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

Shikha Handa, Sanober Wasim, B. P. Kalra, Anil Rawat, Vipan Chandar, Alpa Gupta


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.


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

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