Serological diagnosis of jaundice epidemics in India

Enterically transmitted non-A, nonB- hepatitis (ET-NANBH) is a major public health problem in India, where the endemicity of this disease is high and poor public sanitation coupled with compromised quality of drinking water leads to major and minor outbreaks. Sophisticated technics for characterization of hepatitis E virus (HEV) are not easily available/affordable, resulting in continuation of the diagnosis of NANBH for most epidemics. This study attempts to serologically determine the etiology of epidemics of NANBH in India. Eighteen outbreaks of jaundice occurring in various regions of India over a period of twenty months were selected for this laboratory based study. Representative cases of each outbreak were subjected to detailed serological investigation for immunological markers of viral hepatitis. Each serum sample was tested for the immunological markers of acute or recent infection with hepatitis A or B viruses (anti-HAV-IgM, HBsAg and anti-HBc-IgM) by Macro ELISA (Abbott). The sera found to be negative for these three markers ie non-A, non-B hepatitis (NANBH) sera were further tested for anti-HEV by Macro ELISA (anti-HEV EIA, Abbott). A highly significant number of NANBH sera were reactive for anti-HEV in case of almost all the outbreaks. The lowest figure for anti-HEV positivity in NANBH sera of outbreak was compared with anti-HEV positivity in the controls and found to be significantly high. It was concluded that anti-HEV is an important marker revealing probability of the NANBH outbreak being due to HEV.