Acute sporadic viral hepatitis in Ethiopia: causes, risk factors, and effects on pregnancy

One hundred and ten consecutive cases of acute sporadic hepatitis among Ethiopian patients were studied to define viral causes, identify risk factors, and analyze demographic and clinical data. IgM antibodies to hepatitis A virus were found in nine patients (8%), and hepatitis B surface antigen and IgM antibodies to hepatitis B core antigen were found in 22 (20%); these findings were considered evidence of acute hepatitis A and hepatitis B, respectively. Sera from the remaining 79 patients were tested for antibodies to hepatitis E virus by a blocking fluorescent antibody test. Thirty-six (33%) of these patients were seropositive, as compared to 4 (7%) of 59 healthy control subjects; for 43 patients (39%), the cause of the acute sporadic hepatitis was unidentified. Twenty-one (19%) of the patients had antibodies to hepatitis C virus, as determined by ELISA. Demographic, biochemical, and clinical data (except in regard to sequelae) were comparable for the different types of infections. The study subjects included 32 pregnant women, 19 (59%) of whom had hepatitis E virus infection; these infections caused death in eight of the women (mostly in the third trimester) and 10 fetal complications. Thus, hepatitis E virus is a common cause of acute sporadic viral hepatitis in Ethiopian patients, and its occurrence during pregnancy is associated with high maternal and fetal morbidity and mortality.