Hepatitis A and hepatitis E virus co-infection in children with acute viral hepatitis, associated risk factors and clinical outcome in a tertiary care hospital: A prospective observational study

Introduction: Acute viral hepatitis (AVH) is mostly caused by hepatitis A virus (HAV) and hepatitis E virus (HEV). Hepatitis B virus, on the other hand, is a major cause of chronic liver disease in children and adolescents.  
Objectives: To determine the seroprevalence and clinical outcomes of HAV and HEV in children of different age groups in a tertiary care hospital in Eastern Uttar Pradesh, India.
Method: During the study period, 382 clinically suspected cases of acute hepatitis were examined. Data included demographic information; and clinical history of illness specifically linked to the hepato-biliary system.
Results: A total of 382 samples was screened for AVH of which 58 (15.1%) were HAV positive, 21 (5.4%) were HEV positive and 12 (3.1%) were positive for both anti‑HAV and anti‑HEV antibodies indicating HAV‑HEV co‑infection. There was also significant co-infection between hepatitis A and E. Male children (54%) were more prone to all kinds of viral hepatitis than female children (46%), with the most common age group being 0-5 years in HAV cases and 11-15 years in HEV cases. Icterus was the most prevalent clinical sign in the hepatitis profile, followed by fever, hepatomegaly and nausea.
Conclusions: In this tertiary care hospital in Eastern Uttar Pradesh, India, the most frequent viral hepatitis infection in children was hepatitis A, followed by HEV. There was significant co-infection between hepatitis A and E.