Epidemiology of Viral Hepatitis in a Tertiary Care Hospital of North India

Introduction: Viral hepatitis is used to describe protracted hepatocellular necrosis and inflammation, often with fibrosis, that lasts longer than 6 months and is caused by HBV, HCV, HBV-associated HDV or HEV. Chronic hepatitis is classified histologically by the degree of hepatocellular necrosis, inflammation, and fibrosis. Jaundice is a consistent clinical presentation of viral hepatitis. These hepatitis causing viruses can infect a person via various routes. HBV & HCV are transmitted through exposure to infected body fluids whereas HAV and HEV are transmitted by consuming contaminated food or water. India has more than 37 million HBV carriers and contributes a large proportion of HBV burden (Puri, 2014). In view of this problem, the study was conducted to highlight the viral agents responsible for causing hepatitis in patient presenting with jaundice in a tertiary care hospital in north India, to find out various epidemiological factors associated with these infections and developing strategies for surveillance of preventable viral hepatitis.

Aims: 1) To study the etiological profile of Hepatitis in IPD patients. 2) To estimate the sero-positivity of Hepatitis causing viruses in IPD patient of hepatitis, presenting with jaundice using ELISA.

Materials and Methods: The study was conducted in a tertiary care hospital of north India over a period of one year, from 1st July, 2016 to 30th June 2017. It was a cross-sectional prospective study. All analysis procedures were performed using commercial kits based on the enzyme-linked immunosorbent assay (ELISA) as per the manufacturer's instructions.

Results: A total of 573 serum samples from patients with clinical suspicion of jaundice were tested, out of which 236 (41.2%) patient’s serum were tested positive for viral hepatitis in which HBsAg was detected in 52 cases, Hepatitis C was not detected in any case, Hepatitis D was detected in 3 cases, Hepatitis E was detected in 108 cases and remaining were other acute viral hepatitis cases. Out of 236 cases positive for viral hepatitis, 47 were children and 189 were adults, females (155 cases) outnumbered males (81 cases). HBsAg was associated with other diseases in 21 cases. The maximum number of cases in which HBsAg was detected belonged to 21-30 years of age. Hepatitis B was associated with HIV infection in 13 cases. Hepatitis D and B virus coinfection was found in 3 cases. Hepatitis E was detected in 108 cases among which only 3 cases had co-infection with Hepatitis B.

Conclusion: The viruses responsible for hepatitis can increase the mortality as well as morbidity when they are associated with other diseases. The prevalence of Hepatitis B was more common in younger population. The increasing frequency of i.v. drug abuse can be a contributory factor for this, which necessitates the counselling & vaccination of young population regarding the same. HEV, which has a feco-oral route of transmission, was found in many cases, which can be prevented by improving the hygiene and creating awareness. There must be frequent testing of the vulnerable age groups to prevent them from the hepatitis causing viral infections.