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Year : 2003  |  Volume : 21  |  Issue : 2  |  Page : 115--117

A hospital based study of Hepatitis E by serology

B Mishra, H Srinivasa, S Muralidharan, S Charles, RS Macaden 
 Department of Microbiology, St. John's Medical College, Bangalore - 560034, Karnataka, India

Correspondence Address:
H Srinivasa
Department of Microbiology, St. John«SQ»s Medical College, Bangalore - 560034, Karnataka


Hepatitis E virus is recently recognised as an important cause of non-A, non-B hepatitis. A total of 569 serum samples were screened for HEV between April 1997 and March 2000, by a commercially available HEV IgM capture ELISA. The diagnosis was invariably acute viral hepatitis for differential diagnosis of jaundice. The percentage of seropositivity was found to be 18.8% in confirmed Hepatitis E cases.

How to cite this article:
Mishra B, Srinivasa H, Muralidharan S, Charles S, Macaden R S. A hospital based study of Hepatitis E by serology.Indian J Med Microbiol 2003;21:115-117

How to cite this URL:
Mishra B, Srinivasa H, Muralidharan S, Charles S, Macaden R S. A hospital based study of Hepatitis E by serology. Indian J Med Microbiol [serial online] 2003 [cited 2020 Aug 5 ];21:115-117
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Hepatitis E Virus (HEV) is now recognised as an important cause of enterically transmitted non-A non-B viral hepatitis. Several reports are available in India about well-characterised HEV cases, which are mainly about large- scale epidemics in communities.[1],[2],[3],[4] However, information about the clinical and epidemiological characteristics of HEV cases which may be either from epidemic source or sporadic in origin are scanty in India.[3],[5] The present study aims to i) determine the occurrence of specific IgM antibodies to HEV in clinical cases of hepatitis, ii) study the outcome of infection with hepatitis E in pregnant women and iii) correlate co-existing liver conditions in confirmed hepatitis E cases.

 Materials and Methods

A total of 569 patients seen at out-patient department or hospitalised with diagnosis of hepatitis at St. John's Medical College Hospital, Bangalore were included. The study was carried out between April 1997 and March 2000. Three to five millilitre of blood was collected from the patients. IgM antibodies to HEV was detected employing a commercially available ELISA (Gene lab diagnostics, Singapore). Case records of all the HEV IgM antibody positive cases were reviewed to determine the association of HEV infection with pregnancy and co-existing clinical conditions. The serological status for other hepatitis viruses namely HBV (HBs Ag, Anti HBc IgM, HBe Ag), HCV antibodies and HAV IgM antibodies were reviewed. Liver function tests and histopathology of liver biopsies were also studied in those patients.


Out of 569, 107 serum samples were positive for HEV IgM. The case fatality rate was 4/107 (3.75%). The clinical profile of these patients are shown in [Table:1].

Among the seropositives, 72 were males and 35 were females (male:female ratio = 1.9: 1). Thus a male preponderance was noted. Age specific distribution of IgM serogpositivity is shown in [Table:2]. Seropositives to HEV were noted in all age groups. But 11-20 age group had less sero-positivity than other age groups (p value et al,[6] Khuroo,[2] Panda et al,[7] have convincingly demonstrated that HEV is an important cause of Non-A Non-B viral hepatitis. Epidemic and point source out breaks are common in rainy season when flooding leads to sewage contamination of drinking water.[8] Our data fits with the existing epidemiological features of HEV in endemic areas. Occurrence of HEV specific IgM was noted in 18.8% of serum samples [Table:2]. Male preponderance was noted. The youngest person seropositive was aged 2 years and the oldest case was 67 years. Thus all age groups were susceptible to hepatitis E infection. However, adults (over 20 years ) recorded more sero-positives than adolescents and children [12% Vs 20.5% ; P valueSalmonella typhi. These features probably suggest either food or water as a common vehicle for disease transmission.

In summary, HEV was an important cause of acute, subacute hepatitis in this part of India. The study revealed many typical epidemiological characteristics reported in the literature. Around one third of hepatitis E cases also had other infectious and non-infectious diseases as associated clinical conditions. More studies are needed to understand these associations and their impact on course of the disease.


1Khuroo MS. Study of an epidemic of Non-A Non-B hepatitis. Possibility of another human hepatitis virus distinct from post-transfusion Non-A Non-B type. Am J Med 1980;68:818-825.
2Khuroo MS,Rustogi VK,Dawson GJ, et al. Spectrum of hepatitis E virus infection in India. J Med Virol 1994;43:281-286.
3Radhakrishnan 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.
4Viswanathan R. Infectious hepatitis in Delhi(1955-1956):a critical study with Epidemiology. Ind J Med Res, Suppl 1957;45:1.
5Arankalle VA, Chobe LP, Jha J, et al. Etiology of acute sporadic non - A non-B viral hepatitis in India. J Med Virol 1993;40:121-125.
6Wong Dc, Purcell RH, Srinivasan MA, et al. Epidemic and endemic hepatitis in India: Evidence for Non-A Non-B etiology. Lancet 1980;2:876.
7Panda SK, Dutta R, Kaur J, et al. Enterically transmitted non-A, non-B hepatitis: recovery of virus like particles from an epidemic in South Delhi and transmission studies in rhesus monkey. Hepatology 1989;10:466.
8Okuda K, Hai Y. Acute hepatitis and acute hepatic failure. In: Hepatobiliary diseases: Pathophysiology and Imaging, Ist ed. Okuda K, Mitchell DG, Itai Y, Ariyama J. Eds., (Blackwell Science, U.K) 2001:88-89.
9Tandon BN. Viral hepatitis in tropics and its management, JAMA India - The physicians' Update 2001;4:102-106.