Enteric viral hepatitis in the Socialist Republic of Vietnam (Southern Vietnam)

Aim: To study the hepatitis A (HAV) and hepatitis Е (HEV) prevalence in the Southern region of Vietnam based on the frequency analysis of the antibodies to hepatitis A and E viruses detection in the local population and groups at increased risk of infection.

Materials and methods. Serological markers of enteral viral hepatitis were determined in blood serum samples from adults aged 18 to 65 years of three groups: conditionally healthy individuals (n = 397), HIV-infected (n = 316), and patients with chronic viral hepatitis (n = 268). The ELISA method was used for the qualitative detection of anti-HAV IgG, anti-HAV IgM, anti-HEV IgG, anti-HEV IgM.

Results. When analyzing the prevalence of anti-HAV IgG in samples obtained from conditionally healthy, HIV-infected, and patients with chronic viral hepatitis, no differences were found between the groups. The incidence of anti-HAV IgG in the general group (n = 981) was 80.1%, in the absence of anti-HAV IgM. There were no gender-age differences in the frequency of anti-HAV IgG in the examined groups. Antibodies anti-HEV IgG in the groups of conditionally healthy, patients with chronic viral hepatitis, and HIV-infected were present in the samples in 36,2%, 33,2%, and 39,8% of cases, respectively. The prevalence of anti-HEV IgM in these groups was 3,27%, 4,1%, and 3,79%, respectively. In the general group (n = 981), anti-HEV IgG was detected in 36,6% of cases, anti-HEV IgM in 3,66%, which corresponds to the prevalence of antibodies to HEV in endemic regions.

Conclusion. A high incidence of enteral viral hepatitis markers was shown in residents of South Vietnam, including the groups of conditionally healthy, patients with chronic viral hepatitis, and HIV-infected. There is an obvious need for further studies of the spread extent of hepatitis A and hepatitis E in the Socialist Republic of Vietnam using currently available highly sensitive diagnostic methods, including sequencing of the virus›s nucleotide sequences.

1. Mikhailov M.I., Shahgildyan I.V., Onishchenko G.G. Enteral viral hepatitis (etiology, epidemiology, diagnosis, prevention) monograph / M. I. Mikhailov, I. V. Shakhgildyan, G. G. Onishchenko. M.: VUNMTS Roszdrav. Series: Questions of Practical Epidemiology.; 2007.349 p.

2. Malinnikova E.Yu., Mikhailov M.I., Kyuregyan K.K. Viral hepatitis E. Current concepts in the etiology, epidemiology, diagnosis, clinical picture and prevention. G. Infectious Diseases: News, Opinions, Education. 2014. №3. с. 13-22.

3. Nan Y., Wu C., Zhao Q., Zhou E.M. Zoonotic hepatitis E virus: an ignored risk for public health. Front Microbiol. 2017. 8. P.2396. DOI: 10.3389/fmicb.2017.02396.

4. Esaulenko E.V., Sukhoruk A.A., Bushmanova A.D., Ingabire T., Ostankova Yu.V. Current epidemiological, molecular and genetic characteristics of enteric viral hepatitis in Russia. Almanac of Clinical Medicine. 2018. 46(1). 50–8. doi: 10.18786/2072-0505-2018-46-1-50-58

5. WHO. Fact sheets, 2021. Hepatitis A. Available online: https://www.who.int/news-room/fact-sheets/detail/hepatitisa, (accessed on 15.08. 2021)

6. Baert L., Debevere J., Uyttendaele M. The efficacy of preservation methods to inactivate foodborne viruses. Int J Food Microbiol. 2009. 131(2-3). P. 83-94 DOI:10.1016/j.ijfoodmicro

7. WHO. Hepatitis E: Fact Sheet, 2020. Available online: https://www.who.int/news-room/fact-sheets/detail/hepatitise (accessed on 15.08. 2021).

8. Maila H.T., Bowyer S.M., Swanepoel R. Identification of a new strain of hepatitis E virus from an outbreak in Namibia in 1995. J. Gen. Virol. 2004. 85. P. 89–95. DOI: 10.1099/vir.0.19587-0

9. Viswanathan R. Infectious hepatitis in Delhi (1955-56): A critical study-epidemiology. 1957. Natl. Med.J. India 2013. 26. P. 362–377.

10. Pallerla S.R., Harms D., Johne R., Todt D., Steinmann E. et al. Hepatitis E virus infection: circulation, molecular epidemiology, and impact on global health. Pathogens. 2020. 9. 856. p. 1-22. Available online: http://www.mdpi.com/journal/pathogens DOI:10.3390/pathogens9100856

11. Khuroo M.S. Discovery of hepatitis E: the epidemic nonA, non-B hepatitis 30 years down the memory lane. Virus Res. 2011. V.161(№1). P. 3–14. DOI: 10.1016/j.virusres.2011.02.007

12. Shrestha A. Viral Hepatitis in Nepal: Past, Present, and Future. Euroasian J Hepatogastroenterol. 2016. 6(1). P. 59–61. doi: 10.5005/jp-journals-10018-1169

13. Teshale E.H., Hu D.J. Hepatitis E: Epidemiology and prevention. World J Hepatol. 2011. 3(12). P.285-291. doi: 10.4254/wjh.v3.i12.285

14. Bushmanova A.D., Sukhoruk A.A., Ivanova N.V., Esaulenko E.V. Characteristics of hepatitis A on the background of chronic hepatitis B. Kazan Medical Journal 2017. V. 98. № 4. С. 521-526.

15. Gripenberg M., Aloysia D›Cor N., L›Azou M., Marsh G., Druelles S., Nealon J. Changing sero-epidemiology of hepatitis A in Asia Pacific countries: A systematic review. Int J Infect Dis. 2018. 68. P.13-17. doi: 10.1016/j.ijid.2017.12.021.

16. Hau C.H., Hien T.T., Tien N.T., Khiem H.B., Sac P.K. et al. Prevalence of enteric hepatitis A and E viruses in the Mekong River delta region of Vietnam. Am J Trop Med Hyg. 1999. 60(2). P.277-280. DOI: 10.4269/ajtmh.1999.60.277

17. Sa-nguanmoo P., Posuwan N., Vichaiwattana P., Vuthitanachot V., Saelao S. et al. Declining Trend of Hepatitis A Seroepidemiology in Association with Improved Public Health and Economic Status of Thailand. PLoS One. 2016. 11(3). e0151304. doi: 10.1371/journal.pone.0151304.

18. Skinhøj P., Aldershvile J., Black F., Kjersem H., Kryger P., Mathiesen L. Viral hepatitis in southeast Asian refugees. J Med Virol. 1981;7(2):149-55. doi: 10.1002/jmv.1890070209.

19. He J., Innis B.L., Shrestha M.P. et al. Evidence that rodents are a reservoir of hepatitis E virus for humans in Nepal. J Clin Microbiol. 2002. 40. P.4493–4498. doi: 10.1128/JCM.40.12.4493-4498.2002.

20. Van Nguyen D., Van Nguyen C., Bonsall D., Ngo T.T., Carrique-Mas J. et al. Detection and Characterization of Homologues of Human Hepatitis Viruses and Pegiviruses in Rodents and Bats in Vietnam. Viruses. 2018. 10(3). pii: E102. doi: 10.3390/v10030102.

21. Purdy M.A., Khudyakov Y.E. The molecular epidemiology of hepatitis E virus infection. Virus Res. 2011. 161(1). P. 31–39. doi: 10.1016/j.virusres.2011.04.030.

22. Berto A., Pham H. A., T. T. N. Thao, N. H. T. Vy, S. L. Caddy, et al. Hepatitis E in southern Vietnam: Seroepidemiology in humans and molecular epidemiology in pigs. Zoonoses Public Health. 2018. 65(1). P.43–50. doi: 10.1111/zph.12364

23. Hoan N.X., Huy P.X., Sy B.T., Meyer C.G., Son T.V., Binh M.T., Giang D.P., Tu Anh D., Bock C.T., Wang B., Tong H.V., Kremsner P.G., Song L.H., Toan N.L., Velavan T.P. High Hepatitis E virus (HEV) Positivity Among Domestic Pigs and Risk of HEV Infection of Individuals Occupationally Exposed to Pigs and Pork Meat in Hanoi, Vietnam. Open Forum Infect Dis. 2019. 6(9):ofz306. doi: 10.1093/ofid/ofz306.

24. Tran H.T., Ushijima H., Quang V.X., Phuong N., Li T.C. et al. Prevalence of hepatitis virus types B through E and genotypic distribution of HBV and HCV in Ho Chi Minh City, Vietnam. Hepatol Res. 2003. 26(4). P.275-280.

25. Buchy P., Monchy D., An T.T., Srey C.T., Tri D.V. et al. Prevalence of hepatitis A, B, C and E virus markers among patients with elevated levels of Alanine aminotransferase and Aspartate aminotransferase in Phnom Penh (Cambodia) and Nha Trang (Central Vietnam). Bull Soc Pathol Exot. 2004. 97(3). P.165-171.

26. Hoan N.X., Tong H.V., Hecht N., Sy B.T., Marcinek P., Meyer C.G., Song le H., Toan N.L., Kurreck J., Kremsner P.G., Bock C.T, Velavan T.P. Hepatitis E Virus Superinfection and Clinical Progression in Hepatitis B Patients. EBioMedicine. 2015. 2(12). P. 2080-6. doi: 10.1016/j.ebiom.2015.11.020.

27. Jacobs C., Chiluba C., Phiri C., Lisulo M.M., Chomba M. et al. Seroepidemiology of hepatitis E virus infection in an urban population in Zambia: strong association with HIV and environmental enteropathy. J Infect Dis. 2014. 209(5). P.652-657. doi: 10.1093/infdis/jit409.

28. Neukam K., Barreiro P., Macias J., Avellon A., Cifuentes C. et al. Chronic hepatitis E in HIV patients: rapid progression to cirrhosis and response to oral ribavirin. Clin Infect Dis. 2013. 57(3). P.465–468. doi: 10.1093/cid/cit224.

29. Feldt T., Sarfo F.S., Zoufaly A., Phillips R.O., Burchard G. et al. Hepatitis E virus infections in HIV-infected patients in Ghana and Cameroon. J Clin Virol. 2013. 58(1). P.18–23. doi: 10.1016/j.jcv.2013.05.004.

30. Pineda J.A., Cifuentes C., Parra M., Merchante N., Perez-Navarro E. et al. Incidence and natural history of hepatitis E virus coinfection among HIV-infected patients. AIDS. 2014. 28(13). P.1931–1937. doi: 10.1097/QAD.0000000000000378.

31. Pischke S., Ho H., Urbanek F., Meyer-Olsen D., Suneetha P.V. Hepatitis E in HIV-positive patients in a low-endemic country. J Viral Hepat. 2010. 17(8). P.598–599. doi: 10.1111/j.1365-2893.2009.01219.x.

32. Pischke S., Gisa A., Suneetha P.V., Wiegand S.B., Taubert R., Schlue J., Wursthorn K., Bantel H., Raupach R., Bremer B., Zacher B.J., Schmidt R.E., Manns M.P., Rifai K., Witte T., Wedemeyer H. Increased HEV seroprevalence in patients with autoimmune hepatitis. PLoS One. 2014. 9. doi: 10.1371/journal.pone.0085330.