{
  "abstract": "Hepatitis E virus (HEV) is an underrecognized cause of acute viral hepatitis worldwide, with growing public health relevance, particularly in settings where routine diagnostic testing is limited. Hepatitis A virus (HAV) is another epidemiologically related hepatitis virus, but few studies have directly compared these infections in Brazil. This study aimed to (1) determine the frequency of acute hepatitis E (AHE) and evaluate the contribution of HEV infection to the burden of hepatitis among patients with suspected acute disease attended in public healthcare institutions in Brazil; (2) assess the prevalence of acquired immunity to HEV and HAV; and (3) compare demographic characteristics, risk factors, and clinical-laboratory findings associated with HEV and HAV infections. We enrolled 1,721 adults (≥18 years) with suspected acute hepatitis from 16 Brazilian states between October 2019 and May 2023. Serum samples were tested for anti-HEV IgG/IgM and anti-HAV IgG/IgM by immunoassay and for HEV and HAV RNA by RT-PCR. Demographic, behavioral, clinical, and laboratory data were collected using a standardized questionnaire. Group comparisons were performed using univariate analyses and logistic regression, with statistical significance set at p < 0.05. Anti-HEV IgG was detected in 89 individuals (5.2%), whereas anti-HAV IgG was detected in 1,352 (78.6%). Anti-HEV IgG seroprevalence was higher in the South, Southeast, and Central West regions and among heterosexuals, and it increased with age, reaching 13.0% among individuals aged ≥65 years. Seropositivity was associated with markers of previous exposure or immunity, including HAV, HBV, Leptospira, and Toxoplasma. A total of 124 acute hepatitis cases were identified: 16 (12.9%) AHE and 108 (87.1%) acute hepatitis A (AHA). Compared with AHA cases, AHE cases occurred in older individuals and were more frequent among women and heterosexual participants. All AHA cases occurred in urban areas, whereas AHE cases were observed in both urban and rural settings. AHA cases showed higher aminotransferase levels and more frequent jaundice than AHE cases. HEV accounts for a small but distinct proportion of suspected acute hepatitis cases in Brazil and shows epidemiological and clinical characteristics that differ from HAV. Incorporating HEV testing into routine diagnostic algorithms may improve etiological clarification and surveillance of acute hepatitis. Author summary: We conducted a multicenter study of 1,721 adults with suspected acute hepatitis from five Brazilian regions. Anti-HEV IgG was detected in 5.2% of participants, with clear geographic and demographic variation, whereas anti-HAV IgG was much more frequent (78.6%). AHA was much more frequent than AHE: 87.1% vs. 12.9%. We also identified distinct epidemiological profiles: AHE affected older adults, was more frequent among women and heterosexual individuals, and occurred in both urban and rural settings. AHE cases had milder clinical and biochemical profiles than AHA cases, which showed higher aminotransferase levels and more frequent jaundice. These findings highlight an important gap in routine diagnostic testing for acute hepatitis in Brazil, because hepatitis E may be missed without targeted testing. Adding HEV testing to standard diagnostic panels could improve patient care and public health surveillance.",
  "abstract_shown": true,
  "affiliations": [
    "Laboratório de Patologia Clínica e de Anatomia Patológica, Hospital Israelita Albert Einstein, São Paulo, Brazil",
    "LIM07, Instituto de Medicina Tropical, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil",
    "Centro de Pesquisa em Medicina Tropical, Secretaria de Estado da Saúde de Rondônia, Porto Velho, Rondônia, Brazil",
    "Hospital Dia Esterina Corsini de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil",
    "Fundação de Medicina Tropical Dr. Vieira Machado de Manaus, Secretaria de Estado da Saúde do Amazonas, Manaus, Amazonas, Brazil",
    "Unidade de Saúde de Referência de Doença de Rio Branco, Secretaria Municipal da Saúde, Rio Branco, Acre, Brazil",
    "Departamento de Medicina, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil",
    "Hospital São José das Doenças Infecciosas de Fortaleza, Serviço de Transplante de Fígado do Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil",
    "Hospital Universitário Professor Edgar Santos de Salvador, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Bahia, Brazil",
    "Hospital de Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil",
    "Hospital Nereu Ramos, Secretaria de Estado da Saúde, Florianópolis, Santa Catarina, Brazil",
    "Hospital Municipal São José, Prefeitura de Joinville, Joinville, Santa Catarina, Brazil",
    "Fundação Universidade Regional de Blumenau (FURB), Blumenau, Santa Catarina, Brazil",
    "UniCesumar, Maringá, Paraná, Brazil",
    "Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Paraná, Brazil",
    "Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil",
    "Centro de Testagem e Aconselhamento Santa Marta de Porto Alegre, Prefeitura de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil",
    "Santa Casa de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil",
    "Consórcio Intermunicipal de Saúde de Pato Branco, Pato Branco, Paraná, Brazil",
    "Secretaria Municipal de Saúde de Florianópolis, Prefeitura de Florianópolis, Florianópolis, Santa Catarina, Brazil",
    "Equipe de Gastrohepatologia, Hospital Felício Rocho, Belo Horizonte, Minas Gerais, Brazil",
    "Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil",
    "Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil",
    "Polo de Heplatites, Instituto de Assistência dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil",
    "Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil",
    "Hospital Universitário de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil",
    "Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil",
    "Centro de Referência e Tratamento de IST AIDS, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil",
    "Disciplina de Infectologia do Centro Universitário Faculdade de Medicina do ABC de São Paulo, São Bernardo do Campo, São Paulo, Brazil",
    "Hospital das Clínicas de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil",
    "Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil",
    "Hospital Universitário Júlio Muller, Ambulatório 3 de Infectologia de Cuiabá, Cuiabá, Mato Grosso, Brazil",
    "Universidade Cruzeiro do Sul de São Paulo, São Paulo, Brazil",
    "Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde e Ambiente do Ministério da Saúde (Dathi/SVSA/MS), Brasília, Distrito Federal, Brazil",
    "Instituto de Infectologia Emílio Ribas de São Paulo, Secretaria de Estado da Saúde, São Paulo, São Paulo, Brazil",
    "LIM01, Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil",
    "LIM03, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 67,
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      "name": "Ketti Gleyzer de Oliveira"
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      "name": "Cirley M. D. O. Lobato"
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      "name": "Maria Isabel Schinoni"
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      "name": "Edmundo Pessoa de Almeida Lopes"
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      "name": "Magali C. Luiz"
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      "name": "Raquel F. L. Garcia"
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      "name": "Sabrina Sabino da Silva"
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      "name": "Aline Satie Oba-Kuniyoshi"
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      "name": "Dennis Armando Bertolini"
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      "name": "Eduardo Emerim"
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      "name": "Marcelle Lucena"
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      "name": "Rosângela Rodrigues Teixeira"
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    {
      "name": "Mônica da Costa Guedes"
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    {
      "name": "Livia Melo Villar"
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    {
      "name": "Lia Lewis Ximenez"
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    {
      "name": "Clarice Gdalevici"
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      "name": "Maria Cássia Jacintho Mendes-Correa"
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      "name": "Michele Soares Gomes-Gouvea"
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      "name": "Flair José Carrilho"
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    {
      "name": "Gerson Sobrinho Salvador de Oliveira"
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    {
      "name": "Paulo Roberto A. Ferreira"
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      "name": "Pablo Andres Munoz Torres"
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      "name": "Glória Selegatto"
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    {
      "name": "Luciana Vilas Boas Casadio"
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      "name": "Simone Tenore"
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      "name": "Olavo Henrique Munhoz Leite"
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      "name": "Fernanda Fernandes Souza"
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      "name": "Tânia Reuter"
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      "name": "Francisco Souto"
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      "name": "Michele Nascimento-Sales"
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      "name": "Maria Lucia Gomes Ferraz"
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      "name": "Ana Catharina de Seixas Santos Nastri"
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      "name": "Ana Paula Maciel Gurski"
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  "bibtex": "https://research.draconitic.com/paper/9vy6nxdqasq7z.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pntd.0014834",
  "fulltext_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014834",
  "id": "9vy6nxdqasq7z",
  "issns": [
    "1935-2735"
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  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
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  "native_subjects": [
    [
      "openalex",
      "2721|Hepatitis Viruses Studies and Epidemiology"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Hepatitis viruses/Hepatitis A virus"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Hepatitis viruses/Hepatitis E virus"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Hepatitis viruses/Hepatitis A virus"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Hepatitis viruses/Hepatitis E virus"
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    [
      "plos",
      "/Medicine and health sciences/Gastroenterology and hepatology/Liver diseases/Infectious hepatitis/Hepatitis A"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Infectious diseases/Viral diseases/Hepatitis/Hepatitis A"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Infectious diseases/Viral diseases/Hepatitis/Hepatitis E"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Hepatitis viruses/Hepatitis A virus"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Hepatitis viruses/Hepatitis E virus"
    ],
    [
      "plos",
      "/People and places/Geographical locations/South America/Brazil"
    ],
    [
      "plos",
      "/People and places/Population groupings/Age groups"
    ],
    [
      "plos",
      "/People and places/Population groupings/Sexuality groupings/Heterosexuals"
    ],
    [
      "plos",
      "/People and places/Population groupings/Sexuality groupings/Men who have sex with men"
    ]
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  "pmcid": null,
  "pmid": null,
  "published": "2026-10-26",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/9vy6nxdqasq7z.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:17Z",
      "native_id": "10.1371/journal.pntd.0014834",
      "source": "plos",
      "url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014834"
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  "subjects": [
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      "field": "biology",
      "origin": "plos:microbiology",
      "subfield": "microbiology"
    },
    {
      "field": "medicine",
      "origin": "plos:infectious diseases",
      "subfield": "infectious-disease"
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  ],
  "title": "Hepatitis E in suspected acute hepatitis cases in Brazil: A comparison with hepatitis A",
  "title_text": "Hepatitis E in suspected acute hepatitis cases in Brazil: A comparison with hepatitis A",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:17Z",
  "url": "https://research.draconitic.com/paper/9vy6nxdqasq7z",
  "venue": "PLOS Neglected Tropical Diseases",
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}