Introduction
Five hepatotropic viruses are the causative agent of viral hepatitis, i.e., Hepatitis A, B, C, D and E Virus, and Hepatitis E Virus, presents a significant pathological state globally. In these viruses, currently established virus is Hepatitis E virus because it becomes a main etiological representative spread enterically.1 Some studies in Asian nation are large epidemics of liver disease which are transmitted through water, originally associated to infectious disorders caused by hepatotropic virus, prompt the presence of a new discovered sort of hepatitis which is transmitted enterically, that was suggested a name hepatitis E. 2, 3 In 1983 hepatitis E virus was discovered by researchers of a deadly disease of unexplained liver disease in Soviet troopers in Afghanistan. 4 When a team member of analytical section ate feculent content of infected armed forces caused AVH (acute viral hepatitis) and while observing stool under microscope infective agent particle was seen. In fected macaques sequenced mistreatment liver samples were obtained and afterward cloned them with the help of infective agent. 5, 6 For detection of HEV (hepatitis E virus) antibodies an Enzyme bioassay was conjointly developed. 7 HEV primary strains, pig HEV, was known and characterised from pigs within the US. 8 In 1955-56 first well studied epidemic infection of Hepatitis in New-Delhi, poignant a complete of twenty nine thousand people; this occurred because of feculent contamination of drinking water. 1 Though originally thought of to be a pandemic of infectious hepatitis-A, stored sera is used in retrospective testing from the infected patients prompt that a completely unique virus was responsible. 1 Since the 1990, after analytical study and sequence of genome, infection of liver as result of this infective particle was referred as Hepatitis E and particle was called HEV. 9 A quarter of total expecting ladies are at greater risk to infection more so in their 28-40 weeks of pregnancy and this might be unique attribution of the virus. 10, 11 It is believed that regarding India, major infective vehicle of liver disease via digestive tract which isn’t caused by Hepatitis A is believed to be Hepatitis E virus.12 Currently Hepatitis E Virus is recognized because the commonest explanation for acute hepatitis worldwide. 13, 14, 15
Material and Methods
A prospective observational study was carried out for one year in the Teerthanker Mahaveer edical college & research center (TMMC&RC) Moradabad from January 2020 to December 2020. Total 195, Hepatitis-E assumed affected cases be in use during this report. Patients of all age group with a clinical symptom such as fatigue, itching, pyrexia, nausea and jaundice are incorporated in this study. The sample was transported to the microbial.
Collection of sample
5ml blood sample was collect through Venipuncture as of every tolerant. The patient upper limb be joined by means of a tourniquet and alcohol character be use intended for disinfection. Then every bloods sample was transferred into a labeled plastic microtitre tube plane vial. 16
(Venipuncture process)
The Venipuncture procedure is complex requiring both knowledge and skill to perform.16
Patients were identified for blood collection.
Tourniquet was applied 3.5-4.2 inches above the selected puncture site and tourniquets were not placed too tightly.
Puncture site was disinfected with 72% ethanol.
Allowed to air dry through the skin onto lumen vain.16
Hepatitis-E virus speedly card test method following Immunochromatogaraphy.
Sample was self-collected, in the plain vial.
Collected sample were sent to the research laboratory with the requisition.16
Hepatitis- E virus card method
Insight Hepatitis-E virus IgM is a speedly, self-performing, Immunochromatogaraphy. 16
Result
Table 1
Hepatitis E positive and hepatitis E negative patients in total 195 clinical samples.
|
S. No |
HEV positive patients |
HEV negative patients |
Total HEV patients |
|---|---|---|---|
|
Male |
11 |
172 |
195 |
|
Female |
12 |
||
|
Total |
23 |
Table 2
The sex wise distribution Hepatitis-E positive cases
|
S.No |
Test |
Male |
Female |
||
|
|
Immuno- Chromatographic |
Case |
Per % |
Cases |
Per % |
|
|
|
11 |
48% |
12 |
52% |
Discussion
Hepatitis E virus infection can be seen worldwide but the prevalence rate of hepatitis infected population is highest in South and East Asian region. HEV infections are the most usual reason for not only isolated cases but also epidemic of acute hepatitis infection in India.17 Studies show that Hepatitis E virus has an intersecting course in pregnant women and pregnant women are at high risk of hepatitis E infection particularly in second and third trimester and due to this possibility of maternal complications such as postpartum haemorrhage, premature rupture of membrane. Medical complications such as coagulation failure, hepatic encephalopathy, fetal complication like preterm absorption still births, are increased.17
Western UP, being an industrial hub and region of better job opportunities has lead to the migration of people flocking to have better socio-economic condition. This resulted in extra burden in the health care system of this region. However, it takes time to pull oneself out of poverty and more often life of people doesn’t change much. Harsh realities, debt and challenging situations make migrants more susceptible and vulnerable to infectious disease than local people.
In our study the frequency of HEV 11.79% different age groups this rate of infection is almost similar to the study of Mittal A et al (2016), 18 in which rate of hepatitis E infection is 14.9%, our study differ from study of Chandra N S et al (2013) 19 and P. Jain et al (2013). 20 In this study Hepatitis- E reactive cases are 49.7% and 17.97%. Show that high prevalence of hepatitis-E positive cases, this rate show that in this locality prevalence of Hepatitis E virus is lower as compare to other regions of India.
In our study gender wise distribution of Hepatitis E 11(48%) were male and 12 (52%). which show difference from other studies like Mittal A et al (2016), 18 in which 69.76% were males and 30.23% were female and Chandra N S et al (2013) 19 distribution of hepatitis E infection is 67.73% males and 34.26% females, this study show that susceptibility of female population is much more due lack of awareness about the diseases and transmission of infection patients do not present to medical care facilities and try to treat jaundice like symptoms by themselves.
Our study found that Hepatitis E primarily affects adults between age group of 21 to 40 which is similar to the study of Chandra N S et al (2013).19 The data shows the drift in infection regarding the age group. This drift is unique feature of epidemiology of HEV and has been observed by many other Indian researchers. As socio-economic status of individuals improve along with health care system of surrounding, exposure to infection caused by HAV in children has decreased dramatically. Therefore, we can drive from this that there is eventual change in the age group infected from HEV from childhood to adult age group Kaur et al (2017). 21 And a complementary study Aggrawal S et al (2017) 22 shows high prevalence in common age group of 3-18 years, this shows that hepatitis E virus infects young children and adults.
Conclusion
Result represented important information and association in Hepatitis E Positive cases.
Study is based on a sample size and it gives basic information towards infected patients with Hepatitis E Virus.
Females 12(52%) were more affected by the Hepatitis-E virus infection as compare to Males 11(48%).
Our finding concludes that most common mode of transmission of Hepatitis-E virus is Faeco-oral route (contamination food and water).
Prevalence of HEV in patients attending Teerthanker Mahaveer hospital was very low in compare to the general population in India.
HEV still remains as a major culprit of infectious diseases globally. Both susceptible and infected individuals might exist side by side in rapidly evolving societies. Hence, isolated cases and epidemic infection caused by HEV will stand as a concern in these places. This requires proper information regarding mode of transmission of infection caused by HEV and precautionary measure that can be undertaken to prevent it.
Hygienic practices for prevention of HEV infection include hand washing, avoid drinking tap water and raw meat products in area with poor sanitation, and heating foods nearly >850 c for one minute.
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