The infective causes of acute hepatitis and jaundice amongst hospital patients

Collaboration

• Mahosot Hospital, Vientiane Capital.
• Setthathirath Hospital, Vientiane Capital.

Funding

• Luxembourg Ministry of Foreign and European Affairs, Defence, Development Cooperation and Foreign Trade.
• Luxembourg Institute of Health.

Objectives

In the absence of current data, we aimed to conduct a comprehensive cross-sectional, hospital based study to determine the causes of acute jaundice and hepatitis among patients in Vientiane Capital.

Background

Two previous studies examined the causes of jaundice and hepatitis in Laos. Both studies were conducted in Vientiane. The first, a case-control study in 1995-1996, identified leptospirosis in 21% of the cases and IgM antibodies against hepatitis A and B virus in 14% and 10% of cases, respectively. The second study, conducted between 2001 and 2004, detected hepatitis A virus in 36% of the patients. The prevalence for both hepatitis B and C virus was 5%. In addition to that, 13% of the participants were diagnosed with scrub typhus, murine typhus or leptospirosis.

Since 2004, no study addressed the causes of hepatitis in hospital patients in the Lao PDR. Since then, considerable progress has been made in improving sanitation, blood safety and immunisation activities, which all may have impacted the epidemiology of hepatitis in the country.

Methodology

The protocol for a cross-sectional study was developed after reviewing existing literature and conducting interviews with local healthcare providers. Permission from the National Ethic Committee for Health Research was obtained in October 2023. Consequently, the study was implemented at Mahosot hospital and Setthathirath hospital in a consecutive fashion, starting first at the Gastroenterology department at Mahosot hospital. After informed consent and enrolment, participants are asked to complete a questionnaire covering topics such as age, socio-economic background, risk behaviours and medical history. A second questionnaire is used to gather information on the diagnosis.

The data is collected via REDCap software on tablets, provided by the LaoLuxLab / Vaccine-Preventable Disease laboratory. Similar to the hospitalization study mentioned above, digital data collection enables real-time monitoring of the data collection process, timely detection of issues and data entry errors as well as immediate feedback and corrective actions.

In addition to the face-to-face interview, participants are asked to provide a blood sample for laboratory analysis. The collected samples are transferred to the Institut Pasteur du Laos where they are processed and stored at -80°C until further analysis. The collected specimens will be tested according to standardised guidelines to identify possible hepatitis aetiologies relevant in the context of Laos, including but not limited to hepatitis viruses.

Results

The study is ongoing and as of November 21, 85 participants were enrolled. The median age of the participants was 39 years old, ranging from 16 to 82 years (Figure 3). Most of the participants were from Vientiane Capital (69%) and Vientiane Province (8%) and male (53%). The majority (92%) of participants belonged to the Tai-Kadai/Lao Loum ethnolinguistic group.

Conclusion & perspectives

This hospital-based study seeks to fill the critical knowledge gap regarding the causes of acute hepatitis in Laos. By identifying the primary etiologies among these patients, the findings can guide healthcare providers in developing better diagnostic and care strategies. The results will also inform public health initiatives in Laos, such as the National Strategic Plan on Viral Hepatitis 2024-2030.