Hepatitis E in suspected acute hepatitis cases in Brazil: A comparison with hepatitis A

Hepatitis E virus (HEV) is an underrecognized cause of acute viral hepatitis worldwide, with growing public health relevance, particularly in settings where routine diagnostic testing is limited. Hepatitis A virus (HAV) is another epidemiologically related hepatitis virus, but few studies have directly compared these infections in Brazil. This study aimed to (1) determine the frequency of acute hepatitis E (AHE) and evaluate the contribution of HEV infection to the burden of hepatitis among patients with suspected acute disease attended in public healthcare institutions in Brazil; (2) assess the prevalence of acquired immunity to HEV and HAV; and (3) compare demographic characteristics, risk factors, and clinical-laboratory findings associated with HEV and HAV infections. We enrolled 1,721 adults (≥18 years) with suspected acute hepatitis from 16 Brazilian states between October 2019 and May 2023. Serum samples were tested for anti-HEV IgG/IgM and anti-HAV IgG/IgM by immunoassay and for HEV and HAV RNA by RT-PCR. Demographic, behavioral, clinical, and laboratory data were collected using a standardized questionnaire. Group comparisons were performed using univariate analyses and logistic regression, with statistical significance set at p < 0.05. Anti-HEV IgG was detected in 89 individuals (5.2%), whereas anti-HAV IgG was detected in 1,352 (78.6%). Anti-HEV IgG seroprevalence was higher in the South, Southeast, and Central West regions and among heterosexuals, and it increased with age, reaching 13.0% among individuals aged ≥65 years. Seropositivity was associated with markers of previous exposure or immunity, including HAV, HBV, Leptospira, and Toxoplasma. A total of 124 acute hepatitis cases were identified: 16 (12.9%) AHE and 108 (87.1%) acute hepatitis A (AHA). Compared with AHA cases, AHE cases occurred in older individuals and were more frequent among women and heterosexual participants. All AHA cases occurred in urban areas, whereas AHE cases were observed in both urban and rural settings. AHA cases showed higher aminotransferase levels and more frequent jaundice than AHE cases. HEV accounts for a small but distinct proportion of suspected acute hepatitis cases in Brazil and shows epidemiological and clinical characteristics that differ from HAV. Incorporating HEV testing into routine diagnostic algorithms may improve etiological clarification and surveillance of acute hepatitis.

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Journal
PLoS neglected tropical diseases
Published
2026-10-26
DOI
https://doi.org/10.1371/journal.pntd.0014834
Primary Topic
Hepatitis Viruses Studies and Epidemiology
Type
article
Field-Weighted Citation Impact
0.00

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article

Hepatitis E in suspected acute hepatitis cases in Brazil: A comparison with hepatitis A

Adalgisa Ferreira, Olavo Henrique Munhoz Leite, Ana Catharina de Seixas Santos Nastri, Luciana Vilas Boas Casadio et al.
PLoS neglected tropical diseases
Hepatitis Viruses Studies and Epidemiology
article

Hepatitis E in suspected acute hepatitis cases in Brazil: A comparison with hepatitis A

Adalgisa Ferreira, Olavo Henrique Munhoz Leite, Ana Catharina de Seixas Santos Nastri, Luciana Vilas Boas Casadio, Cristina Pimenta, R. Salinas, Paulo Roberto Abrão Ferreira, João Renato Rebello Pinho, Magali Chaves Luiz, Cirley Maria de Oliveira Lobato, Roberta Sitnik, Elodie Bomfim Hyppólito, Gérson Fernando Mendes Pereira, Mário Peribañez Gonzalez, Eduardo Emerim, Raymundo Paraná, Júlia Teixeira Ton, Michele Soares Gomes‐Gouvêa, Mário Reis Álvares‐da‐Silva, Maria Lúcia Gomes Ferraz, Edmundo Pessoa Lopes, Clarice Gdalevici, Gerson Sobrinho Salvador de Oliveira, Fernanda de Mello Malta, Flávia Moreno Alves de Souza, Deyvid Amgarten, María Isabel Schinoni, Flair José Carrilho, Dennis Armando Bertolini, Elton Carlos de Almeida, Simone de Barros Tenore, Gabriela Perdomo Coral, Fernanda Fernandes Souza, Pedro Henrique Sebe Rodrigues, Erick Gustavo Dorlass, Glória Selegatto, Tania Queiroz Reuter, Maira Marranghello Maluf, Silvia N. O. Uehara, Mariana Pinheiro Alves Vasconcelos, Lívia Melo Villar, Ana Paula Maciel Gurski, Pablo Andres Munoz Torres, Maria Cássia Jacintho Mendes-Corrêa, Ricardo Andreotti Siqueira, Cesar Inoue, Thais Domingues, Bruna Emanuelle Alvarenga Fanis, Caroline Thomas Panico, Mônica da Costa Guedes, Raquel F. L. Garcia, Maria Cecília Araripe Sucupira, Denize Ornelas Pereira Salvador de Oliveira, Paulo R. Acosta, Rosângela Rodrigues Teixeira, Arlene S. Pinto, Lia Lewis Ximenez, Peter James Robinson, Michele Nascimento-Sales, Andréa Salomão, Ketti Gleyzer de Oliveira, Raymundo Soares de Azevedo, Marcelle Lucena, Aline Satie Oba-Kuniyoshi, Sabrina Sabino da Silva, Francisco Souto, Layze Oliveira Castberg Sousa
article en

Abstract

Hepatitis E virus (HEV) is an underrecognized cause of acute viral hepatitis worldwide, with growing public health relevance, particularly in settings where routine diagnostic testing is limited. Hepatitis A virus (HAV) is another epidemiologically related hepatitis virus, but few studies have directly compared these infections in Brazil. This study aimed to (1) determine the frequency of acute hepatitis E (AHE) and evaluate the contribution of HEV infection to the burden of hepatitis among patients with suspected acute disease attended in public healthcare institutions in Brazil; (2) assess the prevalence of acquired immunity to HEV and HAV; and (3) compare demographic characteristics, risk factors, and clinical-laboratory findings associated with HEV and HAV infections. We enrolled 1,721 adults (≥18 years) with suspected acute hepatitis from 16 Brazilian states between October 2019 and May 2023. Serum samples were tested for anti-HEV IgG/IgM and anti-HAV IgG/IgM by immunoassay and for HEV and HAV RNA by RT-PCR. Demographic, behavioral, clinical, and laboratory data were collected using a standardized questionnaire. Group comparisons were performed using univariate analyses and logistic regression, with statistical significance set at p < 0.05. Anti-HEV IgG was detected in 89 individuals (5.2%), whereas anti-HAV IgG was detected in 1,352 (78.6%). Anti-HEV IgG seroprevalence was higher in the South, Southeast, and Central West regions and among heterosexuals, and it increased with age, reaching 13.0% among individuals aged ≥65 years. Seropositivity was associated with markers of previous exposure or immunity, including HAV, HBV, Leptospira, and Toxoplasma. A total of 124 acute hepatitis cases were identified: 16 (12.9%) AHE and 108 (87.1%) acute hepatitis A (AHA). Compared with AHA cases, AHE cases occurred in older individuals and were more frequent among women and heterosexual participants. All AHA cases occurred in urban areas, whereas AHE cases were observed in both urban and rural settings. AHA cases showed higher aminotransferase levels and more frequent jaundice than AHE cases. HEV accounts for a small but distinct proportion of suspected acute hepatitis cases in Brazil and shows epidemiological and clinical characteristics that differ from HAV. Incorporating HEV testing into routine diagnostic algorithms may improve etiological clarification and surveillance of acute hepatitis.

PLoS neglected tropical diseasesVol. 20(10)
Universidade Federal de Mato Grosso do Sul (BR), Universidade Estadual de Maringá (BR), Universidade Federal da Bahia (BR), Universidade Federal do Rio Grande do Sul (BR), Universidade Federal de Ciências da Saúde de Porto Alegre (BR), Universidade de São Paulo (BR), Universidade Federal do Ceará (BR), Universidade Federal de Pernambuco (BR), Hospital Israelita Albert Einstein (BR), Centro Universitário Cesumar (BR), Hospital Felício Rocho (BR), Universidade Regional de Blumenau (BR), Ministério da Saúde (BR), Secretaria da Saúde (BR), Faculdade de Medicina do ABC (BR), Ministério da Saúde (ST), Universidade Cruzeiro do Sul (BR), Secretaria Municipal de Saúde (BR), Prefeitura Municipal de Porto Alegre (BR), Universidade Federal do Maranhão (BR), Universidade Federal do Espírito Santo (BR), Fundação Oswaldo Cruz (BR), Universidade Federal de São Paulo (BR)
Department of Science and Technology, Ministry of Science and Technology, India, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina do ABC, Universidade de São Paulo, Ministério da Saúde, Fundação Oswaldo Cruz, Sociedade Beneficente Israelita Brasileira Albert Einstein, Universidade Federal de Pernambuco, Universidade Federal do Espírito Santo
Openalex Percentile: Top 14%
Hepatitis Viruses Studies and Epidemiology
DOIOpen Access PDFOpenAlex
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