Parenteral Risk Research Articles

Identification of GBV‐C hepatitis G RNA in chronic hepatitis C patients

Sera from patients with chronic hepatitis C were examined for the presence of GBV-C/HGV RNA by RT-PCR. The amplified products, derived from the 5′ non-coding, NS3, and NS5a regions, were detected in 19 (19%) of the 100 HCV RNA-positive samples. Analysis of GBV-C/HGV prevalence rates revealed that dual infections are related to shared parenteral risk factors. Intravenous drug abuse and multiple transfusions were the factors clearly associated with a simultaneous HCV and GBV-C/HGV infection. Apart from this, patients with dual infections had a statistically significant lower mean age compared to those patients infected solely by HCV. Determination of HCV genotypes involved in GBV-C/HGV coinfection by RFLP analysis showed no correlation between the presence of GBV-C/HGV and a distinct HCV genotype. The study demonstrates that, based on the assessment of risk criteria, GBV-C/HGV is transmitted efficiently parenterally and is frequently linked to hepatitis C coinfection, regardless of HCV genotype. © 1996 Wiley-Liss, Inc.

Identification of GBV-C hepatitis G RNA in chronic hepatitis C patients.

Sera from patients with chronic hepatitis C were examined for the presence of GBV-C/HGV RNA by RT-PCR. The amplified products, derived from the 5' non-coding, NS3, and NS5a regions, were detected in 19 (19%) of the 100 HCV RNA-positive samples. Analysis of GBV-C/HGV prevalence rates revealed that dual infections are related to shared parenteral risk factors. Intravenous drug abuse and multiple transfusions were the factors clearly associated with a simultaneous HCV and GBV-C/HGV infection. Apart from this, patients with dual infections had a statistically significant lower mean age compared to those patients infected solely by HCV. Determination of HCV genotypes involved in GBV-C/HGV coinfection by RFLP analysis showed no correlation between the presence of GBV-C/HGV and a distinct HCV genotype. The study demonstrates that, based on the assessment of risk criteria, GBV-C/HGV is transmitted efficiently parenterally and is frequently linked to hepatitis C coinfection, regardless of HCV genotype.

Phylogenetic tree-based epidemiological analysis of hepatitis C virus transmission in a region of Japan with a high prevalence of infection.

Local clustering of hepatitis C virus (HCV) infection has been demonstrated in various regions in Japan. HCV genotypes have now been compared between infected individuals from districts of Saga prefecture with either a high (H district) or low (L district) prevalence of HCV-seropositivity. The prevalence of HCV genotype 1b was significantly higher (P < 0.001) in the H district (45/50; 90%) than in the L district (19/36; 52.8%). A phylogenetic tree was constructed based on the genomic sequences of viral isolates from 20 patients infected with genotype 1b in the H district. Almost all these HCV strains clustered in the same regions of the tree. With regard to risk factors for HCV transmission, the percentage of patients with a history of surgery was significantly higher in the H district than in the L district (58 versus 33.3%; P < 0.05). Of 20 patients infected with similar strains of HCV in the H district, 16 (80%) had at least one parenteral risk factor associated with medical care. These results indicate an increased transmission of similar strains of HCV in the H district as a result of nosocomial infection.

Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses.

The purpose of this study was to estimate the prevalence and correlates of four blood-borne viral infections among illicit drug injectors with up to 6 years of injecting experience. We analyzed data from 716 volunteers recruited in 1988 and 1989. Test results for hepatitis C virus (HCV), hepatitis B virus (HBV), human immunodeficiency virus, type 1 (HIV), and human T-lymphotropic virus types I and II (HTLV) were examined across six sequential cohorts defined by duration of drug injection. Overall, seroprevalence of HCV, HBV, HIV, and HTLV was 76.9%, 65.7%, 20.5% and 1.8%, respectively, and 64.7%, 49.8%, 13.9%, and 0.5%, respectively, among those who had injected for 1 year or less. Among the newest initiates, HCV and HBV were associated with injecting variables, and HIV was associated with sexual variables. The high rates of HCV, HBV, and HIV infections among short-term injectors emphasizes the need to target both parenteral and sexual risk reduction interventions early. Renewed efforts at primary prevention of substance abuse are indicated.

Demographic Determinants of Hepatitis C Virus Seroprevalence Among Blood Donors

To measure demographic determinants of hepatitis C virus (HCV) seroprevalence among blood donors in the United States. Cross-sectional epidemiological study. Five blood centers in different regions of the United States. A total of 862,398 consecutive volunteer blood donors with one or more nonautologous donations from March 1992 through December 1993. Demographic data collection, serological screening with second-generation anti-HCV enzyme immunoassay, and confirmation with anti-HCV recombinant immunoblot. There were 3126 donors with at least one blood donation confirmed HCV-seropositive, for a crude prevalence of 3.6 per 1000. Age-specific HCV seroprevalence rose from 0.5 per 1000 donors younger than 20 years to a maximum of 6.9 per 1000 in donors aged 30 to 39 years and declined in older age groups. There was interaction between age and educational attainment, with 30- to 49-year-olds with less than a high school diploma at highest risk of HCV infection (odds ratio [OR], 33.0; 95% confidence interval [CI], 23.0 to 47.2 compared with those younger than 30 years with a bachelor's degree or higher degree). Other independent risk factors for HCV seropositivity included male sex (OR, 1.9; 95% CI, 1.8 to 2.1), black race (OR, 1.7; 95% CI, 1.6 to 1.9), Hispanic ethnicity (OR, 1.3; 95% CI, 1.1 to 1.5), previous blood transfusion (OR, 2.8; 95% CI, 2.5 to 3.1), and first/only time donor status (OR, 4.2; 95% CI, 3.9 to 4.5 compared with repeat donors). Seropositivity for human T-lymphotropic virus types I and II, human immunodeficiency virus, or hepatitis B core antigen was highly associated with HCV seropositivity (OR, 10.4; 95% CI, 9.6 to 11.4 for one vs no marker). Despite a low overall HCV prevalence in blood donors in the United States, there is a marked variation in HCV seroprevalence by demographic subgroup, even after controlling for prior blood transfusion, a recognized risk factor for HCV. Further study of the prevalence of other parenteral risk factors such as past injection drug use among blood donors is needed.

Parenteral Ketorolac and Risk of Gastrointestinal and Operative Site Bleeding

To evaluate the risk of gastrointestinal and operative site bleeding associated with the use of parenteral ketorolac tromethamine. Postmarketing surveillance inception cohort study. A total of 35 hospitals throughout the Philadelphia, Pa, region, 1991 to 1993. Patients administered 10,272 courses of parenteral ketorolac therapy were compared with patients administered 10,247 courses of a parenteral opiate who were matched to the ketorolac patients by hospital, admitting service, and date of initiation of study drug. Medical records were reviewed for demographics, medical history, doses and duration of study drug, various aspects of the hospital course including surgery and concomitant medications, and adverse events. The multivariate adjusted odds ratio (OR) comparing ketorolac with opiates for gastrointestinal bleeding was 1.30 (95% confidence interval [CI], 1.11 to 1.52); for operative site bleeding, the OR was 1.02 (95% CI, 0.95 to 1.10). The OR was elevated further in subjects 75 years of age or older for both gastrointestinal bleeding (OR = 1.66; 95% CI, 1.23 to 2.25) and operative site bleeding (OR = 1.12; 95% CI, 0.94 to 1.35). A dose-response relationship was evident between average daily ketorolac dose and both gastrointestinal bleeding and operative site bleeding (trend test P < .001 for both). When analgesic therapy lasted 5 or fewer days, ketorolac was associated with only a small increased risk of gastrointestinal bleeding (OR = 1.17; 95% CI, 0.99 to 1.30); when therapy was prolonged beyond 5 days, the OR was 2.20 (95% CI, 1.36 to 3.57). The association of ketorolac with operative site bleeding was not affected by duration of therapy. The overall associations between ketorolac use and both gastrointestinal bleeding and operative site bleeding are small. However, the risk associated with the drug is larger and clinically important when ketorolac is used in higher doses, in older subjects, and for more than 5 days. Improving physicians' prescribing practices by limiting the dose and duration of ketorolac use, especially in the elderly, should enhance its overall risk-benefit balance.

Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study

Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study

V3 peptide binding pattern and HIV-1 transmission route in Rio de Janeiro.

To characterize antibody binding to a panel of V3 loop peptides representing diverse HIV-1 neutralization epitopes, 149 HIV-1 infected individuals from Rio de Janeiro (RJ) were investigated. Results were analyzed with respect to risk factors for infection and other epidemiological and clinical data. Peptide reactivity was not associated with sex, clinical status, CD4 counts, antigenemia or beta 2-microglobulin serum level. A segregation of peptide reactivity according to route of infection was encountered. This finding suggests that more then one viral strain may be circulating in RJ, in subjects with different risk factors for HIV-1 infection. An investigation of prevalent HIV-1 genotypes, serotypes and immunotypes may be of importance for the design and selection of potential vaccines to be used in Brazil as well as for the selection of populations to be included in future vaccine efficacy trials.

HCV genotypes in Swedish blood donors as correlated to epidemiology, liver disease and hepatitis C virus antibody profile.

Sixty-two anti-HCV and HCV-RNA positive Swedish blood donors (44 men, 18 women; median age 34 years) were studied. HCV genotypes were correlated to parenteral risk factors, liver morphology, serum alanine aminotransferase (ALAT) levels and HCV antibody profile. Forty percent of the donors were infected with HCV genotype 1a, 10% with 1b, 21% with 2b, and 29% with 3a. Intravenous drug use (IVDU) was more common in donors with genotype 3a than in those with genotype 1a (p = 0.024), and prior blood transfusion more common in genotype 2b than in 3a (p = 0.012). Chronic active hepatitis with and without cirrhosis was found in 38% of donors infected with genotype 2b as compared to 8% of donors infected with 1a (p = 0.034). Forty percent of donors with genotype 1a had normal ALAT at the time of liver biopsy versus 11% with genotype 3a (p = 0.046). Antibodies to C33c and C22-3 were present in nearly all donors whereas reactivity to C100-3 and 5-1-1 was detected more often in donors with genotypes 1a and 1b as compared to donors with genotypes 2b and 3a. In conclusion, genotype 3a was correlated to IVDU or tattooing as parenteral risk factors for the acquisition of HCV infection, and genotype 2b to prior blood transfusion. Donors with genotypes 1a seemed to have less severe liver disease than those infected with genotypes 2b and 3a.

Herpes simplex virus-2 may increase susceptibility of the sexual transmission of hepatitis C.

Antibodies against herpes simplex viruses-1 and -2, cytomegalovirus, and syphilis were determined in six heterosexual couples with strong indications of having sexually transmitted hepatitis C virus infection and in 17 other heterosexual couples in which one partner was hepatitis C virus viremic (source partner), but the other had remained hepatitis C virus uninfected (exposed partner). Antibody testing was done with an enzyme-linked immunosorbent assay. Anti-herpes simplex virus 2 and anti-hepatitis C virus findings were further confirmed by immunoblotting. Hepatitis C virus RNA was determined by polymerase chain reaction and genotyped with type-specific primers. Five of six anti-hepatitis C virus-positive exposed heterosexual partners without parenteral risk factors, compared with three of 17 anti-hepatitis C virus-negative exposed partners, had antibodies to herpes simplex virus-2. On the other hand, no statistically significant difference was found regarding the frequency of herpes simplex virus-2 seropositivity when source partners in the anti-hepatitis C virus concordant and discordant couples were compared. The presence of antibodies to herpes simplex virus-1, cytomegalovirus, and syphilis did not significantly differ between source or exposed partners in anti-hepatitis C virus concordant and discordant couples, respectively. No predominance of any one hepatitis C virus genotype or liver morphology in couples concordant compared with discordant for anti-hepatitis C virus was found. The findings support the role of herpes simplex virus-2 in the heterosexual transmission of hepatitis C virus infections, and more specifically an increase in susceptibility to hepatitis C virus infections in exposed heterosexual partners with antibodies to herpes simplex virus-2.

Vertical transmission of hepatitis C virus

Few studies have been published on vertical transmission of hepatitis C virus (HCV), although it is the most common cause of hepatitis C in children. We aimed to determine the rate of vertical transmission of HCV in at risk neonates and to assess the effect of possible risk factors.A prospective follow-up study was conducted in 35 children of seropositive mothers during an 18-month period (July 1997-January 1999). Testing for anti-HCV antibodies was performed with third generation enzyme linked immunoadsorbent assay. HCV-RNA was qualitatively analyzed with reverse transcriptase polymerase chain reaction (RT-PCR) and hepatic enzyme studies.All the 35 children studied were positive for HCV antibodies at birth. The children became HCV negative at a mean age of 6 months. HCV infection was detected in two children (5.7%). The mother of one of these children had both HCV and human immunodeficiency virus (HIV) infection. Among the 35 seropositive mothers, a risk factor for percutaneous transmission of HCV (parenteral injection, drug addiction, or previous transfusions) was detected in 19(54%) and HIV coinfection was found in 9(26%).The present study is consistent with other studies that found a vertical HCV transmission rate of approximately 5%, with a greater risk if the mothers had HCV/HIV coinfection or parenteral risk factors. Studies with greater numbers of subjects are required to determine the prevalence of HCV in expectant mothers and the precise rate of vertical transmission. Infected children should be followed up to evaluate the repercussions of HCV infection.

Clinical significance of concomitant hepatitis C infection in patients with alcoholic liver disease.

The significance of antibodies to hepatitis C virus in patients with chronic alcoholic liver disease is unclear. Prior studies have utilized the first-generation enzyme-linked immunosorbent assay, which is limited by problems with sensitivity and specificity. Hepatitis C virus infection in 137 patients with biopsy-proven alcoholic liver disease was assessed with second-generation hepatitis C virus antibody assays and reverse transcription-polymerase chain reaction for detection of hepatitis C virus RNA in the serum. The patients were categorized into three groups according to results of serological testing. Discriminant-function analysis was used to determine which factors (risk, biochemical and histological) could best differentiate the three groups. Thirty-three patients were reactive on second-generation enzyme-linked immunosorbent assay/second-generation recombinant immunoblot assay and RNA positive (group 1). Twelve were reactive on second-generation enzyme-linked immunosorbent assay/second-generation recombinant immunoblot assay but RNA negative (group 2). Eighty-six were nonreactive on second-generation enzyme-linked immunosorbent assay, and six were reactive on second-generation enzyme-linked immunosorbent assay but negative on second-generation recombinant immunoblot assay and negative for hepatitis C virus RNA (group 3). Seventy-six percent of patients in group 1 and 58% in group 2 had parenteral risk factors, compared with only 1% in group 3 (p < 0.00001). The mean ALT level was higher in group 1 patients (p < 0.05). The mean histologic activity index was significantly higher in group 1 (p = 0.0007).(ABSTRACT TRUNCATED AT 250 WORDS)

Coinfection With Human T-Cell Lymphotropic Virus Type I and HIV in Brazil

To study the effect of human T-cell lymph-tropic virus type I (HTLV-I) on markers of human immunodeficiency virus (HIV) disease progression. A retrospective, nested case-control study. A university hospital outpatient HIV clinic in Rio de Janeiro, Brazil. Human immunodeficiency virus-seropositive adults participating in a prospective HIV cohort study. The HIV clinical stage, CD4+ lymphocyte counts, and other laboratory parameters in 27 individuals infected with HIV and HTLV-I (coinfection) and 99 age-matched, HIV-seropositive, HTLV-seronegative controls (single infection). Variables independently associated with coinfection included higher CD4+ lymphocyte count (odds ratio [OR], 2.3; 95% confidence limits [CL], 1.3, 4.1), higher CD4+ percentage (OR, 2.0; 95% CL, 1.3, 3.2), beta 2-microglobulin level of 254 nmol/L or more (OR, 6.8; 95% CL, 1.3, 35.4), World Health Organization stages 3 and 4 (OR, 4.4; 95% CL, 1.1, 18.0), and reporting a parenteral risk factor (OR, 7.4; 95% CL, 1.4, 38.9). When stratified by p24 antigenemia, coinfection was associated with an estimated 82% higher CD4+ lymphocyte count (P < .05). Coinfection was associated with higher CD4+ lymphocyte counts, more advanced clinical disease, and higher beta 2-microglobulin levels than HIV infection alone. The higher mean CD4+ lymphocyte count does not appear to offer immunologic benefit. Caution should be exercised when using CD4+ lymphocytes as a surrogate marker in studies of HIV infection in populations where HTLV-I is prevalent. Further studies are needed to address whether current CD4+ lymphocyte values for the initiation of antiretroviral therapy and chemoprophylaxis against opportunistic infections in HIV infection are appropriate in coinfection.

Coinfection with human T-cell lymphotropic virus type I and HIV in Brazil. Impact on markers of HIV disease progression

<h3>Objectives.</h3> —To study the effect of human T-cell lymphtropic virus type I (HTLV-I) on markers of human immunodeficiency virus (HIV) disease progression. <h3>Design.</h3> —A retrospective, nested case-control study. <h3>Setting.</h3> —A university hospital outpatient HIV clinic in Rio de Janeiro, Brazil. <h3>Participants.</h3> —Human immunodeficiency virus—seropositive adults participating in a prospective HIV cohort study. <h3>Main Outcome Measures.</h3> —The HIV clinical stage, CD4⁺lymphocyte counts, and other laboratory parameters in 27 individuals infected with HIV and HTLV-I (coinfection) and 99 age-matched, HIV-seropositive, HTLV-seronegative controls (single infection). <h3>Results.</h3> —Variables independently associated with coinfection included higher CD4⁺lymphocyte count (odds ratio [OR], 2.3; 95% confidence limits [CL], 1.3,4.1), higher CD4⁺percentage (OR, 2.0; 95% CL, 1.3, 3.2), β₂-microglobulin level of 254 nmol/L or more (OR, 6.8; 95% CL, 1.3, 35.4), World Health Organization stages 3 and 4 (OR, 4.4; 95% CL, 1.1,18.0), and reporting a parenteral risk factor (OR, 7.4; 95% CL, 1.4, 38.9). When stratified by p24 antigenemia, coinfection was associated with an estimated 82% higher CD4⁺lymphocyte count (<i>P</i>&lt;.05). <h3>Conclusion.</h3> —Coinfection was associated with higher CD4⁺lymphocyte counts, more advanced clinical disease, and higher β₂-microglobulin levels than HIV infection alone. The higher mean CD4⁺lymphocyte count does not appear to offer immunologic benefit. Caution should be exercised when using CD4⁺lymphocytes as a surrogate marker in studies of HIV infection in populations where HTLV-I is prevalent. Further studies are needed to address whether current CD4⁺lymphocyte values for the initiation of antiretroviral therapy and chemoprophylaxis against opportunistic infections in HIV infection are appropriate in coinfection. (<i>JAMA</i>. 1994;271:353-357)

Risk Factors for Hepatitis C Virus Seropositivity in Heterosexual Couples

To determine the risk of heterosexual transmission of hepatitis C virus (HCV) and to identify other risk factors for HCV seropositivity in heterosexual couples. Retrospective cross-sectional study comparing HCV-seropositive and HCV-seronegative heterosexual men and women. Couples recruited from the community and screened for participation in a study of the heterosexual transmission of human immunodeficiency virus. A total of 340 subjects, 170 men and 170 women in sexual partnerships, aged 18 through 61 years. Seropositivity for HCV antibodies. Overall, 31 (18%) of the 170 women and 56 (33%) of the 170 men were positive by a four-antigen HCV immunoblot. Injection drug use and hemophilia were strongly associated with HCV seropositivity. Sixty-four percent of injection drug users were positive (odds ratio [OR], 27.0; 95% confidence interval [CI], 13.4 to 56.1; P < .0001), as were all four hemophiliacs in the study. History of blood transfusion was significantly associated with HCV seropositivity (OR, 2.7; 95% CI, 1.1 to 7.0; P = .02). Positivity for HCV was not associated with measures of sexual behavior within couples or with numbers of other sexual partners, history of sexually transmitted diseases, or human immunodeficiency virus seropositivity. However, two of the 31 women without parenteral risk but with a long-term HCV-positive male partner were HCV seropositive compared with none of 81 women with an HCV-negative male partner (P = .07). These results provide little evidence of HCV sexual transmission but are consistent with infrequent sexual transmission. They corroborate the importance of injection drug use and transfusion of blood or blood products in transmitting HCV and underscore the importance of ascertaining parenteral exposures when examining sexual transmission of HCV.

Hepatitis C virus antibody positive blood donors.

In an analysis of 15 blood donors referred from the Blood Transfusion Service to the Queen Elizabeth Hospital, Birmingham, more than 50% of anti-hepatitis C virus (HCV) positive patients had a parenteral risk factor. Most were serum HCV-RNA positive, and all were liver HCV-RNA positive. Although no physical signs of liver disease were apparent, all anti-HCV positive donors had abnormal liver histology.

Is HCV transmitted by the vertical/perinatal route?

Hepatitis type C is the major aetiological cause of both parenterally transmitted and cryptogenic, sporadic or community acquired nonAnonB hepatitis. The lack of known parenteral risk factors in a consistent number of cases with nonAnonB hepatitis has stimulated the search of other possible modes of viral transmission. The aim of this report is to review the evidence both for and against vertical/perinatal transmission of HCV from anti-HCV positive mothers to infants.

Risk factors for hepatitis C virus antibody positivity in blood donors in a low-risk country.

Demographic variables, sexual risk behavior and prevalence of parenteral risk factors were studied in 305 randomly selected donors seronegative for hepatitis C virus, in 170 randomly selected donors reactive on solely enzyme-linked immunosorbent assay (ELISA C-100), in 71 consecutive donors reacting indeterminately according to the second-generation recombinant immunoblot assay (RIBA II) and in 46 consecutive donors found to be positive using the RIBA II. Donors who were positive by RIBA II had significantly more often a risk factor, for example use of intravenous drugs or previous blood transfusion, than donors reacting indeterminately (34 out of 46) (73.9%) versus 14 out of 71 (19.7%, p = 0.0000). Donors reacting indeterminately by RIBA II had one of those risk factors significantly more often than seronegative donors (14 out of 71) (19.7%) versus 23 out of 280 (7.8%, p < 0.005). When donors either positive or indeterminate by RIBA II were compared with donors negative for hepatitis C antibodies, the odds ratio for a possible parenteral source of infection was 7.6 (p = 0.0000). Subjects who had received a poor education (odds ratio 0.3, p < 0.001) or who lived in southern Finland (odds ratio 2.3, p < 0.05) were also at higher risk for being positive or indeterminate in RIBA II. First-time donors were also prone to having antibodies according to RIBA II (odds ratio 2.2, p = 0.1), whereas sexual risk behavior, gender, age, occupational class and type of residential area were not risk factors for hepatitis C antibodies in RIBA.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for hepatitis C virus infection in blood donors: a case-control study.

To investigate risk factors for hepatitis C virus (HCV) infection in Sydney blood donors. Blood donors confirmed to be positive for HCV antibodies were compared with blood donors with a positive result of a screening assay, but whose HCV antibody status had not been confirmed. A questionnaire on sexual, parenteral and other potential risk factors was administered to both groups. Blood Transfusion Service in Sydney. The study enrolled 220 donors who had confirmed HCV infection, and 210 donors who did not. The relative risk associated with injecting drug use was 63 (95% confidence interval, 19-260) when comparison was made with all other donors. Among donors who did not report injecting drug use, a significant, independent increase in risk was found in association with having had a tattoo. Among donors who did not give a history of parenteral exposure, there was a significantly greater risk in people with more than one life-time sexual partner than in those with at most one partner. A history of injecting drug use was elicited as the most important risk factor in Sydney blood donors with antibodies to hepatitis C. Having had a tattoo, and an increased number of lifetime sexual partners were also independently associated with HCV infection.

Acute sporadic hepatitis E in children living in Cairo, Egypt.

Seventy-three pediatric patients with acute hepatitis and 19 control patients without liver disease living in Cairo, Egypt, were evaluated with a newly developed Western blot assay for IgM antibody to hepatitis E virus (IgM anti-HEV). The mean age of acute hepatitis patients was 6.4 years (range, 1-13 years); 56% were male. Among the 73 acute cases, hepatitis A was diagnosed in 30 (41%), possible acute hepatitis B in three (4%), hepatitis E in nine (12%), and by exclusion, non-A, non-B hepatitis in 29 (40%). Two additional acute cases were positive for both IgM anti-HAV and IgM anti-HEV. None of the 19 control subjects had IgM anti-HEV. Parenteral risk factors were associated with cases of non-A, non-B hepatitis but were not associated with acute hepatitis E. Contact with a family member with jaundice was associated with acute hepatitis A. In contrast to prior epidemics of enterically-transmitted non-A, non-B hepatitis, HEV was found to be a common cause of acute hepatitis in a pediatric population. This study provides additional evidence that HEV may be a frequent cause of acute sporadic hepatitis among children living in some developing countries.