Analysis of the epidemiological trends of hepatitis A and E in Zhejiang Province and clinical characteristics of severe patients

This study analyses the epidemiological trends and severe clinical characteristics of hepatitis A virus (HAV) and hepatitis E virus (HEV) in Zhejiang Province from 2019 to 2024, utilising data from the Zhejiang Provincial Centre for Disease Control and Prevention and a tertiary hospital. Epidemiologically, HAV incidence remained low and stable, with case numbers ranging from 400 to 657 and an incidence rate of 0.5–0.6 per 100,000 population. HEV exhibited an upward trend, reaching 3,153 cases and an incidence rate of 3.1 per 100,000 in 2024. The HEV severe disease rate increased from 19% in 2021 to 38%-39%, potentially associated with a higher proportion of elderly patients. Clinically, 245 HEV patients (170 mild, 75 severe) and 37 HAV patients (6 acute icteric, 31 anicteric) were included. Severe HEV patients exhibited greater age, longer hospital stays, more complications, and more pronounced abnormalities in liver enzymes, bilirubin, and coagulation parameters; Concurrent alcoholic hepatitis (OR = 2.324, P = 0.040) and chronic hepatitis B (HBV, OR = 4.794, P < 0.001) constituted independent risk factors for severe disease, while alcohol consumption history and HBV co-infection were associated with more severe symptoms and hepatic injury. Patients with acute icteric HAV presented higher indirect bilirubin (IBIL) and glutamyltransferase(GGT) levels, though no definitive risk factors for severe disease were identified. This study clarifies the rising incidence of HEV in Zhejiang Province and identifies risk factors associated with severe disease, providing evidence for targeted prevention, control, and clinical management of viral hepatitis in this region.