Viral Hepatitis in the Elderly

Andres F Carrion MD; Paul Martin MD; FACG


Am J Gastroenterol. 2012;107(5):691-697. 

In This Article

Hepatitis E

Hepatitis E virus (HEV) infection is endemic and epidemic in Asia, Africa, and Mexico, whereas in the United States and Western Europe only sporadic cases have been reported. The NHANES III indicated, however, that the seroprevalence of anti-HEV IgG antibodies in the US population is 21%.[75] This data concurs with a previously reported seroprevalence of anti-HEV IgG in blood donors in the United States (18.3%) implying that subclinical HEV infection is frequent in non-endemic areas.[76] Although only limited data on acute HEV infection in the elderly are available, the seroprevalence of anti-HEV IgG antibodies in Indonesia has been reported to increase with age: 38% in children 5–9 years of age, and 70% in adults older than 60 years. The high seroprevalence of anti-HEV IgG reflects cumulative risk for infection throughout life in areas of the world where the infection is endemic.[77] Similarly, the seroprevalence of anti-HEV IgG was higher among elderly vs. younger immigrants from the former Soviet Union living in Germany (7.6% vs. 1–2%, respectively).[78] Differences in the seroprevalence of anti-HEV IgG in different age groups have also been reported in the United States. For example, 16% of blood donors younger than 60 years of age had positive anti-HEV IgG compared with 25.5% in those older than 60 years.[79] Importantly, a recent study demonstrated that a small but important proportion (3%) of patients with of acute liver injury in the United States suspected to be drug-induced were also seropositive for anti-HEV IgM. After reassessment and causality analysis, HEV was considered a probable etiology of acute liver injury in these cases. The majority of patients with serology consistent with acute HEV infection (78%) were older than 60 years of age.[80]

In conclusion, exposure to HEV also occurs frequently in Western industrialized countries and until the epidemiology of this virus is better understood, HEV should be considered a potential etiology of acute hepatitis in the elderly.


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