Seroprevalence of antibodies to hepatitis E virus in two large communities in Havana, Cuba.

Hepatitis E virus (HEV) infection is an important cause of acute viral hepatitis in tropical and sub-tropical regions that occurs both as epidemic episodes and sporadic cases. The aim of this investigation was to estimate the prevalence of total immunoglobulin (Ig) anti-hepatitis E virus (anti-HEV) and the risk factors associated to two communities in Havana City. Serum samples (n=469) obtained from healthy individuals with no history of viral hepatitis were screened for total anti-HEV by enzyme immunoassay (EIA). An overall prevalence of 10% (47/469) (95% CI; 7.52-13.19%) was obtained. Higher anti-HEV prevalence was found in the municipality of Marianao (12.1%) compared to Playa (7.1%). Analysis of risk factors revealed a significant association of total anti-HEV prevalence in age group 41-60 years old, with a risk ratio of 3.21 (95% CI: 1.09-9.7) (P=0.01). No relation was found between anti-HEV and other variables such as gender, risk occupations, surgery and transfusions. The detection of total anti-HEV in individuals with no overt acute hepatitis suggests the existence of sub-clinical or anicteric HEV infection in these municipalities.

Dual infection with hepatitis A and E viruses in outbreaks and in sporadic clinical cases: Cuba 1998-2003.

Viral hepatitis ranks as the fifth cause of morbidity for infectious diseases in Cuba. Epidemics are observed frequently in the population, the hepatitis A virus being the main agent responsible for such epidemics. Previous reports also confirmed the circulation of the hepatitis E virus. From 1998 to 2003, 258 serum samples were collected by the Reference Laboratory on Viral Hepatitis during 33 outbreaks of acute viral hepatitis as well as from 39 sporadic clinical cases. Sera were tested for anti-HAV and anti-HEV IgM by EIA. Overall of the 33 outbreaks studied sera from 12 (36.4%) were positive for anti-HAV IgM only, from 7 (21.2%) were positive for anti-HEV IgM only, and from 14 (42.4%) were positive for antibodies to both viruses. Individually of the 258 sera collected, 137 (53.1%) were positives for anti-HAV IgM, 20 (7.8%) were positives for anti-HEV IgM, 33 (12.8%) were positives for both markers and 68 (26.4%) were negative to both. Of the clinical cases, 4 (10.3%) were positives for anti-HAV IgM, 13 (33.3%) were positives for anti-HEV IgM and 5 (12.8%) were positives for both markers. Seventeen (43.6%) sera were negatives for all viral hepatitis markers available (A-E). A high positivity for HEV was found in outbreaks tested with the kit produced by CIGB. In particular HEV seems to infect individuals of all ages. The results demonstrate the co-circulation of and co-infection with two enterically transmitted viruses; however a higher positivity was observed for anti-HAV than to anti-HEV (53.1% vs. 7.8%) in outbreaks.