The Smouldering Attacks of Acute Viral Hepatitis Caused by Hepatitis A & E Virus: An Update from India

Introduction: Acute viral hepatitis [AVH] due to feco-oral group of hepatitis viruses is endemic in
India. Till recently outbreaks of hepatitis E virus infection were more common than ones due to
hepatitis A virus. A change in the epidemiology of these infections has been observed over the last
decade.
Aim: The present study aimed at determining the seroprevalence of IgM antibodies to hepatitis A and
E virus in clinically diagnosed acute viral hepatitis cases. And to determine the various epidemiologic
factors associated with it.
Study Design: A cross sectional study was carried out on patients with acute viral hepatitis referred
from paediatric and gastro enterology department of Princess Esra hospital.
Place and Duration of Study: Serum samples from one hundred and eight symptomatic subjects
were analysed for anti IgM antibodies to hepatitis A and E virus and liver function test in the
department of laboratory medicine for Microbiology and biochemistry at Princess Esra Hospital,
Deccan College of Medical Sciences between January 2013 and January 2014.
Methodology: After obtaining informed consent, blood samples were collected from all the subjects
under strict aseptic precautions and tested for anti- HAV and Anti-HEV IgM antibodies using capture
Elisa from Diasorin [Italy]. Biochemical analyses included estimation of serum aminotransferases,
alkaline phosphatase and bilirubin levels.
Results: An overall seropositivity of 54% was observed in the present study. More number of the
subjects as 46.29% tested positive for anti HAV IgM than for anti HEV IgM as 7.4%. Co-infections due
to both hepatitis A & E virus were nil. Acute viral hepatitis due to hepatitis A virus was more common
in children in the age group 6-10 years followed by 11-15 years and least in 0-5 years of age
indicating an epidemiological shift. Whereas infection with hepatitis E virus was more common in
adolescent and adults. Males were more susceptible to both the infections than females. Liver
function test results correlated well with viral markers indicating acute hepatic parenchymal
inflammation and injury. The socioeconomic status of the individuals revealed that 95% of the
subjects were from below poverty line and didn’t have access to proper drinking water and sanitary
facilities. None were vaccinated against Hepatitis A virus. In the rest 46.31% of the cases of AVH the
aetiology remained unspecified.
Conclusion: From the above data it is evident that more than 50% of the AVH cases in the present
study were due to faeco-oral group of hepatitis viruses. A strategic approach for control and
prevention of the same is required. It is envisaged that with the new national action plan [2019] in
place to combat viral hepatitis as part of SDG 3.3 which aims at and ensures “health for all”. India will
be able to successfully bring down the prevalence of acute viral hepatitis effectively if not completely
by 2030.