Questions

1
Vohra Hepatitis E in children

• Questions
• Frequency
• Epidemics
• Hospital Acute hepatitis/FHF/SAHF
• Epidemiological studies
• Co-infection
• Severity
• Recommended therapy

2
Vohra Hepatitis E in children

• Epidemics (lt10 years)
• Delhi (1995) 7
• Karnal (1987) 11
• Kanpur (1991) 5.8
• Kashmir (1980) 0.5
• Young children are spared!
• Hospital studies acute hepatitis ()
• n HAV HEV A/E HBV
• Chennai (Malathi, 1998) 127 39 16 13 13
• Chandigarh (Poddar, 2002) 172 64 16 7 7
• Pune (Chadha 94-97) 98 74 5 7 5
• Common cause of acute hepatitis

3
Age wise distribution (Poddar 2002)
Vohra Hepatitis E in children
Seroepidemiology
4
SeverityFulminant hepatic failure
Vohra Hepatitis E in children
Sub-acute hepatic failure
HEV is a common cause of FHF in children
5
Vohra Hepatitis E in children

• Mathur n2070 (Urban and Rural)
• 45 of all IgG ? IgM antibody , (12 of
  total study)
• No child jaundice
• 6.5 elevated SGPT (underestimate)
• 5 had h/o jaundice inapparent or anicteric
  hepatitis common
• Increase in IgG positivity with age was less than
  expected
• (IgM positive cases in the younger cohort)

6
Vohra Hepatitis E in children

• Conclusions
• HEV is 2nd most common cause of acute viral
  hepatitis in children
• HEV is 2nd most common cause of hepatic failure
  in children
• Co-infection is common
• Dual infections have a higher fatality rate
• Exposure to HEV early (North India)
• Anicteric hepatitis/Inapparent infection is
  common in children
• Epidemics - children are spared ?protection
• Waning of antibody levels