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In these endemic countries, the disease takes two major epidemiological forms. The form that was recognized first was occurrence of large outbreaks affecting several hundred to several thousand cases of acute hepatitis, usually over a short period of a few weeks.
However, it was soon realized that the viral agent was also responsible for a variable but significant proportion of sporadic cases with acute hepatitis. For instance, in India, Pakistan and China, of all hepatitis viruses, among all hepatitis viruses, HEV accounts for the largest proportion of patients.