Polymerase chain reaction-based prevalence of hepatitis A, hepatitis E and TT viruses in sewage from an endemic area

Background/Aims: Hepatitis A and E viruses (HAV, HEV) are transmitted enterically and are highly endemic in India. This study aims to evaluate prevalence of these and TT virus (TTV) in the sewage. Methods: Influent and effluent samples from a sewage treatment plant from Pune, India were collected twice a week for 1 year and subjected to nested polymerase chain reaction (PCR) for the detection of HAV RNA, HEV RNA and TTV DNA. HAV and HEV PCR products were sequenced. Effluent samples were not collected for 5 months as the plant was non-functional. Results: The overall prevalence was 24.42% (21/86, HAV), 10.98% (9/82, HEV) and 12.7% (8/63, TTV). Prevalence of HAV was significantly higher than HEV (P=0.023). During summer months, significantly higher HAV RNA positivity was noted (P<0.01). A substantial reduction in HAV RNA positivity (15/48 vs. 2/48, P=0.0008) was recorded for treated sewage samples. However, HEV RNA or TTV DNA positivity did not reduce significantly. Of the 17 HAV and HEV RNA negative sewage samples concentrated using ultracentrifugation, 13 and none were positive for HAV and HEV RNA, respectively. Phylogenetic analyses grouped these viruses in IB and Ia, respectively, the genotypes most prevalent in India. Conclusions: Sewage may play an important role in maintaining hyper-endemicity of these infections. Sustained efforts are obligatory to render sewage less/non-infectious