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Chung Hua Min Kuo Hsiao Erh Ko I Hsueh Hui Tsa Chih 1998
May;39(3):150-156
Hepatitis E in India.
Tomar BS
Department of Pediatric Gastroenterology, S.M.S. Medical
College, Jaipur, India. tomar-dr@jpl.vsnl.net.in
Institute of Pediatric Gastroenterology is superspecialised
referral institute for all Pediatric Gastroenterological diseases
from all over the country and for adjoining countries. We
have our data and experience on 10,500 cases of proven Hepatitis
E (HEV) in Pediatric population. HEV is non-enveloped 27-30
nm diameter RNA virus, prototype for alpha-like supergroup
of positive stranded RNA virus. Indian HEV strain has 97%
nucleotide and 98% amino acid sequence identity with Chinese
strains but much diversity with Mexican strain. More than
70% acute hepatitis occurring in Pediatric population in this
subcontinent are caused by HEV and 80% of these are sporadic.
90% cases were enterically transmitted, spread primarily by
fecally contaminated drinking water (70%) and by food (20%),
in 9.5% case spread probably was because of person to person
and household contact. We could demonstrate HEV in urine,
respiratory secretions. Interestingly we found HEV in insects
like Flies, Cockroaches, and also in engorged Bedbugs and
in Mosquitoes, apart from briefly boiled Mussels, and partially
cooked cockles. Maternal-neonatal transmission could be seen
if mother had HEV infection in third trimester of pregnancy.
In 5 cases we could demonstrate HEV in breast milk. By studying
on 10 volunteers, 40% have anicteric form only accompanied
by anorexia, epigastric pain. HEV appeared in serum before
the icteric phase. Shedding of virus in stool starts before
the icteric phase and continued during the high levels of
abnormal ALT. Hepatitis IgG anti-HEV persist up to 4 years.
In 5 cases we could establish Transfusion associated Hepatitis
(TAH). No chronicity could be documented. 5% cases had fulminant
viral Hepatitis (FVH)/Sub fulminant viral Hepatitis (SVH),
alpha-interferon (IFN) has been proved beneficial in these
cases, further use of intravenous PGEl could also be beneficial.
Inadequate chlorination of drinking water was an important
additional factor for causing epidemics. A free residual chlorine
concentration of at least 0.5 mg/l for minimum of 30 minutes
is considered adequate as quality of drinking water.
PMID: 9684519, UI: 98349148
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