Profile of clinical characteristics and serologic markers of sporadic hepatitis E in a community cohort study

ABSTRACT

Hepatitis E virus (HEV) is a pathogen of global significance, but the value of HEV-related markers in the diagnosis of hepatitis E remains controversial. Previous studies on hepatitis E profiles have been mainly cross-sectional and conducted among inpatients in large hospitals, and hepatitis E cases have been primarily defined by limited partial markers. In this community-based study, 4,110 active hepatitis cases from a population of nearly 600,000 were followed over 48 months and serial serum samples were collected. Both HEV pathogen (HEV RNA and antigen) and anti-HEV antibody markers were used to determine HEV infection status and the relationship between hepatitis and HEV infection. In total, 98 hepatitis E patients were identified and all available isolates from 58 patients belonged to HEV genotype 4. The mean age of the patients was 58.14 years, with an overwhelming proportion of males (70.4%). Hepatitis E accounted for 22.86% of active hepatitis cases with alanine aminotransferase levels ≥15.0-fold the upper limit of normal, suggesting the need to include HEV in routine testing for these patients. Ninety-two hepatitis E patients were positive for at least 2 of HEV antigen, anti-HEV IgM, and HEV RNA markers at presentation, and 90.22% of them were positive for HEV antigen and anti-HEV IgM. HEV antigen, HEV RNA, and anti-HEV IgM positivity were observed in 89.80%, 82.65%, and 93.88% of hepatitis E patients at presentation, respectively. However, only 57.14% of anti-HEV IgM positivity occurred in hepatitis E patients. These findings will advance our understanding of hepatitis E and improve diagnosis.

KEYWORDS:

• Hepatitis E virus
• active hepatitis
• antigen
• serial serum samples
• dynamic

Acknowledgments

This work was supported by the National Natural Science Foundation of China (grant number 82071783, 82171746, 82001757, and 31730029) and Fundamental Research Funds for the Central Universities (20720220005).

Author contributions

Z-M.T., G-P.W., J.Z., S-J.H., Z-Z.Z, and N-S.X. conceived the study and designed the experiments; S-J.H., T.W., and J.Z. recruited patients and collected samples; Z-M.T., G-P.W., D.Y., S-L.W., C.L., and W-K.T performed experiments; Z-M.T., G-P.W., Y-B.W., M-J. F., Y-L.Z., Y-S.G., S-J.H., and Z-Z.Z. analyzed the data; Z-M.T, G-P.W., and Z-Z.Z wrote the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).