{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:43:40Z","timestamp":1790898220913,"version":"4.1.0"},"reference-count":143,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T00:00:00Z","timestamp":1674172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Viral hepatitis is an infection of human hepatocytes resulting in liver damage. Dual infection of two hepatotropic viruses affects disease outcomes. The hepatitis A virus (HAV) and hepatitis E virus (HEV) are two enterically transmitted viruses; they are single-stranded RNA viruses and have common modes of transmission. They are transmitted mainly by the fecal-oral route and ingestion of contaminated food, though the HAV has no animal reservoirs. The HAV and HEV cause acute self-limiting disease; however, the HEV, but not HAV, can progress to chronic and extrahepatic infections. The HAV\/HEV dual infection was reported among acute hepatitis patients present in developing countries. The impact of the HAV\/HEV on the prognosis for acute hepatitis is not completely understood. Studies showed that the HAV\/HEV dual infection increased abnormalities in the liver leading to fulminant hepatic failure (FHF) with a higher mortality rate compared to infection with a single virus. On the other hand, other reports showed that the clinical symptoms of the HAV\/HEV dual infection were comparable to symptoms associated with the HAV or HEV monoinfection. This review highlights the modes of transmission, the prevalence of the HAV\/HEV dual infection in various countries and among several study subjects, the possible outcomes of this dual infection, potential model systems for studying this dual infection, and methods of prevention of this dual infection and its associated complications.<\/jats:p>","DOI":"10.3390\/v15020298","type":"journal-article","created":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T03:21:54Z","timestamp":1674616914000},"page":"298","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Dual Infection of Hepatitis A Virus and Hepatitis E Virus\u2014 What Is Known?"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8207-6401","authenticated-orcid":false,"given":"Ibrahim M.","family":"Sayed","sequence":"first","affiliation":[{"name":"Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA"},{"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,20]]},"reference":[{"key":"ref_1","unstructured":"(2022, October 15). Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hepatitis-a."},{"key":"ref_2","unstructured":"(2022, October 15). Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hepatitis-e."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"a033480","DOI":"10.1101\/cshperspect.a033480","article-title":"Hepatitis A Virus Genome Organization and Replication Strategy","volume":"8","author":"McKnight","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_4","unstructured":"Martin, A., and Lemon, S.M. (2002). Hepatitis Viruses, Springer."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1002\/hep.27990","article-title":"Is hepatitis E virus an emerging problem in industrialized countries?","volume":"62","author":"Sayed","year":"2015","journal-title":"Hepatology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1038\/nature13806","article-title":"Hepatitis A virus and the origins of picornaviruses","volume":"517","author":"Wang","year":"2015","journal-title":"Nature"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"001778","DOI":"10.1099\/jgv.0.001778","article-title":"ICTV Virus Taxonomy Profile: Hepeviridae 2022","volume":"103","author":"Purdy","year":"2022","journal-title":"J. Gen. Virol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"8259","DOI":"10.1073\/pnas.89.17.8259","article-title":"Computer-assisted assignment of functional domains in the nonstructural polyprotein of hepatitis E virus: Delineation of an additional group of positive-strand RNA plant and animal viruses","volume":"89","author":"Koonin","year":"1992","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"763","DOI":"10.2217\/fvl.15.29","article-title":"The emergence of hepatitis E virus in Europe","volume":"10","author":"Sayed","year":"2015","journal-title":"Future Virol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1073\/pnas.1614955114","article-title":"Hepatitis E virus ORF3 is a functional ion channel required for release of infectious particles","volume":"114","author":"Ding","year":"2017","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.1099\/vir.0.010561-0","article-title":"ORF3 protein of hepatitis E virus is essential for virion release from infected cells","volume":"90","author":"Yamada","year":"2009","journal-title":"J. Gen. Virol."},{"key":"ref_12","unstructured":"Hepatovirus, F.P.G. (2022, October 15). Available online: https:\/\/ictv.global\/report\/chapter\/picornaviridae\/picornaviridae\/hepatovirus."},{"key":"ref_13","unstructured":"Feldman, M., Friedman, L.S., and Brandt, L.J. (2010). Sleisenger and Fordtran\u2019s Gastrointestinal and Liver Disease, W.B. Saunders. [9th ed.]."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1002\/hep.31138","article-title":"Transmission of Rat Hepatitis E Virus Infection to Humans in Hong Kong: A Clinical and Epidemiological Analysis","volume":"73","author":"Sridhar","year":"2021","journal-title":"Hepatology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1002\/hep.25505","article-title":"The global burden of hepatitis E virus genotypes 1 and 2 in 2005","volume":"55","author":"Rein","year":"2012","journal-title":"Hepatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1099\/jgv.0.001435","article-title":"Update: Proposed reference sequences for subtypes of hepatitis E virus (species Orthohepevirus A)","volume":"101","author":"Smith","year":"2020","journal-title":"J. Gen. Virol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"9860","DOI":"10.1073\/pnas.94.18.9860","article-title":"A novel virus in swine is closely related to the human hepatitis E virus","volume":"94","author":"Meng","year":"1997","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.coviro.2014.12.006","article-title":"Zoonotic origin of hepatitis E","volume":"10","author":"Pavio","year":"2015","journal-title":"Curr. Opin. Virol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.3201\/eid2307.170318","article-title":"Rabbit Hepatitis E Virus Infections in Humans, France","volume":"23","author":"Abravanel","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.3201\/eid2006.140140","article-title":"New hepatitis E virus genotype in camels, the Middle East","volume":"20","author":"Woo","year":"2014","journal-title":"Emerg. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Shirazi, R., Pozzi, P., Gozlan, Y., Wax, M., Lustig, Y., Linial, M., Mendelson, E., Bardenstein, S., and Mor, O. (2021). Identification of Hepatitis E Virus Genotypes 3 and 7 in Israel: A Public Health Concern?. Viruses, 13.","DOI":"10.3390\/v13112326"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"El-Kafrawy, S.A., Hassan, A.M., El-Daly, M.M., Qadri, I., Tolah, A.M., Al-Subhi, T.L., Alzahrani, A.A., Alsaaidi, G.A., Al-Abdullah, N., and Kaki, R.M. (2020). Seroprevalence of Dromedary Camel HEV in Domestic and Imported Camels from Saudi Arabia. Viruses, 12.","DOI":"10.3390\/v12050553"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.3201\/eid2212.160979","article-title":"New Hepatitis E Virus Genotype in Bactrian Camels, Xinjiang, China, 2013","volume":"22","author":"Woo","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1038\/nature12029","article-title":"A pathogenic picornavirus acquires an envelope by hijacking cellular membranes","volume":"496","author":"Feng","year":"2013","journal-title":"Nature"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e00969-17","DOI":"10.1128\/mBio.00969-17","article-title":"TIM1 (HAVCR1) Is Not Essential for Cellular Entry of Either Quasi-enveloped or Naked Hepatitis A Virions","volume":"8","author":"Das","year":"2017","journal-title":"mBio"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1053\/j.gastro.2017.09.020","article-title":"Hepatitis E Virus Lifecycle and Identification of 3 Forms of the ORF2 Capsid Protein","volume":"154","author":"Montpellier","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1086\/314565","article-title":"Molecular confirmation of hepatitis A virus from well water: Epidemiology and public health implications","volume":"179","author":"Cromeans","year":"1999","journal-title":"J. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"161","DOI":"10.2105\/AJPH.75.2.161","article-title":"A waterborne outbreak of hepatitis A in Meade County, Kentucky","volume":"75","author":"Bergeisen","year":"1985","journal-title":"Am. J. Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1086\/381671","article-title":"Hepatitis A transmitted by food","volume":"38","author":"Fiore","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.ijfoodmicro.2017.03.008","article-title":"Occurrence of hepatitis A and E and norovirus GI and GII in ready-to-eat vegetables in Italy","volume":"249","author":"Terio","year":"2017","journal-title":"Int. J. Food Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s00705-019-04501-9","article-title":"Co-contamination of food products from family farms in an environmental disaster area in Southeast Brazil with pathogenic bacteria and enteric viruses","volume":"165","author":"Rogovski","year":"2020","journal-title":"Arch. Virol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"108661","DOI":"10.1016\/j.ijfoodmicro.2020.108661","article-title":"HAV detection from milk-based products containing soft fruits: Comparison between four different extraction methods","volume":"328","author":"Battistini","year":"2020","journal-title":"Int. J. Food Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.virusres.2011.01.016","article-title":"From barnyard to food table: The omnipresence of hepatitis E virus and risk for zoonotic infection and food safety","volume":"161","author":"Meng","year":"2011","journal-title":"Virus Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.ijfoodmicro.2007.11.068","article-title":"Inactivation of infectious hepatitis E virus present in commercial pig livers sold in local grocery stores in the United States","volume":"123","author":"Feagins","year":"2008","journal-title":"Int. J. Food Microbiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1053\/j.gastro.2015.10.048","article-title":"Chronic Infection With Camelid Hepatitis E Virus in a Liver Transplant Recipient Who Regularly Consumes Camel Meat and Milk","volume":"150","author":"Lee","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ijfoodmicro.2013.09.003","article-title":"Tracing enteric viruses in the European berry fruit supply chain","volume":"167","author":"Maunula","year":"2013","journal-title":"Int. J. Food Microbiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1093\/infdis\/164.5.852","article-title":"An epidemic of hepatitis A attributable to the ingestion of raw clams in Shanghai, China","volume":"164","author":"Halliday","year":"1991","journal-title":"J. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"7350","DOI":"10.1128\/AEM.01177-09","article-title":"Risk assessment in shellfish-borne outbreaks of hepatitis A","volume":"75","author":"Costafreda","year":"2009","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s12560-012-9087-8","article-title":"Occurrence of human enteric viruses in commercial mussels at retail level in three European countries","volume":"4","author":"Kokkinos","year":"2012","journal-title":"Food Environ. Virol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.3201\/eid1511.091094","article-title":"Hepatitis E outbreak on cruise ship","volume":"15","author":"Said","year":"2009","journal-title":"Emerg. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"875","DOI":"10.15585\/mmwr.mm7024a2","article-title":"Hepatitis A Virus Infections Among Men Who Have Sex with Men-Eight U.S. States, 2017\u20132018","volume":"70","author":"Foster","year":"2021","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.15585\/mmwr.mm7139a1","article-title":"Widespread Hepatitis A Outbreaks Associated with Person-to-Person Transmission-United States, 2016\u20132020","volume":"71","author":"Foster","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1557988319895141","DOI":"10.1177\/1557988319895141","article-title":"Acute Hepatitis A Outbreak Among Men Who Have Sex With Men in Krakow, Poland; February 2017-February 2018","volume":"13","author":"Wickramasuriya","year":"2019","journal-title":"Am J Mens Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"a032144","DOI":"10.1101\/cshperspect.a032144","article-title":"Transmission and Epidemiology of Hepatitis E Virus Genotype 3 and 4 Infections","volume":"8","author":"Dalton","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1086\/651077","article-title":"Evidence of person-to-person transmission of hepatitis E virus during a large outbreak in Northern Uganda","volume":"50","author":"Teshale","year":"2010","journal-title":"Clin. Infect. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1002\/jmv.25630","article-title":"Low seroprevalence and zero incidence rate of hepatitis E in men who have sex with men during a hepatitis A outbreak","volume":"92","author":"Leonel","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_47","first-page":"428","article-title":"Hepatitis E virus infection prevalence among men who have sex with men involved in a hepatitis A virus outbreak in Italy","volume":"17","author":"Spada","year":"2019","journal-title":"Blood Transfus."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1111\/jvh.13367","article-title":"No evidence of sexual transmission of HEV among individuals using HIV pre-exposure prophylaxis","volume":"27","author":"Migueres","year":"2020","journal-title":"J. Viral Hepat."},{"key":"ref_49","first-page":"1323","article-title":"HEV and HAV seroprevalence in men that have sex with men (MSM): An update from Milan, Italy","volume":"90","author":"Greco","year":"2018","journal-title":"J. Viral Hepat."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1900537","DOI":"10.2807\/1560-7917.ES.2020.25.29.1900537","article-title":"Transmission of viral hepatitis through blood transfusion in Sweden, 1968 to 2012","volume":"25","author":"Dahl","year":"2020","journal-title":"Euro Surveill"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1001\/archinte.1984.00350200071011","article-title":"Transmission of hepatitis A by transfusion of blood products","volume":"144","author":"Sherertz","year":"1984","journal-title":"Arch. Intern. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"20812","DOI":"10.2807\/1560-7917.ES2014.19.21.20812","article-title":"Transfusion-transmitted hepatitis E in Germany, 2013","volume":"19","author":"Huzly","year":"2014","journal-title":"Euro Surveill"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1016\/S0140-6736(14)61034-5","article-title":"Hepatitis E virus in blood components: A prevalence and transmission study in southeast England","volume":"384","author":"Hewitt","year":"2014","journal-title":"Lancet"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1111\/trf.12530","article-title":"Hepatitis E virus seroprevalence and molecular study among blood donors in China","volume":"54","author":"Ren","year":"2014","journal-title":"Transfusion"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1111\/trf.13994","article-title":"Unique clinical courses of transfusion-transmitted hepatitis E in patients with immunosuppression","volume":"57","author":"Satake","year":"2017","journal-title":"Transfusion"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1002\/jmv.1890460213","article-title":"Hepatitis E virus infection in hemophiliacs","volume":"46","author":"Barzilai","year":"1995","journal-title":"J. Med. Virol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1053\/j.gastro.2006.01.007","article-title":"Acute hepatitis A infection in pregnancy is associated with high rates of gestational complications and preterm labor","volume":"130","author":"Elinav","year":"2006","journal-title":"Gastroenterology"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1111\/j.1447-0756.2011.01757.x","article-title":"Fulminant hepatitis A infection in second trimester of pregnancy requiring living-donor liver transplantation","volume":"38","author":"Simsek","year":"2012","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/0029-7844(96)00259-1","article-title":"Intrauterine transmission of hepatitis A virus","volume":"88","author":"Leikin","year":"1996","journal-title":"Obstet. Gynecol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1016\/j.ijid.2008.06.009","article-title":"Acute hepatitis A in a pregnant woman at delivery","volume":"13","author":"Motte","year":"2009","journal-title":"Int. J. Infect. Dis."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"28","DOI":"10.7326\/0003-4819-147-1-200707030-00005","article-title":"Maternal and fetal outcomes in pregnant women with acute hepatitis E virus infection","volume":"147","author":"Patra","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1111\/jvh.12730","article-title":"Risk factors for vertical transmission of hepatitis E virus infection","volume":"24","author":"Sharma","year":"2017","journal-title":"J. Viral Hepat."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"3647","DOI":"10.1080\/14767058.2019.1582630","article-title":"Hepatitis E virus infection and its associated adverse feto-maternal outcomes among pregnant women in Qinhuangdao, China","volume":"33","author":"Li","year":"2020","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"101536","DOI":"10.1016\/j.clinre.2020.08.012","article-title":"Prevalence and clinical features of hepatitis E virus infection in pregnant women: A large cohort study in Inner Mongolia, China","volume":"45","author":"Ma","year":"2021","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"355","DOI":"10.15585\/mmwr.mm6912a6","article-title":"Notes from the Field: Nationwide Hepatitis E Outbreak Concentrated in Informal Settlements-Namibia, 2017\u20132020","volume":"69","author":"Bustamante","year":"2020","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"941","DOI":"10.3201\/eid2405.171845","article-title":"Chronic Genotype 3 Hepatitis E in Pregnant Woman Receiving Infliximab and Azathioprine","volume":"24","author":"Charre","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1002\/jmv.21147","article-title":"Dual infection with hepatitis A and E viruses in outbreaks and in sporadic clinical cases: Cuba 1998\u20132003","volume":"80","author":"Quintana","year":"2008","journal-title":"J. Med. Virol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/S0255-0857(21)02055-7","article-title":"Outbreak of acute viral hepatitis due to hepatitis E virus in Hyderabad","volume":"25","author":"Sarguna","year":"2007","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.4269\/ajtmh.18-0232","article-title":"Epidemiology of Hepatitis A and Hepatitis E Based on Laboratory Surveillance Data-India, 2014\u20132017","volume":"99","author":"Murhekar","year":"2018","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"230","DOI":"10.4103\/ijmm.IJMM_19_197","article-title":"Infectious hepatitis: A 3-year retrospective study at a tertiary care hospital in India","volume":"37","author":"Samaddar","year":"2019","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s13337-019-00541-6","article-title":"Viral hepatitis among acute hepatitis patients attending tertiary care hospital in central India","volume":"30","author":"Barde","year":"2019","journal-title":"Virusdisease"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"261","DOI":"10.4103\/0255-0857.115631","article-title":"Prevalence of hepatitis A virus, hepatitis B virus, hepatitis C virus, hepatitis D virus and hepatitis E virus as causes of acute viral hepatitis in North India: A hospital based study","volume":"31","author":"Jain","year":"2013","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"567","DOI":"10.4103\/jfmpc.jfmpc_1212_21","article-title":"Seroprevalence of hepatitis A and hepatitis E in patients at a teaching hospital of northern India over a period of 8 years","volume":"11","author":"Bansal","year":"2022","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4103\/0974-2727.199636","article-title":"Hepatitis E virus: A leading cause of waterborne viral hepatitis in Northwest Districts of Punjab, India","volume":"9","author":"Kaur","year":"2017","journal-title":"J. Lab. Physicians"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Paul, R.C., Nazneen, A., Banik, K.C., Sumon, S.A., Paul, K.K., Akram, A., Uzzaman, M.S., Iqbal, T., Tejada-Strop, A., and Kamili, S. (2020). Hepatitis E as a cause of adult hospitalization in Bangladesh: Results from an acute jaundice surveillance study in six tertiary hospitals, 2014\u20132017. PLoS Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0007586"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1007\/s10096-018-3329-0","article-title":"Acute hepatitis A is the chief etiology of acute hepatitis in Egyptian children: A single-center study","volume":"37","author":"Fouad","year":"2018","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"88","DOI":"10.18683\/germs.2020.1189","article-title":"Prevalence of hepatitis E virus in children with acute hepatitis: One Egyptian center study","volume":"10","author":"Zaki","year":"2020","journal-title":"Germs"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1002\/jmv.1890370407","article-title":"Acute sporadic hepatitis E in children living in Cairo, Egypt","volume":"37","author":"Hyams","year":"1992","journal-title":"J. Med. Virol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"3931","DOI":"10.1016\/j.watres.2004.06.014","article-title":"Detection of enteric viruses, Giardia and Cryptosporidium in two different types of drinking water treatment facilities","volume":"38","author":"Ali","year":"2004","journal-title":"Water Res."},{"key":"ref_80","first-page":"1182","article-title":"Presence of enteric hepatitis viruses in the sewage and population of Greater Cairo","volume":"17","author":"Kamel","year":"2011","journal-title":"Clin. Microbiol. Infect. Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis."},{"key":"ref_81","first-page":"597","article-title":"Detection of hepatitis E virus in greater Cairo. Two wastewater treatment plants and its prevalence among workers of these plants","volume":"73","author":"Gamil","year":"1998","journal-title":"J. Egypt. Public Health Assoc."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1002\/jmv.23277","article-title":"Molecular characterization of hepatitis E virus in patients with acute hepatitis in Venezuela","volume":"84","author":"Villalba","year":"2012","journal-title":"J. Med. Virol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1159\/000492425","article-title":"Hepatitis E Virus Genotype 1 and Hepatitis A Virus Dual Infection in Pediatric Patients with a Low Socioeconomic Status from Mexico","volume":"61","author":"Mirazo","year":"2018","journal-title":"Intervirology"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"20","DOI":"10.4149\/av_2020_103","article-title":"The investigation of hepatitis A virus and hepatitis E virus co-infection in humans and animals in China","volume":"64","author":"Li","year":"2020","journal-title":"Acta Virol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1002\/(SICI)1096-9071(199603)48:3<215::AID-JMV1>3.0.CO;2-B","article-title":"Acute viral hepatitis types E, A, and B singly and in combination in acute liver failure in children in north India","volume":"48","author":"Arora","year":"1996","journal-title":"J. Med. Virol."},{"key":"ref_86","first-page":"14","article-title":"Changing Patterns of Aetiology of Acute Sporadic Viral Hepatitis in India-Newer Insights from North-East India","volume":"6","author":"Das","year":"2014","journal-title":"Int. J. Curr. Res. Rev."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1093\/tropej\/48.4.210","article-title":"Changing spectrum of sporadic acute viral hepatitis in Indian children","volume":"48","author":"Poddar","year":"2002","journal-title":"J. Trop. Pediatr."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1093\/tropej\/44.5.275","article-title":"Clinical and viral marker pattern of acute sporadic hepatitis in children in Madras, South India","volume":"44","author":"Malathi","year":"1998","journal-title":"J. Trop. Pediatr."},{"key":"ref_89","first-page":"433","article-title":"Prevalence of enterically transmitted hepatitis viruses in patients attending a tertiary--care hospital in south India","volume":"43","author":"Radhakrishnan","year":"2000","journal-title":"Indian J. Pathol. Microbiol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1099\/jmm.0.072249-0","article-title":"Prevalence of hepatitis E virus infection in West Bengal, India: A hospital-based study","volume":"63","author":"Chandra","year":"2014","journal-title":"J. Med. Microbiol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"102","DOI":"10.4103\/0255-0857.150908","article-title":"Prevalence of Hepatitis A virus (HAV) and Hepatitis E virus (HEV) in the patients presenting with acute viral hepatitis","volume":"33","author":"Joon","year":"2015","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"6130","DOI":"10.4103\/jfmpc.jfmpc_1373_20","article-title":"Simultaneous infection of Hepatitis A and Hepatitis E viruses amongst acute viral hepatitis patients: A hospital-based study from Uttarakhand","volume":"9","author":"Kalita","year":"2020","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.4103\/jfmpc.jfmpc_1746_21","article-title":"Prevalence of Hepatitis A virus (HAV) and Hepatitis E virus (HEV) in patients presenting with acute viral hepatitis: A 3-year retrospective study at a tertiary care Hospital in Western India","volume":"11","author":"Palewar","year":"2022","journal-title":"J. Family. Med. Prim. Care"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"229","DOI":"10.4103\/1319-3767.56094","article-title":"Natural course of fulminant hepatic failure: The scenario in Bangladesh and the differences from the west","volume":"15","author":"Alam","year":"2009","journal-title":"Saudi J. Gastroenterol."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Mazhar, M.K.A., Finger, F., Evers, E.S., Kuehne, A., Ivey, M., Yesurajan, F., Shirin, T., Ajim, N., Kabir, A., and Musto, J. (2021). An outbreak of acute jaundice syndrome (AJS) among the Rohingya refugees in Cox\u2019s Bazar, Bangladesh: Findings from enhanced epidemiological surveillance. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0250505"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"495","DOI":"10.3350\/kjhep.2007.13.4.495","article-title":"[Recent etiology and clinical features of acute viral hepatitis in a single center of Korea]","volume":"13","author":"Kang","year":"2007","journal-title":"Korean J. Hepatol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1089\/vim.2021.0045","article-title":"Spatial and Temporal Distribution of Hepatitis A Virus and Hepatitis E Virus Among Children with Acute Hepatitis in Mexico","volume":"34","author":"Panduro","year":"2021","journal-title":"Viral Immunol."},{"key":"ref_98","first-page":"3","article-title":"Sero-epidemiological study of the hepatitis epidemic in Mitrovica in the aftermath of the war in Kosovo (1999)","volume":"95","author":"Rey","year":"2002","journal-title":"Bull. Soc. Pathol. Exot."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1023\/A:1007514030062","article-title":"HAV and HEV infection in hospitalised hepatitis patients in Alexandria, Egypt","volume":"15","author":"Divizia","year":"1999","journal-title":"Eur. J. Epidemiol."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Ramadan, H.K., Sayed, I.M., Elkhawaga, A.A., Meghezel, E.M., Askar, A.A., Moussa, A.M., Osman, A., Elfadl, A.A., Khalifa, W.A., and Ashmawy, A.M. (2022). Characteristics and outcomes of acute hepatitis of unknown etiology in Egypt: First report of adult adenovirus-associated hepatitis. Infection, 1\u20139.","DOI":"10.1007\/s15010-022-01945-1"},{"key":"ref_101","first-page":"199","article-title":"Seroprevalence of Hav, Hbv, Hcv, and Hev Among Acute Hepatitis Patients at Kenyatta National Hospital in Nairobi, Kenya","volume":"89","author":"Muchiri","year":"2012","journal-title":"East Afr. Med. J."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1056\/NEJMoa0706992","article-title":"Hepatitis E virus and chronic hepatitis in organ-transplant recipients","volume":"358","author":"Kamar","year":"2008","journal-title":"New Engl. J. Med."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1053\/j.gastro.2017.12.028","article-title":"Chronic Hepatitis E in a Renal Transplant Recipient: The First Report of Genotype 4 Hepatitis E Virus Caused Chronic Infection in Organ Recipient","volume":"154","author":"Wang","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/S1473-3099(14)70823-0","article-title":"HEV-associated cryoglobulinaemia and extrahepatic manifestations of hepatitis E","volume":"14","author":"Pischke","year":"2014","journal-title":"Lancet Infect. Dis."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"e2218","DOI":"10.1002\/rmv.2218","article-title":"Model systems for studying extrahepatic pathogenesis of hepatitis E virus. Current knowledge and future directions","volume":"31","author":"Sayed","year":"2021","journal-title":"Rev. Med. Virol."},{"key":"ref_106","first-page":"216","article-title":"Guillain-Barre syndrome associated with acute hepatitis E","volume":"24","author":"Kamani","year":"2005","journal-title":"Indian J. Gastroenterol."},{"key":"ref_107","first-page":"611","article-title":"Clinical features of acute renal failure associated with hepatitis A virus infection","volume":"17","author":"Jung","year":"2010","journal-title":"J. Viral Hepat."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1016\/0264-410X(92)90534-Q","article-title":"Atypical clinical manifestations of hepatitis A","volume":"10","author":"Schiff","year":"1992","journal-title":"Vaccine"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"27","DOI":"10.14581\/jer.11005","article-title":"Encephalitis associated with acute hepatitis a","volume":"1","author":"Lee","year":"2011","journal-title":"J. Epilepsy Res."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"204","DOI":"10.4103\/0976-3147.131695","article-title":"Guillain-Barr\u00e9 syndrome following acute viral hepatitis A","volume":"5","author":"Menon","year":"2014","journal-title":"J. Neurosci. Rural. Pract."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.3201\/eid2809.220487","article-title":"Fulminant Transfusion-Associated Hepatitis E Virus Infection Despite Screening, England, 2016\u20132020","volume":"28","author":"Harvala","year":"2022","journal-title":"Emerg. Infect. Dis."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1056\/NEJM198510243131706","article-title":"Type A viral hepatitis. New developments in an old disease","volume":"313","author":"Lemon","year":"1985","journal-title":"N. Engl. J. Med."},{"key":"ref_113","first-page":"5159934","article-title":"Acute Liver Failure Requiring Liver Transplantation due to Acute Hepatitis A Virus Infection","volume":"2021","author":"Xie","year":"2021","journal-title":"Case Rep. Transplant."},{"key":"ref_114","first-page":"845","article-title":"Etiology of endemic viral hepatitis in urban North India","volume":"33","author":"Kaur","year":"2002","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1111\/j.1440-1746.2006.04509.x","article-title":"Does co-infection with multiple viruses adversely influence the course and outcome of sporadic acute viral hepatitis in children?","volume":"21","author":"Kumar","year":"2006","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_116","first-page":"101","article-title":"A Case of Coinfection of Hepatitis A and E Virus with Hepatic Encephalopathy","volume":"80","year":"2011","journal-title":"Korean J. Med."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"77","DOI":"10.47892\/rgp.2020.401.1035","article-title":"Hepatitis A and hepatitis E virus co-infection with right pleural effusion, ascites and acute acalculous cholecystitis. A case report","volume":"40","year":"2020","journal-title":"Rev. Gastroenterol. Peru"},{"key":"ref_118","first-page":"S31","article-title":"Hepatitis Aand E Co-Infection with Worst Outcome","volume":"26","author":"Saeed","year":"2016","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"47","DOI":"10.4103\/2250-9658.197436","article-title":"Prevalence of hepatitis a virus and hepatitis e virus in the patients presenting with acute viral hepatitis at a tertiary care hospital Jaipur Rajasthan","volume":"5","author":"Mittal","year":"2016","journal-title":"New Niger. J. Clin. Res."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"S103","DOI":"10.29271\/jcpsp.2019.12.S103","article-title":"Acute Viral Hepatitis: Simultaneous Infection from Hepatitis A, B and E Viruses","volume":"29","author":"Butt","year":"2019","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"5904","DOI":"10.3748\/wjg.v19.i35.5904","article-title":"Influence of chronic HBV infection on superimposed acute hepatitis E","volume":"19","author":"Cheng","year":"2013","journal-title":"World J. Gastroenterol."},{"key":"ref_122","doi-asserted-by":"crossref","unstructured":"Migueres, M., Lhomme, S., and Izopet, J. (2021). Hepatitis A: Epidemiology, High-Risk Groups, Prevention and Research on Antiviral Treatment. Viruses, 13.","DOI":"10.3390\/v13101900"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.15585\/mmwr.mm6743a5","article-title":"Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel","volume":"67","author":"Nelson","year":"2018","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1056\/NEJMoa1215246","article-title":"Ribavirin for chronic hepatitis E virus infection in transplant recipients","volume":"370","author":"Kamar","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.ebiom.2018.11.023","article-title":"Evidence for positive selection of hepatitis A virus antigenic variants in vaccinated men-having-sex-with men patients: Implications for immunization policies","volume":"39","author":"Gregori","year":"2019","journal-title":"EBioMedicine"},{"key":"ref_126","first-page":"e331","article-title":"Persistence of antibodies acquired by natural hepatitis E virus infection and effects of vaccination","volume":"23","author":"Su","year":"2017","journal-title":"Clin. Microbiol. Infect. Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1016\/j.jhep.2020.12.028","article-title":"Multimodal investigation of rat hepatitis E virus antigenicity: Implications for infection, diagnostics, and vaccine efficacy","volume":"74","author":"Sridhar","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"3971","DOI":"10.1038\/s41467-020-17737-w","article-title":"Quantitative evaluation of protective antibody response induced by hepatitis E vaccine in humans","volume":"11","author":"Wen","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1128\/JVI.80.3.1352-1360.2006","article-title":"Stable growth of wild-type hepatitis A virus in cell culture","volume":"80","author":"Konduru","year":"2006","journal-title":"J. Virol."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"2056","DOI":"10.1128\/jvi.65.4.2056-2065.1991","article-title":"Antigenic and genetic variation in cytopathic hepatitis A virus variants arising during persistent infection: Evidence for genetic recombination","volume":"65","author":"Lemon","year":"1991","journal-title":"J. Virol."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"3370","DOI":"10.1128\/JVI.72.4.3370-3376.1998","article-title":"A cytopathogenic, apoptosis-inducing variant of hepatitis A virus","volume":"72","author":"Brack","year":"1998","journal-title":"J. Virol."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"2438","DOI":"10.1073\/pnas.1018878108","article-title":"Cross-species infections of cultured cells by hepatitis E virus and discovery of an infectious virus-host recombinant","volume":"108","author":"Shukla","year":"2011","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1128\/JVI.02205-13","article-title":"Hepatitis E virus genotype 1 infection of swine kidney cells in vitro is inhibited at multiple levels","volume":"88","author":"Nguyen","year":"2014","journal-title":"J. Virol."},{"key":"ref_134","doi-asserted-by":"crossref","unstructured":"Burkard, T., Proske, N., Resner, K., Collignon, L., Knegendorf, L., Friesland, M., Verhoye, L., Sayed, I.M., Br\u00fcggemann, Y., and Nocke, M.K. (2022). Viral Interference of Hepatitis C and E Virus Replication in Novel Experimental Co-Infection Systems. Cells, 11.","DOI":"10.3390\/cells11060927"},{"key":"ref_135","doi-asserted-by":"crossref","unstructured":"Jiang, W., Ma, P., and Long, G. (2019). A visualizable hepatitis A virus and hepatitis C virus coinfection model <em>in vitro<\/em>: Coexistence of two hepatic viruses under limited competition in viral RNA synthesis. bioRxiv.","DOI":"10.1101\/709071"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1093\/infdis\/jiz171","article-title":"Hepatitis E Virus (HEV) Open Reading Frame 2 Antigen Kinetics in Human-Liver Chimeric Mice and Its Impact on HEV Diagnosis","volume":"220","author":"Sayed","year":"2019","journal-title":"J. Infect. Dis."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1136\/gutjnl-2015-311109","article-title":"Study of hepatitis E virus infection of genotype 1 and 3 in mice with humanised liver","volume":"66","author":"Sayed","year":"2017","journal-title":"Gut"},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.antiviral.2017.02.011","article-title":"Transmission of hepatitis E virus infection to human-liver chimeric FRG mice using patient plasma","volume":"141","author":"Sayed","year":"2017","journal-title":"Antivir. Res."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"4394","DOI":"10.1128\/JVI.00114-16","article-title":"Hepatitis E Virus (HEV) Genotype 3 Infection of Human Liver Chimeric Mice as a Model for Chronic HEV Infection","volume":"90","author":"Pas","year":"2016","journal-title":"J. Virol."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/j.jhep.2016.01.011","article-title":"Human liver chimeric mice as a new model of chronic hepatitis E virus infection and preclinical drug evaluation","volume":"64","author":"Allweiss","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"e2086","DOI":"10.1002\/rmv.2086","article-title":"Updates in Hepatitis E virus (HEV) field; lessons learned from human liver chimeric mice","volume":"30","author":"Sayed","year":"2020","journal-title":"Rev. Med. Virol."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1093\/infdis\/jix422","article-title":"Murine Tissues of Human Liver Chimeric Mice Are Not Susceptible to Hepatitis E Virus Genotypes 1 and 3","volume":"216","author":"Sayed","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"a031674","DOI":"10.1101\/cshperspect.a031674","article-title":"Murine Models of Hepatitis A Virus Infection","volume":"9","author":"Whitmire","year":"2019","journal-title":"Cold Spring Harb. Perspect. Med."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/2\/298\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:11:56Z","timestamp":1760119916000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/2\/298"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,20]]},"references-count":143,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["v15020298"],"URL":"https:\/\/doi.org\/10.3390\/v15020298","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,20]]}}}