Document Type : Original Research


1 Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

2 Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Cardiology, Tehran University of Medical Sciences, Tehran, Iran


Background & Objective: The prevalence of COVID-19 and its severity have been observed to be on a lower level in underdeveloped countries with poorer standards of hygiene. This disparity may be attributed to the higher seroprevalence of other viral diseases which can result in the presence of antibodies protective against COVID-19. Two of the widespread diseases in such countries are infection to hepatitis A and E viruses (HAV and HEV). In the present study, we explored the relationship between the level of antibodies against these viruses and the susceptibility to COVID-19.
Methods: Ninety patients were studied in two groups of controls and cases each consisting 45 individuals. The cases were patients with the clinical symptoms of COVID-19 and positive RT-PCR test results. The controls were individuals referred to the respiratory triage of Imam Khomeini Hospital Complex and were not demonstrating relevant clinical symptoms of COVID-19 and their RT-PCR test results were negative. Levels of HAV and HEV antibodies were measured and compared in these two groups.
Results: The median of HAV antibody level was 13.6 (IQR=11.5-16.9) and 13.2 (IQR =10.7-14.7) in cases and controls, respectively, showing no statistically significant difference (P = 0.1). Likewise, the median of HEV antibody level was 6.7 (IQR=5.3-7.1) and 7.1 (IQR=6.3-7.5) in cases and controls, respectively, which again showed no statistically significant difference (P=0.41).
Conclusion: The present study was carried out in a region with a relatively high prevalence of HAV and HEV infections. Contrary to our expectations, no statistically significant relationship was observed between the levels of antibodies against these viruses and the susceptibility to COVID-19. Further studies with larger sample sizes and in other countries are needed to come to a definite conclusion.


Main Subjects

  1. WHO Director-General's opening remarks at the media briefing on COVID-19-11 March 2020: World Health Organization; 2020 [Available from:
  2. COVID-19 CORONAVIRUS PANDEMIC [updated September 26, 2020. Available from:
  3. Sarialioglu F, Apak FBB, Haberal M. Can Hepatitis A Vaccine Provide Protection Against COVID-19? Exp Clin Transplant. 2020;2:141-3. [DOI:10.6002/ect.2020.0109] [PMID]
  4. Wu D, Guo CY. Epidemiology and Prevention of Hepatitis A in Travelers. J Travel Med. 2013;20(6):394-9. [DOI:10.1111/jtm.12058] [PMID]
  5. Tomar BS. Hepatitis E in India. Zhonghua Minguo xiao er ke yi xue hui za zhi [Journal] Zhonghua Minguo xiao er ke yi xue hui. 1998;39(3):150-6.
  6. World Health Organization. The global prevalence of hepatitis A virus infection and susceptibility: a systematic review [Internet]. World Health Organization. 2010.
  7. Hoseini SG, Kelishadi R, Ataei B, Yaran M, Motlagh ME, Ardalan G, et al. Seroprevalence of hepatitis A in Iranian adolescents: is it time to introduce a vaccine? Epidemiol Infect. 2016;144(2):291-6. [DOI:10.1017/S0950268815001302] [PMID]
  8. Behzadifar M, Lankarani KB, Abdi S, Taheri Mirghaed M, Beyranvand G, Keshavarzi A, et al. Seroprevalence of Hepatitis E Virus in Iran: A Systematic Review and Meta-analysis. Middle East J Dig Dis. 2016;8(3):189-200. [DOI:10.15171/mejdd.2016.31] [PMID] [PMCID]
  9. Sarialioğlu F, Belen FB, Hayran KM. Hepatitis A susceptibility parallels high COVID-19 mortality. Turk J Med Sci. 2021;51(1):382-4. [DOI:10.3906/sag-2007-133] [PMID] [PMCID]
  10. Lee GY, Poovorawan K, Intharasongkroh D, Sa-Nguanmoo P, Vongpunsawad S, Chirathaworn C, et al. Hepatitis E virus infection: Epidemiology and treatment implications. World J Virol. 2015;4(4):343-55. [DOI:10.5501/wjv.v4.i4.343] [PMID] [PMCID]
  11. Yaqinuddin A. Cross-immunity between respiratory coronaviruses may limit COVID-19 fatalities. Med Hypotheses. 2020;144:110049-. [DOI:10.1016/j.mehy.2020.110049] [PMID] [PMCID]
  12. Walker CM. Adaptive Immune Responses in Hepatitis A Virus and Hepatitis E Virus Infections. Cold Spring Harb Perspect Med. 2019;9(9):a033472. [PMID] [PMCID] [DOI:10.1101/cshperspect.a033472]
  13. Zhang J, Zhang X-F, Huang S-J, Wu T, Hu Y-M, Wang Z-Z, et al. Long-Term Efficacy of a Hepatitis E Vaccine. N Engl J Med. 2015;372 (10):914-22. [DOI:10.1056/NEJMoa1406011] [PMID]
  14. Schmidtke P, Habermehl P, Knuf M, Meyer CU, Sänger R, Zepp F. Cell mediated and antibody immune response to inactivated hepatitis A vaccine. Vaccine. 2005;23(44):5127-32. [DOI:10.1016/j.vaccine.2005.06.022] [PMID]
  15. Ludvigsson JF. Systematic review of COVID‐19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088-95. [DOI:10.1111/apa.15270] [PMID] [PMCID]
  16. Arankalle V, Mitra M, Bhave S, Ghosh A, Balasubramanian S, Chatterjee S, et al. Changing epidemiology of hepatitis A virus in Indian children. Vaccine: Development and Therapy. 2014;4:7. [DOI:10.2147/VDT.S53324]
  17. Aggarwal R, Goel A. Hepatitis A: epidemiology in resource-poor countries. Curr Opin Infect Dis. 2015;28(5):488-96. [PMID] [DOI:10.1097/QCO.0000000000000188]
  18. Bell BP, Negus S, Fiore AE, Plotnik J, Dhotre KB, Williams J, et al. Immunogenicity of an inactivated hepatitis A vaccine in infants and young children. Pediatr Infect Dis J. 2007;26(2):116-22. [PMID] [DOI:10.1097/]
  19. ACHARYA SK, BATRA Y, BHATKAL B, OJHA B, KAUR K, HAZARI S, et al. Seroepidemiology of hepatitis A virus infection among school children in Delhi and north Indian patients with chronic liver disease: implications for HAV vaccination. J Gastroenterol Hepatol. 2003;18(7):822-7. [DOI:10.1046/j.1440-1746.2003.03051.x] [PMID]