ACUTE VIRAL-HEPATITIS IN SAUDI-ARABIA - SEROEPIDEMIOLOGICAL ANALYSIS,RISK-FACTORS, CLINICAL MANIFESTATIONS, AND EVIDENCE FOR A 6TH HEPATITIS AGENT

We conducted a prospective, descriptive cohort study of all 217 cases of acute viral hepatitis (AVH) seen in adults during 1992 at the sole hospitals with infectious disease departments in the second and third largest cities in the Kingdom of Saudi Arabia. In addition, we underto ok a nested case-control study. Our goals were (1) to determine the ca uses, demographics, risk factors, and clinical characteristics of AVH in the Kingdom; (2) to evaluate the reliability of diagnostic tests fo r acute hepatitis C and E; and (3) to assess the relative importance, characteristics, and risk factors of a sixth hepatitis agent, non-A-E. All cases and controls completed a questionnaire. Cases provided bloo d samples for studies of serum bilirubin, alanine and aspartate aminot ransferases, and antibody to hepatitis viruses as well as genome detec tion studies, The results of serological and molecular tests were used to categorize each case as hepatitis A, B, C, D, E, or non-A-E. Histo rical, clinical, and laboratory determinants were statistically analyz ed by comparisons between groups with different types of AVH and contr ols. Analysis of risk factors suggested that hepatitis C and D were pa renterally transmitted, while hepatitis A, E, and non-A-E were not; th e route of transmission of hepatitis B was unclear. Hepatitis E was st rongly associated with living or traveling on the Indian subcontinent, The clinical disease caused by all six agents was indistinguishable. The putative sixth agent caused 13% of cases. The second-generation te sts for antibody to HCV and HEV were relatively reliable for the diagn osis of AVH.