Sero-epidemiology of sporadic acute hepatitis in Bangladesh: high prevalences of infection with type-B, type-E and multiple types of hepatitis virus

Abstract

In a recent investigation of hepatitis in Bangladesh, the sera from 74 adult patients (aged 15-67 years) who had been clinically diagnosed as cases of sporadic acute hepatitis were collected at various hospitals in and around Dhaka. Five cases were positive for IgM antibody against the hepatitis A virus and 30 were positive both for the surface antigen of the hepatitis B virus (HBV) and for IgM antibody against the HBV core (HBc). The six cases found positive for antibodies against the hepatitis D virus were all also positive for the HBV surface antigen but negative for anti-HBc IgM. Thirteen patients harboured hepatitis C virus RNA and 29 were positive for IgM antibody against the hepatitis E virus (HEV). There were 14 non-A-to-E subjects, whose illness was of unknown aetiology. Of the 83 infections with hepatitis viruses detected in the other 60 patients, 6%, 36%, 16%, 7% and 35% were of types A, B, C, D and E, respectively. Each of 28 of the patients (47% of those confirmed to have viral hepatitis) had concomitant infection with more than one type of hepatitis virus. The predominance of HBV and HEV infections and the high prevalence of multiple infection seen among these Bangladeshi cases have not been observed among hepatitis cases in developed countries.

Epidemiology of Hepatitis E in Low- and Middle-Income Countries of Asia and Africa

“…86,87 HEV is also recognized as the causative agent in most cases of acute, sporadic hepatitis. 33,88 A recent population-based study of maternal mortality from Bangladesh suggested that nearly 10% of maternal (pregnancy-related) mortality is likely associated with HEV infection. 89…”

Where Hepatitis B and Hepatitis E Meet: Epidemiological and Clinical Aspects

“…38% has been reported in previous studies in China (34)(35)(36)(37)(38). In Southeast Asia, the HBV-HEV superinfection rate was reported to be 45%, 14% and 9.5% in Vietnam, India and Bangladesh, respectively (39)(40)(41). A clear territory-wise distribution of HBV-HEV superinfection has been observed in Africa where a higher prevalence of 56.7% was reported in Egypt in the northern part of the continent, while insignificant rates of 1% and 0% were reported in Kenya, the Eastern part of Africa (27,42,43) (Table 1).…”

Hepatitis B surface antigen-negative, but HBV DNA-positive patients in Bangladesh

“…Even more alarming is the fact that HBV seems to be major etiological agent of both acute and fulminant hepatitis in Bangladesh. Sugitani et al have reported that HBV was the main etiological factor of sporadic acute hepatitis, and 36% adult patients with sporadic acute hepatitis B in their cohort were infected with the HBV 15 . Another study conducted by us also revealed that about onethird patients with fulminant hepatic failure were infected with the HBV in Bangladesh 16 .…”