Dual infection with hepatitis A and E viruses in outbreaks and in sporadic clinical cases: Cuba 1998–2003

Abstract

Viral hepatitis ranks as the fifth cause of morbidity for infectious diseases in Cuba. Epidemics are observed frequently in the population, the hepatitis A virus being the main agent responsible for such epidemics. Previous reports also confirmed the circulation of the hepatitis E virus. From 1998 to 2003, 258 serum samples were collected by the Reference Laboratory on Viral Hepatitis during 33 outbreaks of acute viral hepatitis as well as from 39 sporadic clinical cases. Sera were tested for anti-HAV and anti-HEV IgM by EIA. Overall of the 33 outbreaks studied sera from 12 (36.4%) were positive for anti-HAV IgM only, from 7 (21.2%) were positive for anti-HEV IgM only, and from 14 (42.4%) were positive for antibodies to both viruses. Individually of the 258 sera collected, 137 (53.1%) were positives for anti-HAV IgM, 20 (7.8%) were positives for anti-HEV IgM, 33 (12.8%) were positives for both markers and 68 (26.4%) were negative to both. Of the clinical cases, 4 (10.3%) were positives for anti-HAV IgM, 13 (33.3%) were positives for anti-HEV IgM and 5 (12.8%) were positives for both markers. Seventeen (43.6%) sera were negatives for all viral hepatitis markers available (A-E). A high positivity for HEV was found in outbreaks tested with the kit produced by CIGB. In particular HEV seems to infect individuals of all ages. The results demonstrate the co-circulation of and co-infection with two enterically transmitted viruses; however a higher positivity was observed for anti-HAV than to anti-HEV (53.1% vs. 7.8%) in outbreaks.

Infección por el virus de la hepatitis E en pacientes con diagnóstico clínico de hepatitis viral en Colombia

“…Un dato similar se describió en un estudio de casos esporádicos de hepatitis viral en Cuba; los autores reportaron una frecuencia de 12,8 % de infección concomitante (IgM anti-HEV y anti-HAV) (57). En el estudio de Gutiérrez, et al, en Venezuela, la frecuencia de IgM anti-HEV fue muy similar entre el grupo de pacientes con marcador de infección aguda por HAV (IgM anti-HAV), con 31 %, y el grupo de negativos para este marcador de hepatitis A, con 29 % (59).…”

Fatal Fulminant Hepatitis E Associated with Autoimmune Hepatitis and Excessive Paracetamol Intake in Southeastern France

“…Suspicion of paracetamol intoxication and autoimmune hepatitis here may have prevented the detection of concurrent hepatitis E. Moreover, the diagnosis of hepatitis E can be jeopardized by concurrent infectious causes of liver cytolysis. Thus, HEV infection was previously detected concurrently with hepatitis B virus (HBV) reactivation (42), primary HBV infection (43), or acute hepatitis A virus infection (44,45). Taken together, previous data support testing for HEV in cases of severe acute liver failure, even when another cause has already been identified.…”

Hepatitis E virus infection in patients with acute non-A, non-B, non-C hepatitis in Central Brazil

“…On the other hand, anti-HEV IgM was detected in 27 out 552 (4.9%) samples from patients clinically suspected of hepatitis E analysed between the years 2006-2013 (Passos-Castilho et al 2015). In other American and European countries, anti-HEV IgM rates ranged from 1.1-4.8% (Haagsman et al 2007, Munné et al 2011) except in groups with specific characteristics such as patients from outbreaks of acute viral hepatitis in Cuba (Lay et al 2008) or hospitalised patients in Chile (Hurtado et al 2005) and Italy (Romanò et al 2011, Candido et al 2012), where those rates were substantially higher (ranging from 20.6-40.3%).…”