European Journal of Cardiovascular Medicine

Hepatitis A virus (HAV) and hepatitis E virus (HEV) are major causes of acute viral hepatitis globally, particularly in developing countries where sanitation and safe water supply remain inadequate [1,2]. Both pathogens are primarily transmitted via the fecal–oral route and can present with a clinical spectrum ranging from asymptomatic infection to severe, self-limiting hepatitis. HAV infection is highly prevalent in childhood and typically confers lifelong immunity, whereas HEV is more common in young adults and carries a substantially higher risk of severe outcomes in pregnant women, including fulminant hepatic failure and increased maternal mortality [3].

Globally, HAV and HEV contribute significantly to the overall burden of viral hepatitis, with their epidemiology closely linked to socio-economic status, population density, water quality, hygiene practices, and seasonal patterns [4]. In India, recurrent outbreaks are often associated with contamination of drinking water or food sources. Epidemiological studies consistently report HAV as the predominant cause of acute viral hepatitis in paediatric populations, while HEV is frequently observed among young adults [1,4,5]. Pregnant women remain a particularly vulnerable group for HEV-related complications, highlighting the urgent need for early diagnosis, targeted preventive strategies, and strengthened public health interventions [2,5].

The early diagnosis of HAV and HEV infections is crucial not only for appropriate clinical management but also for timely public health interventions to control outbreaks. Serological testing for specific IgM antibodies remains the mainstay of diagnosis in acute cases. This study was conducted to determine the prevalence of HAV and HEV among patients presenting with acute viral hepatitis in a tertiary care setting in Guntur, Andhra Pradesh, and to analyze demographic patterns, seasonal variation, and subgroup-specific trends.

Study Design and Setting:
A cross-sectional observational study was carried out in the Department of Microbiology, Guntur Medical College, Guntur, Andhra Pradesh, over a period of six months from January to June 2024. The study included patients of all age groups presenting with clinical features suggestive of acute viral hepatitis at Government General Hospital, Guntur.

Study Population:
A total of 321 serum samples were obtained from patients with suspected acute viral hepatitis. Each patient was represented by a single sample to avoid duplication.

Inclusion Criteria:

Patients of any age and gender with clinical features of acute viral hepatitis (e.g., jaundice, anorexia, malaise, abdominal discomfort, dark-colored urine).

Samples submitted for serological testing against HAV and HEV.

Exclusion Criteria:

Repeat serum samples from the same patient.

Patients with confirmed chronic liver disease or other causes of hepatitis.

Specimen Collection and Processing:
Blood samples were collected under aseptic precautions, and sera were separated and stored at 2–8°C until processing. All samples were tested for IgM anti-HAV and IgM anti-HEV antibodies using commercially available enzyme-linked immunosorbent assay (ELISA) kits, following the manufacturer’s instructions. Testing was performed in duplicate for each sample to ensure accuracy.

Data Analysis:
Demographic variables (age, gender), month-wise distribution, and special subgroup data (children, pregnant women) were recorded. The prevalence of HAV, HEV, and co-infections was calculated. Results were presented in tabular form (Tables 1–5) and analyzed descriptively.

Ethical Considerations:
Institutional Ethics Committee approval was obtained from Guntur Medical College and General Hospital, Guntur prior to the commencement of the study (Approval No: GMC/IEC/04/2024). Written informed consent was obtained from all adult participants and from parents or legal guardians in the case of minors.

A total of 321 serum samples from patients with suspected acute viral hepatitis were analyzed during the six-month study period. The overall prevalence of hepatitis A virus (HAV) infection was 42.9% (138/321), while hepatitis E virus (HEV) infection accounted for 2.49% (8/321) of cases. Co-infection with both HAV and HEV was detected in 1.24% (4/321) of patients (Table 1).

Table 1: Prevalence of HAV, HEV, and Co-infection

Gender-wise distribution revealed a predominance of female patients (63%) compared to males (37%) (Table 2).

Table 2: Gender Distribution of Acute Viral Hepatitis Cases

Age-wise analysis showed that the highest proportion of cases occurred in the 21–30 years age group (28.0%), followed by the 31–40 years group (21.8%). Paediatric patients (0–10 years) accounted for 15.6% of cases, while those aged >50 years formed the smallest group (9.6%) (Table 3).

Table 3: Age-wise Distribution of Acute Viral Hepatitis Cases

Figure 1. Age-wise Distribution of Acute Viral Hepatitis Cases

Month-wise trends demonstrated relatively consistent detection rates across the study period, with a peak observed in March (60 cases), followed by May (56 cases) and June (55 cases) (Table 4).

Table 4: Month-wise Distribution of Acute Viral Hepatitis Cases

Figure 2. Month-wise Distribution of Acute Viral Hepatitis Cases

In special subgroups, HAV infection was predominantly seen in children, whereas HEV infection was more frequently detected among pregnant women (Table 5).

Table 5: Infection Pattern in Special Groups

In the present study, the prevalence of HAV among patients presenting with acute viral hepatitis was 42.9%, while HEV accounted for 2.49% of cases, and co-infection was identified in 1.24%. These results reaffirm that HAV remains the predominant cause of enterically transmitted hepatitis in several parts of India, particularly in areas facing persistent challenges with water quality and sanitation [5,6]. Comparable prevalence patterns have been documented in studies from different regions, including tertiary care centers in South India [7] and nationwide surveillance reports [12].

The female predominance observed in our cohort (63%) contrasts with earlier reports that have shown either male predominance or near-equal gender distribution [8]. This discrepancy may be attributable to regional demographic profiles, healthcare-seeking behaviors, and possible referral bias in our hospital setting.

Age-wise analysis revealed the highest case burden in the 21–30 years age group (28.0%), followed by the 31–40 years group (21.8%). Although HAV infection is traditionally considered a childhood disease, its notable prevalence among young adults may indicate delayed exposure due to improved hygiene during early life, leading to susceptibility in later years [9]. The significant proportion of paediatric cases (15.6%) remains consistent with the well-recognized epidemiology of HAV in resource-limited environments [10].

Seasonal clustering, particularly in March and May, is in agreement with previous studies linking peaks of HAV and HEV incidence to changes in water availability and contamination during transitional climatic periods [11,12]. Collectively, these findings underscore the continuing public health impact of HAV and HEV and highlight the importance of preventive measures, including safe water supply, sanitation improvement, vaccination programs for HAV, and targeted awareness campaigns for high-risk groups such as pregnant women.

This study highlights that hepatitis A virus remains the predominant cause of acute viral hepatitis in the study region, with the highest burden observed among young adults and a significant proportion of cases in children. Hepatitis E virus, though less prevalent overall, was more frequently associated with pregnant women, underscoring its clinical importance in this high-risk group. Seasonal peaks during March and May suggest possible links to environmental and water-related factors. These findings reinforce the need for routine serological screening, improved water quality, sanitation measures, and targeted health education. Incorporating HAV vaccination into regional public health programs could substantially reduce disease incidence and prevent future outbreaks

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