Feco-orally transmitted viral hepatitis in a tertiary care hospital in urban India

Abstract

Objective: To investigate the magnitude and pattern of hepatitis viral markers in feco-orally transmitted acute viral hepatitis with their relation to age and sex. Methods: This prospective study was carried out in two groups of subjects including the study group of 600 patients with clinically suspected infectious hepatitis and control group of 200 patients showing no clinical evidence of acute infectious hepatitis. Serum samples were tested for the presence of anti-hepatitis A virus (HAV) IgM and Anti-hepatitis E virus (HEV) IgM antibodies using commercial ELISA test kits. Results: The seroprevalence rate of feco-orally transmitted acute viral hepatitis was 11.8% in the study group compared to 4.5% in the control group (p=0.007). The prevalence of anti-HAV IgM was 8.3% while that of anti-HEV IgM was 3.5% in the same group. Maximum seropositivity of anti-HAV IgM was seen in 0-10 years of age in the study group (16.8%) followed by 11-20 years (7.2%) and 21-30 years (4.6%). In the study group, the maximum seropositivity of anti-HEV IgM was seen in 21-30 years (10.7%) followed by 31-40 years (2.9%), 11-20 years (2.7%) and 0-10 years (0.9%). Male predominance was seen in both types of acute viral hepatitis. Conclusion: While HEV infection was predominantly seen in young adults, HAV infection was predominantly a childhood infection and its prevalence decreased by age. Being enterically transmitted viral diseases it is recommended that immunization programs, public awareness measures for hygiene and safe drinking water should be consolidated.

Keywords

• Acute hepatitis, hepatitis A virus, hepatitis E virus, IgM seroprevalence

Feco-orally transmitted viral hepatitis in a tertiary care hospital in urban India

Öz

Amaç: Fekal-oral yolla bulaşan akut viral hepatit belirleyicilerinin sıklığı ve özellikleri ile yaş ve cinsiyet ilişkilerinin belirlenmesi. Yöntemler: Bu ileriye dönük araştırma klinik olarak infeksiyöz hepatitten şüphelenilen ve 600 hastayı içeren çalışma gurubu ve akut infeksiyöz hepatit kliniğine sahip olmayan ve 200 hastayı içeren kontrol gurubunda yapıldı. Hasta ve kontrol gurubuna ait serum örnekleri anti-hepatitis A virus (HAV) IgM ve anti-hepatitis E virus (HEV) IgM antikorlarının varlığı açısından ticari ELISA test kitleri ile tarandı. Bulgular: Çalışma gurubunda akut viral hepatit seroprevalansı % 11,8, kontrol gurubunda ise % 4,5 olarak belirlendi (p=0,007). Aynı gurupta anti-HAV IgM prevalansı % 8,3 ve anti-HEV IgM prevalansı %3,5 idi. Çalışma gurubunda en fazla anti-HAV IgM seropozitifliği 0-10 yaş gurubunda (%16,8), daha sonra 11-20 yaş gurubunda (%7,2) ve 21-30 yaş gurubunda (% 4,6) idi. Yine çalışma gurubunda en fazla anti-HEV IgM pozitifliği 21-30 yaş gurubunda (% 10,7) idi ve bu gurubu 31-40 yaş gurubu (% 2,9), 11-20 yaş gurubu (% 2,7) ve 0-10 yaş gurubu (% 0,9) takip ediyordu. Her iki tip akut viral hepatit için erkekler ağırlıktaydı. Sonuç: HEV infeksiyonu ağırlıklı olarak genç erişkin yaş gurubunda görülmekte iken, HAV infeksiyonu ağırlıklı olarak çocuk yaş gurubunda görülmekte ve prevalansı da yaşla birlikte azalmakta idi. Bu viral enfeksiyonların barsak yoluyla bulaşma özelliğinden dolayı aşılama programları ve halkın hijyen ve sağlıklı su tüketimi konusunda bilgilendirilmesinin gerektiğini düşünüyoruz

Anahtar Kelimeler

• Akut hepatit, hepatit A virus, hepatit E virus, IgM seroprevalans

References

1. Hollinger FB, Ticehurst JR. Hepatitis A virus. In: Fields BN, Knipe DM, Howley PM, eds. Fields Virology, 3rd ed. Philadel- phia, Lippincott-Raven 1996:735-782.
2. Lemon SM. Type A viral hepatitis. New developments in an old disease. N Engl J Med 1985;313:1059-1067.
3. Koff RS. Hepatitis A. Lancet 1998;351:1643-1649.
4. Huang CC, Nguyen D, Fernandez J, et al. Molecular cloning and sequencing of the Mexico isolate of hepatitis E virus (HEV). Virology 1992; 191:550-558.
5. Lemon SM. Hepatitis E virus. In: Mandell GL, Bennett JE, Do- lin R, eds. Principles and Practice of Infectious Diseases, 4th edn. New York: Churchill Livingstone, 1995:1663-1666.
6. Acharya SK, Madan K, Dattagupta S, Panda SK. Viral hepatitis in India. Natl Med J India 2006;19:203-217.
7. Centers for Disease Control and Prevention. Epidemiology and Prevention of Viral Hepatitis A to E: An overview, 2000. Available at: http://www.cdc.gov/ncidod/diseases/hepatitis/ slideset/index.htm
8. Jaiswal SPB, Jain AK, Naik G, Soni N, Chitnis DS. Viral hepa- titis during pregnancy. Int J Gynaecol Obstet 2001;72:103- 108.

9. Teshale EH, Hu DJ, Holmberg SD. The two faces of hepatitis E virus. Clin Infect Dis 2010;51:328-334.
10. Gupta A, Chawla Y. Changing epidemiology of hepatitis A infection. Indian J Med Res 2008;128:7-9.
11. Kar P, Budhiraja S, Narang A, Chakravarthy A. Etiology of sporadic acute and fulminant non-A, non-B viral hepatitis in north India. Indian J Gastroenterol 1997;16:43-45.
12. Das K, Agarwal A, Andrew R, Frösner GG, Kar P. Role of hepatitis E and other hepatotropic viruses in etiology of spo- radic acute viral hepatitis. A hospital based study from Urban Delhi. Euro J Epidemiol 2000;16:937-940.
13. Hussain Z, Das BC, Husain SA, Murthy NS, Kar P. Increasing trend of acute hepatitis A in north India: need for identification of high-risk population for vaccination. J Gastroentrol Hepa- tol 2006;21:689-693.
14. Kaur R, Gur R, Berry N, Kar P. Etiology of endemic viral hepatitis in urban North India. Southeast Asian J Trop Med Public Health 2002;33:845-848.
15. Raju GS, Broor S, Singh V, Mehta SK. Fulminant viral hepa- titis: Indian experience. J Gastroenterol Hepatol 1989;4:161- 165.
16. Acharya SK, Batra Y, Bhatkal B, et al. Seroepidemiology of hepatitis A virus infection among school children in Delhi and north Indian patients with chronic liver disease. Implications for HAV vaccination. J Gastroenterol Hepatol 2003;18:822- 827.
17. Thapa BR, Singh K, Singh V, Broor S, Singh V, Nain CK. Pat- tern of hepatitis A and hepatitis B virus markers in cases of acute sporadic hepatitis and in healthy school children from North-West India. Journal of Trop Ped 1995;41:328-329.
18. Poddar U, Thapa BR, Prasad A, Singh K. Changing spectrum of sporadic acute viral hepatitis in Indian children. J Trop Pe- diatr 2002;48:210-213.
19. Mathur P, Arora NK. Epidemiological transition of hepatitis A in India: issues for vaccination in developing countries. In- dian J Med Res 2008;128:699-704.
20. Viswanathan R. Infectious hepatitis in Delhi (1955-56): A criti- cal study. Epidemiology. Indian J Med Res 1957;45:1-30.
21. Khuroo MS, Kamili S, Dar MY, Moecklii R, Jameel S. Hepati- tis E and long term antibody status. Lancet 1993;341:1355.
22. Bradley DW, Hepatitis E virus. In: Webster RG and Granoff A eds. Encylopedia of Virology. London: Academic Press Ltd. 1994;580-586.
23. 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.
24. Tandon BN. Viral hepatitis in tropics and its management. The Physicians Update. JAMA India 2001;4:102-106.