Fecal shedding of hepatitis A virus in Indian patients with hepatitis A and in experimentally infected Rhesus monkey

Hepatitis A is highly endemic in India. The surveillance reports for the di sease from this region are primarily based on the demonstration of hepatiti s A virus (HAV) specific serum IgM and IgG antibodies. The present study wa s conducted to assess the presence and duration of fecal shedding of HAV in patients with hepatitis A and in an experimentally infected rhesus monkey. Nested reverse transcription polymerase chain reaction (RT-PCR) was applie d to fecal specimens from 67 sporadic cases of hepatitis A. Recent infectio n with HAV in these cases was evidenced by the presence of serum anti-HAV I gM. Fecal HAV RNA positivity was observed in nearly 40% patients. The propo rtion of HAV RNA positivity in fecal specimens obtained within the first we ek (36.58%) was not different from those collected in 2-12 weeks post onset (42.42%) (P > 0.05). A significant number of HAV RNA positive stool specim ens showed presence of full virus particles by immune electron microscopy ( IEM). Extended fecal shedding of HAV could be a major contributory factor f or high circulation of virus thereby maintaining hyperendemicity of the dis ease. One of the IEM positive samples was inoculated into an anti-HAV negat ive rhesus monkey. Serum alanine amino transferase levels of the monkey rem ained within the normal limits. However, HAV RNA positivity in the feces wa s noted from 3 to 50 days post inoculation. The monkey seroconverted to ant i-HAV IgM on day 31. This study records prolonged excretion of HAV in human s as well as in experimentally infected rhesus monkey. (C) 2001 Elsevier Sc ience Ireland Ltd. All rights reserved.