Clinico-epidemiological profile of hepatitis A virus and hepatitis E virus co-infection in pediatric age group: a hospital based retrospective study

Authors

  • Shikha Handa Department of Pediatrics, Himalayan Institute of Medical Sciences, SRHU, Jolly Grant, Dehradun, Uttarakhand, India
  • Sanober Wasim Department of Pediatrics, Himalayan Institute of Medical Sciences, SRHU, Jolly Grant, Dehradun, Uttarakhand, India
  • B. P. Kalra Department of Pediatrics, Himalayan Institute of Medical Sciences, SRHU, Jolly Grant, Dehradun, Uttarakhand, India
  • Anil Rawat Department of Pediatrics, Himalayan Institute of Medical Sciences, SRHU, Jolly Grant, Dehradun, Uttarakhand, India
  • Vipan Chandar Department of Pediatrics, Himalayan Institute of Medical Sciences, SRHU, Jolly Grant, Dehradun, Uttarakhand, India
  • Alpa Gupta Department of Pediatrics, Himalayan Institute of Medical Sciences, SRHU, Jolly Grant, Dehradun, Uttarakhand, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20190692

Keywords:

Co-infection, Hepatitis A, Hepatitis E, Public health

Abstract

Background: Hepatitis-A virus (HAV) and Hepatitis E virus (HEV) are two major hepatotropic viruses of great public health importance in the developing countries like India. Both HAV and HEV are enterically transmitted and there are speculations that their co-infection might be associated with a more severe clinical course and increased rate of mortality. The objective of this study is to determine the prevalence, clinical features and biochemical parameters of Hepatitis A and Hepatitis E co-infection in hospitalized patients at a tertiary care centre in Uttarakhand.

Methods: It is a retrospective study, covering a period of 4years and conducted in Himalayan Institute of Medical Sciences, SRHU Jolly Grant, Dehradun. Records of the patients with Hepatitis A and Hepatitis E co-infection were retrieved and analyzed.

Results: Out of total 125 patients of acute viral hepatitis, 13 patients had HAV and HEV co-infection. 100% of the patients with co-infection presented with complaints of fever and jaundice, followed by 76.92% with vomiting, 69.23% with pruritis, 61.53% with pain in abdomen and 23.07% with altered sensorium. Mean Bilirubin, ALT, AST were 8.69±7.27 mg/dl, 2030.69±1726.93IU/L and 1880.07±1881.11IU/L respectively. Average duration of stay was 8.2 days. Encephalopathy was seen in 2 patients. However, no mortality was reported.

Conclusions: Co-infection of HAV and HEV is not rare in pediatric age group. Knowledge about this will be of immense help for planning of future vaccination strategies and for better sanitation program in developing countries like India.

References

Arora NK, Nanda SK, Gulati S, Ansari IH, Chawla MK, Gupta SD. Acute viral hepatitis types E, A, and B singly and in combination in acute liver failure in children in North India. J Med Virol. 1996;48(3):215-22.

Rawat SK, Jain A. Seroprevalence of Hepatitis A and E virus IgM in children suffering from acutehepatitis. J Med Sci Cli Res. 2015;3(3):4616- 20.

Sarthi M, Kumar KGR, Jayasimha VL, Kumar CSV, Patil SS, et al. Prevalence of hepatitis A virus as cause of acute viral hepatitis in central Karnataka, India. Inter J Con Ped. 2017;4(1):87-9.

Bosan A, Qureshi H, Bile KM, Ahmed I, Hafiz R. A review of hepatitis viral infectionsin Pakistan. J Pak Med Assoc. 2010;60(12):1045-54.

Sarker NR, Saha SK, Ghosh DK, Adhikary A, Mridha A, et al. Seropositivity of viral markers in icteric children. Bangladesh Med J. 2014;43(1):26-9.

Jain P, Prakash S, Gupta S, Singh KP, Shrivastava S, et al. Prevalence of hepatitis A virus, hepatitis B virus, hepatitis C virus, hepatitis D virusand hepatitis E virus as causes of acute viral hepatitis in North India: A hospital based study. Indian J Med Microbiol. 2013;31(3):261-5.

World Health Organization (WHO). Regional strategy for the prevention and control of viral hepatitis: Regional office for South-East Asia; 2013.

Satsangi S, Dhiman RK. Combating the wrath of viral hepatitis in India. Indian J Med Res. 2016;144(1):1-5.

Arankalle VA, Tsarev SA, Chadha MS, Alling DW, Emerson SU, Banerjee K, et al. Age-specific prevalence of antibodies to hepatitis A and E viruses in Pune, India, 1982 and 1992. J Infect Dis. 1995;171:447-50.

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;43:433-6.

Mathur P, Arora NK, Panda SK, Kapoor SK, Jailkhani BL, Irshad M. Sero-epidemiology of hepatitis E virus (HEV) in urban and rural children of North India. Indian Pediatr. 2001;38:461-75.

Divizia M, Gabriel R, Stefanoni ML, Renganathan E, El Ghazzawi E, Kader OA, et al. HAV and HEV infection in hospitalized hepatitis patients in Alexandria, Egypt. Eur J Epidemiol. 1999;15:603-9.

Acharya SK, Madan K, Dattagupta S, Panda SK. Viral hepatitis in India. Natl Med J India. 2006;19:203-17.

WHO Hepatitis A Fact Sheet Updated; 2015. Available at: http://www.who.int/mediacentre/factsheets/fs328/en/.

WHO Hepatitis E Fact Sheet Updated; 2015. Available at: http://www.who. int/mediacentre/factsheets/fs280/en/.

Kamar N, Selves J, Mansuy JM, Ouezzani L, Péron JM, Guitard J, et al. Hepatitis E virus and chronic hepatitis in organ transplant recipients. N Engl J Med. 2008;358:811-7.

Malathi S, Mohanavalli B, Menon T, Srilatha P, Sankaranarayanan VS, Raju BB, et al. Clinical and viral pattern of acute sporadic hepatitis in children in Madras, South India. J Trop Pediatr. 1998;44:275-8.

Poddar U, Thapa BR, Prasad A, Singh K. Changing spectrum of sporadic acute viral hepatitis in Indian children. J Trop Pediatr. 2002;48(4):210-3.

Tandon BN, Gandhi BM, Joshi YK. Etiological spectrum of viral hepatitis and prevalence of markers of Hepatitis-A and B virus infection in North India. Bull World Health Organ. 1984;62(1):67-73

Irshad M, Singh S, Ansari MA, Joshi YK. Viral hepatitis in India: A Report from Delhi. Glob J Health Sci. 2010;2:96-103.

Jeong SH, Lee HS. Hepatitis A: Clinical manifestation and management. Intervirol. 2010;53:15-9.

Acharya SK, Batra Y, Hazari S, ChoudhuryV, Panda SK, et al. Etiopathogenesis of acute hepatic failure: Eastern versus Western countries. J Gastroenterol Hepatol. 2002;17(3):268-73.

Kumar S, Ratho RK, Chawla YK, Chakraborti A. The incidence of sporadic viral hepatitis in North India: A preliminary study. Hepatobiliary Pancreat Dis Int. 2007;6(6):596-9.

Sudhamshu KC, Sharma D, Poudyal Nandu, Basnet BK. Acute viral hepatitis in pediatric age groups. JNMA J Nepal Med Assoc. 2014;52(193):687-91.

Acharya SK, Batra Y, Bhatkal B, Ojha B, Kaur K, Hazari S, 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;18:822-7.

Batra Y, Bhatkal B, Ojha B, Kaur K, Saraya A, Panda SK, et al. Vaccination against hepatitis A virus may not be required for schoolchildren in northern India: Results of a seroepidemiological survey. Bull World Health Organ. 2002;80:728-31.

Patel RC, Kamili S, Teshale E. Hepatitis E virus infections in children age 0-15, Uganda outbreak, 2007. J Cli Virol. 2015;73:112-4.

Arora D, Jindal N, Shukla RK, Bansal R. Water Borne Hepatitis A and Hepatitis E in Malwa Region of Punjab, India. J Clin Diagnos Res. 2013;7(10):2163-6.

Monica A, Ruchi K, Ashish B, Pallab S. A study of seroprevalence and co-infection of hepatitis A and hepatitis E viruses in sporadic cases in an endemic area. J Med Sci Health. 2016;2(3):1-5.

Pandaya N, Chaudhary A. Prevalence of hepatitis A virus (HAV) and Hepaitis E Virus (HEV) in the patients presenting with acute viral hepatitis. Int J Appl Res. 2015;1(9):369-71.

Joon A, Rao R, Shenoy 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(1):102-5.

Kumar A, Yachha SK, Poddar U, Singh U, Aggarwal R. Does co-infection with multiple viruses adversely influence the course and outcome of sporadic acute viral hepatitis in children? J Gastroenterol Hepatol. 2006;21:1533-7.

Poddar U, Thapa BR, Prasad A, Sharma AK, Singh K. Natural history and risk factors in fulminant hepatic failure. Arch Dis Child. 2002;86:54-6.

Kumar A, Yachha SK, Poddar U, Singh U, Aggarwal R. Does co‐infection with multiple viruses adversely influence the course and outcome of sporadic acute viral hepatitis in children?. J Gastroenterol Hepatol. 2006;21(10):1533-7.

Dalton HR, Bendall R, Ijaz S, Banks M. Hepatitis E: An emerging infection in developed countries. Lancet Infect Dis. 2008;8:698-709.

Das AK, Ahmed S, Medhi S, Kar P. Changing patterns of aetiology of acute sporadic viral hepatitis in India-Newer insights from North-East India. Int J Curr Res Rev. 2014;6:14-20.

Downloads

Published

2019-02-23

Issue

Section

Original Research Articles