Hepatitis E leads to viral jaundice in Hyderabad

December 2007
By Syed Akbar
Hyderabad, Dec 27: A little known hepatitis E virus is responsible for spread of viral hepatitis (jaundice) in Hyderabad.
The viral hepatitis, caused by hepatitis E virus, remains mostly undiagnosed for the simple reason that doctors go in for serum tests for more famous cousins of HEV, the hepatitis A and hepatitis B viruses. Tests for hepatitis A and B viruses do not reveal the presence of HEV and the patient silently suffers till the immunity builds up or some health expert chances upon the HEV test.
A study conducted by P Sarguna, A Rao and KN Sudha Ramana of the city-based Sir Ronald Ross Institute of Tropical and Communicable Diseases (Fever Hospital), during a recent waterborne outbreak of viral hepatitis in old city, revealed that 78.57 per cent of the cases related to hepatitis E while 5.31 per cent of the cases were because of mixed infection caused by HEV and HAV.
As many as 546 clinically and biochemically documented cases were screened for the hepatotropic viral markers, hepatitis A, B, C, and E by ELISA method. The study revealed that HEV was the major etiological agent transmitted by contaminated drinking water. The researchers highlighted the importance of screening for both enterically (oral route) transmitted hepatotropic viral markers as well as the parenterally (other than oral route) transmitted hepatotropic viral markers during outbreaks of acute viral hepatitis in Hyderabad and elsewhere in the State.
Since the development of jaundice is a characteristic feature of liver disease
(in all hepatitis viral strains), a correct diagnosis can only be made by testing
the serum of patient for the presence of specific viral antigens.
Hepatitis E infection was hitherto considered to be present only in Central and South-East Asia, North and West Africa, and in Mexico, although serological surveys suggest a global distribution of strains of hepatitis E of low pathogenicity. Hyderabad generally has cases of hepatitis A, B and C and now the E strain of the hepatitis virus has made its presence felt in this part of the world.
"Hepatitis E should be suspected in outbreaks of waterborne hepatitis occurring in developing countries, especially if the disease is more severe in pregnant women, or if hepatitis A has been excluded. If laboratory tests are not available, epidemiological evidence can help in establishing a diagnosis," the WHO says in its latest guidelines. The city study on HEV gains significance in the backdrop of these WHO suggestions.