Hepatitis E in suspected acute hepatitis cases in Brazil: A comparison with hepatitis A

@article{oliveira2026hepatitis,
  title = {{Hepatitis E in suspected acute hepatitis cases in Brazil: A comparison with hepatitis A}},
  author = {Ketti Gleyzer de Oliveira and Mariana Pinheiro Alves Vasconcelos and Julia Teixeira Ton and Silvia Naomi de Oliveira Uehara and Roberta Sitnik and Denize Ornelas Pereira Salvador de Oliveira and Layze Oliveira Castberg Sousa and Ricardo Andreotti Siqueira and Peter James Robinson and Thaís Senna de Paula Domingues and Caroline Thomas Panico and César Augusto Inoue and Maria Cecília Araripe Sucupira and Maira Marranghello Maluf and Fernanda de Mello Malta and Deyvid Amgarten and Erick Dorlass and Pedro Sebe and Arlene S. Pinto and Cirley M. D. O. Lobato and Adalgisa Ferreira and Elodie Hyppolito and Raymundo Paraná and Maria Isabel Schinoni and Edmundo Pessoa de Almeida Lopes and Magali C. Luiz and Raquel F. L. Garcia and Sabrina Sabino da Silva and Aline Satie Oba-Kuniyoshi and Dennis Armando Bertolini and Mário Reis Álvares-da-Silva and Raul Salinas Arrojo and Eduardo Emerim and Gabriela P. Coral and Paulo R. Acosta and Marcelle Lucena and Rosângela Rodrigues Teixeira and Mônica da Costa Guedes and Livia Melo Villar and Lia Lewis Ximenez and Clarice Gdalevici and Maria Cássia Jacintho Mendes-Correa and Michele Soares Gomes-Gouvea and Flair José Carrilho and Gerson Sobrinho Salvador de Oliveira and Paulo Roberto A. Ferreira and Pablo Andres Munoz Torres and Glória Selegatto and Luciana Vilas Boas Casadio and Simone Tenore and Olavo Henrique Munhoz Leite and Fernanda Fernandes Souza and Tânia Reuter and Francisco Souto and Michele Nascimento-Sales and Maria Lucia Gomes Ferraz and Ana Catharina de Seixas Santos Nastri and Ana Paula Maciel Gurski and Andréa Salomão and Bruna Emanuelle Alvarenga Fanis},
  journal = {PLOS Neglected Tropical Diseases},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pntd.0014834},
  url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014834},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Hepatitis E in suspected acute hepatitis cases in Brazil: A comparison with hepatitis A
AU  - Ketti Gleyzer de Oliveira
AU  - Mariana Pinheiro Alves Vasconcelos
AU  - Julia Teixeira Ton
AU  - Silvia Naomi de Oliveira Uehara
AU  - Roberta Sitnik
AU  - Denize Ornelas Pereira Salvador de Oliveira
AU  - Layze Oliveira Castberg Sousa
AU  - Ricardo Andreotti Siqueira
AU  - Peter James Robinson
AU  - Thaís Senna de Paula Domingues
AU  - Caroline Thomas Panico
AU  - César Augusto Inoue
AU  - Maria Cecília Araripe Sucupira
AU  - Maira Marranghello Maluf
AU  - Fernanda de Mello Malta
AU  - Deyvid Amgarten
AU  - Erick Dorlass
AU  - Pedro Sebe
AU  - Arlene S. Pinto
AU  - Cirley M. D. O. Lobato
AU  - Adalgisa Ferreira
AU  - Elodie Hyppolito
AU  - Raymundo Paraná
AU  - Maria Isabel Schinoni
AU  - Edmundo Pessoa de Almeida Lopes
AU  - Magali C. Luiz
AU  - Raquel F. L. Garcia
AU  - Sabrina Sabino da Silva
AU  - Aline Satie Oba-Kuniyoshi
AU  - Dennis Armando Bertolini
AU  - Mário Reis Álvares-da-Silva
AU  - Raul Salinas Arrojo
AU  - Eduardo Emerim
AU  - Gabriela P. Coral
AU  - Paulo R. Acosta
AU  - Marcelle Lucena
AU  - Rosângela Rodrigues Teixeira
AU  - Mônica da Costa Guedes
AU  - Livia Melo Villar
AU  - Lia Lewis Ximenez
AU  - Clarice Gdalevici
AU  - Maria Cássia Jacintho Mendes-Correa
AU  - Michele Soares Gomes-Gouvea
AU  - Flair José Carrilho
AU  - Gerson Sobrinho Salvador de Oliveira
AU  - Paulo Roberto A. Ferreira
AU  - Pablo Andres Munoz Torres
AU  - Glória Selegatto
AU  - Luciana Vilas Boas Casadio
AU  - Simone Tenore
AU  - Olavo Henrique Munhoz Leite
AU  - Fernanda Fernandes Souza
AU  - Tânia Reuter
AU  - Francisco Souto
AU  - Michele Nascimento-Sales
AU  - Maria Lucia Gomes Ferraz
AU  - Ana Catharina de Seixas Santos Nastri
AU  - Ana Paula Maciel Gurski
AU  - Andréa Salomão
AU  - Bruna Emanuelle Alvarenga Fanis
PY  - 2026
DA  - 2026/10/26
JO  - PLOS Neglected Tropical Diseases
DO  - 10.1371/journal.pntd.0014834
UR  - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014834
AB  - 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.
SN  - 1935-2735
ER  -