Laboratory-Confirmed Hepatitis A, Hepatitis E, and Rotavirus Infections at a Tertiary Care Center in Eastern Rajasthan, India: A Prospective Observational Study

Background Hepatitis A virus (HAV) and hepatitis E virus (HEV) are important fecal-oral viral causes of acute hepatitis, whereas rotavirus is a major cause of acute gastroenteritis in India. Their occurrence varies by age, season, sanitation, and local exposure patterns. This prospective study assessed the laboratory positivity, temporal distribution, and clinico-epidemiological characteristics of HAV, HEV, and rotavirus infections among eligible patients tested at a tertiary care center in Eastern Rajasthan, India. Methods This prospective observational study was conducted at RVRS (Rajmata Vijaya Raje Scindia) Government Medical College, Bhilwara, Rajasthan, from January 2025 to March 2026. Eligible patients with clinically suspected acute viral hepatitis and/or acute diarrheal illness were enrolled consecutively. Demographic, socioenvironmental, clinical, and laboratory data were recorded using a structured case record form. Anti-HAV immunoglobulin M (IgM) and anti-HEV IgM antibodies were detected by enzyme-linked immunosorbent assay (ELISA), while rotavirus infection was confirmed by stool antigen testing. Results A total of 3,038 patients were tested for HEV, 2,574 for HAV, and 560 for rotavirus. Rotavirus showed the highest laboratory positivity, detected in 80/560 patients (14.3%; 95% confidence interval (CI): 11.5-17.4), followed by HAV in 350/2,574 patients (13.6%; 95% CI: 12.3-15.0) and HEV in 319/3,038 patients (10.5%; 95% CI: 9.4-11.7). Among the 749 laboratory-confirmed cases, the overall number of cases was highest during October-December 2025 (227/749, 30.3%). HEV cases peaked during July-September 2025 (113/319, 35.4%), HAV cases during January-March 2026 (123/350, 35.1%), and rotavirus cases during October-December 2025 (56/80, 70.0%). Mean age differed significantly across etiologies: HEV, 19.45 ± 10.31 years; HAV, 17.96 ± 13.49 years; and rotavirus, 4.21 ± 1.59 years (Kruskal-Wallis H = 99.64, p < 0.001). Males predominated among HAV (222/350, 63.4%) and rotavirus cases (50/80, 62.5%), whereas females predominated among HEV cases (199/319, 62.4%) (p < 0.001). Open defecation was reported more frequently among HAV (30.6%) and HEV (30.1%) cases than among rotavirus cases (12.5%) (p = 0.004). Nausea/vomiting, loss of appetite, jaundice, and dark urine were more common among HAV and HEV cases, whereas abdominal pain was most frequent among rotavirus cases (61.3%) (all p < 0.001). Conclusions HAV, HEV, and rotavirus contributed substantially to laboratory-confirmed enteric viral infections among eligible patients tested in Eastern Rajasthan. The three etiologies showed distinct seasonal, demographic, and clinical patterns. Continued prospective laboratory surveillance, timely diagnostic testing, safe water access, and improved sanitation and hygiene practices are needed to reduce the burden of these infections.