HAV and HEV infection in hospitalised hepatitis patients in Alexandria, Egypt

A total of 202 serum and stool samples from acute hepatitis patients attend ing the Fever Hospital of Alexandria, Egypt, have been studied to reveal ma rkers of hepatitis virus infection. Anti-HAV IgM were detected in 21 out of 202 sera (10.4%), whereas 201 sera (99.5%) had anti-HAV IgG. The first age attack was in the class-age 0-9 years with 64.7% of anti-HAV IgM positive sera. Among 202 patients, anti-hepatitis E IgG (sample/over cut off > 1.0) was identified in 90 patients (44.5%). The anti-HEV seropositivity ranged f rom 17.6% to 60.0% in the different age groups, with the highest level in t he class-age 20-29 years. Anti-hepatitis E IgM were identified in 49 patien ts with the first age attack in the class-age 10-19 years (39.4%). HAV RNA was identified by nested PCR in 7 samples out of 15, whereas HEV RNA was pr esent in 4 out of 75 stool samples. Direct DNA sequence of the latter PCR p roducts confirmed the presence of the HEV genome; comparison of the sequenc es of the isolates from Egypt with those in data banks revealed the highest homology to the Burma strain. Our data confirm that HAV and HEV are common causes of acute sporadic hepatitis in Alexandria but with different peak a ge positivity. Occasionally, but not infrequently, dual infections (HAV-HEV and HEV-enteric viruses) were also found. The risk analysis indicates that patients living in rural areas are exposed to a higher risk of hepatitis E infection compared to the urban population, whereas the presence of anti-H EV IgG was significantly associated with consumption of common village wate r and use of indoor dry pit and oral therapy for schistosomiasis.