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2025 ; 25
(1
): 1395
Nephropedia Template TP
gab.com Text
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Serological and molecular characterization of hepatitis E virus and co-infections
during the 2014 Biratnagar outbreak in Nepal
#MMPMID41131491
Gupta BP
; Sah AK
; Sah AK
; Gupta VP
; Ghimire DP
; Acharya N
; Wagle C
BMC Infect Dis
2025[Oct]; 25
(1
): 1395
PMID41131491
show ga
INTRODUCTION: Hepatitis E virus (HEV) is a leading cause of acute viral hepatitis
in South Asia, frequently causing waterborne outbreaks. Despite the recognized
past and potential future epidemic burden in Nepal, data on the serological and
molecular characteristics of, and co-infections with, Hepatitis A, B, and C
viruses remain scarce. This study aimed to perform a detailed virological and
serological characterization of a 2014 outbreak in Biratnagar, Nepal, to define
the etiology and evaluate diagnostic patterns. METHODS: In this cross-sectional
study, 211 patients with suspected acute viral hepatitis were enrolled from three
hospitals in Biratnagar, Nepal, during the outbreak peak (April-May 2014). Serum
samples were tested for HEV RNA (qRT-PCR), antigen, IgM, and IgG (ELISA),
alongside HAV IgM, HBV core antibody, and HCV antibody. Concordance between HEV
markers was assessed using Cohen's ?, associations with co-infections via
Fisher's exact tests, and clinical correlates with Mann-Whitney U tests. RESULTS:
HEV marker positivity among the 211 patients was as follows: HEV RNA was detected
in 12 patients (5.7%), HEV antigen in 29 patients (13.7%), and HEV IgM in 36
patients (17.1%), indicating acute or recent infection. HEV IgG, reflecting past
or recent exposure, was detected in 62 patients (29.4%). All successfully
sequenced HEV RNA-positive isolates were identified as genotype 1a, consistent
with the predominant HEV genotype reported in Nepal. In contrast, HAV, HBV, and
HCV infections were infrequent, each accounting for less than 3% of cases, and no
significant co-infections were observed. Concordance between HEV markers was
variable, supporting the utility of a combined molecular and serological
diagnostic approach to capture infections at different stages. CONCLUSION: This
study provides a detailed characterization of HEV markers during the 2014
Biratnagar outbreak and confirms the circulation of HEV genotype 1a. HAV, HBV,
and HCV infections were uncommon, with no significant co-infections observed.
These findings offer valuable insights into HEV marker distribution and
co-infection patterns, which can inform public health strategies, including
enhanced surveillance, improved access to safe water, and consideration of
targeted vaccination to mitigate future outbreaks in endemic settings.
|*Coinfection/epidemiology/virology
[MESH]
|*Disease Outbreaks
[MESH]
|*Hepatitis E virus/genetics/immunology/isolation & purification/classification
[MESH]