both viruses demonstrated a marked increase during the winter and monsoon seasons. There is a higher seroprevalence of hepatitis A as compared to hepatitis E, and a seasonal surge in both cases was seen in this region of Northern India during the monsoon and winter months.

Conclusion and Implications for Translation:

The diagnosis of acute viral hepatitis (AVH) requires serological validation to identify viral agents, revealing high seroprevalence of hepatitis A in Northern India with seasonal increases during monsoon and winter. Coinfections with hepatitis A (HAV) and E (HEV) are low, but their implications need further study. Public health strategies should focus on safe drinking water access, improved sewage systems, hygiene education, routine HAV immunization, and efficient outbreak detection to reduce morbidity and prevent epidemics in high-risk areas.