Background and Aims: An acute hepatitis, caused by hepatitis E virus (HEV), is a significant global health concern, especially in developing countries. HEV has 1 serotype and 8 genotypes, which are further divided into subtypes. Despite the availability of sporadic cases and outbreak data from India, specific information regarding HEV epidemiological data is lacking from central India. This study was conducted to understand epidemiological and molecular features of HEV in central India. Methods: In this 3-year study conducted from July 2012 to June 2015, IgM ELISA was used for the diagnosis of suspected HEV cases. For identifying the genotype, nRT PCR was conducted and the PCR products were sequenced and analysed. Clinical and demographic data were analysed using statistical tools to highlight the trends. Result: Out of 1,369 suspected cases, 341 (24.9%) were positive for HEV. The positivity was significantly higher in males (69.2%) and in the age group of > 15–45 years (72.5%). The HEV cases peaked during the summer. Subtypes 1a and 1f of genotype 1 were detected in the area during the study period. Conclusion: HEV is a major aetiological agent of viral hepatitis in central India with adults and males at higher risk of infection. Two subtypes of the virus were detected in the region. Continuous serological surveillance and molecular monitoring will help to understand the epidemiology of HEV infection, outbreak mitigation and aid in providing treatment.

1.
WHO: Hepatitis E. http://www.who.int/mediacentre/factsheets/fs280/en/ (accessed May 17, 2015).
2.
Chandra NS, Ojha D, Chatterjee S, Chattopadhyay D: Prevalence of hepatitis E virus infection in West Bengal, India: a hospital-based study. J Med Microbiol 2014; 63: 975–980.
3.
Aggarwal R: Hepatitis E: Epidemiology and natural history. J Clin Exp Hepatol 2013; 3: 125–133.
4.
Kumar S, Subhadra S, Singh B, Panda BK: Hepatitis E virus: the current scenario. Int J Infect Dis 2013; 17:e228–e233.
5.
Murthy KA, Khan IM, Kiran PK, Hakeem H: A study of viral hepatitis E infection in a tertiary care hospital in Mysore, South India. Open Forum Infect Dis 2014; 1:ofu036.
6.
Teshale EH, Hu DJ, Holmberg SD: The two faces of hepatitis E virus. Clin Infect Dis 2010; 51: 328–334.
7.
Chandra V, Taneja S, Kalia M, Jameel S: Molecular biology and pathogenesis of hepatitis E virus. J Biosci 2008; 33: 451–464.
8.
Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J: Hepatitis E. Lancet 2012; 379: 2477–2488.
9.
Oliveira Filho F: Molecular studies on hepatitis E viruses; dissertation, Justus Liebig University Giessen, 2013, p 114.
10.
Sridhar S, Teng JLL, Chiu TH, Lau SKP, Woo PCY: Hepatitis E virus genotypes and evolution: emergence of camel hepatitis E variants. Int J Mol Sci 2017; 20: 18–36.
11.
Chandra NS, Rai RR, Malhotra B: Phylogenetic analysis of hepatitis E virus in Northwest India. Hepat Res Treat 2012; 2012: 976434.
12.
Legrand-Abravanel F, Mansuy JM, Dubois M, Kamar N, Peron JM, Rostaing L: Hepatitis E virus genotype 3 diversity, France. Emerg Infect Dis 2009; 15: 110–114.
13.
La Rosa G, Muscillo M, Vennarucci VS, Garbuglia AR, La Scala P, Capobianchi MR: Hepatitis E virus in Italy: molecular analysis of travel-related and autochthonous cases. J Gen Virol 2011; 92: 1617–1626.
14.
CDC: Viral hepatitis – hepatitis E information. http://www.cdc.gov/hepatitis/hev/hevfaq.htm#section1 (accessed May 20, 2015).
15.
Rosario V, Nihal L, Illiayaraja J, Reddy PK, Sarkar R, Eapen CE: Investigation of an epidemic of Hepatitis E in Nellore in south India. Trop Med and Int Health 2010; 15: 1333–1339.
16.
Arankalle VA, Paranjape S, Emerson SU, Purcell RH, Walimbe AM: Phylogenetic analysis of hepatitis E virus isolates from India (1976–1993). J Gen Virol 1999; 80: 1691–1700.
17.
Arankalle VA, Chobe LP, Joshi MV, Chadha MS, Kundu B, Walimbe AM: Human and swine hepatitis E viruses from Western India belong to different genotypes. J Hepatol 2002; 36: 417–425.
18.
Arankalle VA, Chobe LP, Walimbe AM, Yergolkar PN, Jacob GP: Swine HEV infection in south India and phylogenetic analysis (1985–1999). J Med Virol 2003; 69: 391–396.
19.
Chobe LP, Lole KS, Arankalle VA: Full genome sequence and analysis of Indian swine hepatitis E virus isolate of genotype 4. Vet Microbiol 2006; 114: 240–251.
20.
Barde PV, Godbole S, Bharti PK, Chand G, Agarwal M, Singh N: Detection of dengue virus 4 from central India. Indian J Med Res 2012; 136: 491–494.
21.
Chandra NS, Sharma A, Rai RR, Malhotra B: Contribution of hepatitis E virus in acute sporadic hepatitis in north western India. Indian J Med Res 2012; 136: 477–482.
22.
Perez-Gracia MT, Garcia M, Suay B, Mateos-Lindemann ML: Current knowledge on hepatitis E. J Clin Transl Hepatol 2015; 3: 117–126.
23.
Mishra B, Srinivasa H, Muralidharan S, Charles S, Macaden RS: A hospital based study of hepatitis E by serology. Indian J Med Microbiol 2003; 21: 115–117.
24.
Labrique AB, Zaman K, Hossain Z, Saha P, Yunus M, Hossain A: Population seroprevalence of hepatitis E virus antibodies in rural Bangladesh. Am J Trop Med Hyg 2009; 81: 875–881.
25.
Zhang S, Wang J, Yuan Q, Ge S, Zhang J, Xia N: Clinical characteristics and risk factors of sporadic hepatitis E in central China. Virol J 2011; 8: 152.
26.
Manmohan G, Patil R, Khan MI, Gupta SK: Retrospective hospital based study of infective causes of jaundice in Tamilnadu, India. Calicut Med J 2011; 9:e4.
27.
Aggarwal R, Jameel SL: Hepatitis E. Hepatology 2011; 54: 2218–2226.
28.
Murali AR, Kotwal V, Chawla S: Chronic hepatitis E: a brief review. World J Hepatol 2015; 7: 2194–2201.
29.
Pujhari SK, Kumar S, Ratho RK, Chawla YK, Chakraborti A: Phylogenetic analysis and subtyping of acute and fulminant strains of hepatitis E virus isolates of North India with reference to disease severity. Arch Virol 2010; 155: 1483–1486.
30.
Arankalle VA, Lole KS, Deshmukh TM, Chobe LP, Gandhe SS: Evaulation of human (genotype1) and swine (genotype 4) ORF2 based ELISAs for anti HEV IgM and IgG detection in an endemic country and search for type 4 human HEV infections. J Viral Hepat 2007; 12: 435–445.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.