The aim of the study was to describe the characteristics of acute hepatitis E in Greater Cairo.

Acute hepatitis E patients were identified through a surveillance of acute hepatitis using the following definition: recent (<3 weeks) onset of fever or jaundice, ALT =3 times the upper limit of normal (uln), negative markers for other causes of viral hepatitis and detectable hepatitis E virus (HEV) RNA. Comparison of the liver tests between acute hepatitis E and hepatitis A (HAV), case-control analysis (4 sex and age (±1 year) matched HAV controls per case) to explore risk factors and phylogenetic analyses were performed.

Of the 17 acute HEV patients identified between 2002 and 2007, 14 were male. Median age was 16 years (interquartile range (IQR) 13-22). Compared to HAV (N=68 sex-and ±1 year age-matched), HEV patients had higher bilirubin (mean (SD) 10.9 (5.7) uln vs 7.5(4.4) uln, p=0.05) and AST levels (38.6(27.1) uln vs 18.3(18.1) uln, p=0.02). Co-infection (HCV RNA or HBs-antigen positive /IgM anti-HBc negative) was diagnosed in 4 patients.

In univariate matched analysis (17 cases, 68 matched controls), HEV cases were more likely to live in a rural area than HAV (matched OR 7.9(95%CI 2.0-30.4). Of the 16 isolates confirmed genotype 1, 15 belonged to the same cluster with 94% to 98.5% identity in the ORF2 region. Our findings documented the sporadic nature of HEV in greater Cairo, characterized a large number of Egyptian HEV genotype 1strains and identified living in a rural area as a potential risk factor for infection