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Objective: Hepatitis E virus is a hepatotropic virus,endemic in the developing world. It causes outbreaks and sporadic cases due to fecal contamination of water supplies, genotype 1 and 2 being responsible. Symptomatic disease in endemic hotspots is commonly seen in young adults (15-40 years). Asymptomatic/mild infection is common in children and in majority cases, disease goes unnoticed. With this background in mind, this study was designed to estimate the prevalence of HEV in a dedicated children’s hospital and to describe the clinical profile of HEV positive patients.
MATERIAL AND METHODS: The prevalence of HEV in children was analysed between 2015 and 2020. Clinical and laboratory parameters of all patients who were admitted between this time frame were scrutinised.
RESULTS: A total of 19,147 samples were received for IgM HEV in 6 years. Fifty four HEV positive children required hospitalisation between 2015 and 2020. Thirty one of these were males(57%). Maximum admissions were seen in those aged more than 5 years of age(81%). Fever was the most common presenting complaint. Acute hepatitis was seen in 28 patients and fulminant hepatitis in 6 patients. Hepatitis A virus was the most common co-infection seen in these patients(20%) followed by enteric fever(9%).Immune deficiency was an underlying factor in 5 patients. Majority of the patients recovered from the illness(>90%).
CONCLUSIONS: HEV is more common in children aged above 5 years of age. It causes asymptomatic/mild illness in majority of the cases. Associated infection with other hepatotropic viruses like HAV may be seen in some cases. Progression to chronic liver disease may be seen in immune deficient children, hence follow up is necessary and vaccination should be introduced in this group of patients.
Hepatitis E virus (HEV) belongs to the Hepeviridae family and isan important common cause of acute viral hepatitis worldwide (1-3). Infection in humans is caused by 4 genotypes, type 1 and 2 are anthropotropic, prevalent in endemic countries and type 3 and 4 are zoonotic, found in developed parts of the world.The incidence of disease is higher in age group 15-26 years, when caused by genotype 1 and 2 while in the developed world it mainly affects individuals who are more than 50 years of age.(4) In the clinical perspective, HEV infections have diverse clinical manifestations, majority of infections being asymptomatic due to spontaneous clearance of the virus. Other varied presentations include acute and self-limiting hepatitis, acute-on-chronic liver disease, chronic hepatitis, cirrhosis, and liver failure. The classical clinical presentation of acute hepatitis in HEV infected patients includes jaundice, fever, flu-like symptoms, abdominal pain, vomiting, anorexia, and hepatomegaly. However, chronicity has been observed in immunosuppressed hosts and fulminant infection with mortality rates of around 25% are seen in pregnant women.(5)Additionally, HEV-associated extrahepatic manifestations involving various organs have been reported, although the causal link for many of them still needs to be proven.(6,7,8,9)
The incubation period of HEV infection is usually 2-6 weeks. (10) At the time of diagnosis, HEV RNA and anti-HEV IgM can be detected, followed by anti-HEV IgG antibodies. Anti-HEV IgM antibodies have a positivity for a short period of time (approximately 3-4 months), but sometimes it persists for a year.(11) HEV RNA can be detected in the blood after 3 weeks of exposure, and viral shedding lasts approximately 4-6 weeks in stool.(12)
In majority of children it causes an asymptomatic/mild illness. The data on clinico-demographic profile of HEV infected children requiring hospitalisation is limited. Hence, this study was designed to understand the demographic profile, clinical picture and disease outcome of hepatitis E infected paediatric population requiring hospital in-patient admission in North India.
In this retrospective study, children infected with Hepatitis E virus from January 2015 to December 2020 were reviewed from the hospital data base. Clinical case records were accessed to evaluate relevant demographic details (age stratified as <1 year, 1-5years, >5 years, gender), clinical presentation (clinical features, presence of any underlying chronic condition/immune deficient state,association with other hepatotropic viruses, presence of any co-infection)and disease outcome (improved and discharged, referral to higher centre and death). Anti-HEV IgM was detected in serum using solid phase capture ELISA (Bioneovan Co Ltd.) following the manufacturer’s instructions. The levels of transaminases in the liver function tests were noted to determine the percentage of patients presenting with acute hepatitis. According to the American College of Gastroenterology, acute hepatitis was defined as severe elevation in transaminases (>15 times the upper limit,i.e., >250 U/L for SGPT and >125 U/L for SGOT). Co-infections namely, Hepatitis A virus, Hepatitis B virus, Hepatitis C virus and Leptospirosis were also detected.
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