Serum samples collected from 68 patients (age, mean +/- the standard deviation [SD], 56.3 +/- 12.8 years) at admission who were subsequently molecularly diagnosed as having
hepatitis E and from 2,781 individuals who were assumed not to have been recently infected with hepatitis E virus (HEV; negative controls; 52.9 +/- 18.9 years), were tested for
immunoglobulin M (
IgM) and
IgA classes of
antibodies to HEV (anti-HEV) by in-house solid-phase
enzyme immunoassay with recombinant open reading frame 2
protein expressed in the pupae of silkworm as the
antigen probe. The 68 patients with
hepatitis E had both anti-HEV
IgM and anti-HEV
IgA. Among the 2,781 controls, 16 (0.6%) had anti-HEV
IgM alone and 4 (0.1%) had anti-HEV
IgA alone: these
IgA/
IgM anti-HEV-positive individuals were not only negative for HEV
RNA but lack
IgG anti-HEV antibody as well (at least in most of the cases). Periodic serum samples obtained from 15 patients with
hepatitis E were tested for HEV
RNA, anti-HEV
IgM, and anti-HEV
IgA. Although HEV
RNA was detectable in the serum until 7 to 40 (21.4 +/- 9.7) days after disease onset, both
IgM and
IgA anti-HEV
antibodies were detectable until 37, 55, or 62 days after disease onset in three patients and up through the end of the observation period (50 to 144 days) in 12 patients. These results indicate that detection of anti-HEV
IgA alone or along with anti-HEV
IgM is useful for serological diagnosis of
hepatitis E with increased specificity and longer duration of positivity than that by
RNA detection.