Background: Most common aetiology of viral hepatitis globally is Hepatitis A except in developing countries where Hepatitis E predominates. Geographical variation is present between the west and the east. However, in many developing countries including India, a change in aetiology is being increasingly reported in the past two decades. Materials __ampersandsignamp; Methods: 591 patients with acute viral hepatitis were prospectively screened to ascertain their aetiology (by appropriate viral markers) in a tertiary care centre from North-East India. Results were double-checked in another tertiary institute in Delhi, including Polymerase Chain Reaction for virus detection. Clinical outcomes, mortality and other relevant findings were recorded. Results: Hepatitis A was the dominant aetiology for both acute and fulminant viral hepatitis that is in contrast to other Indian reports that implicate hepatitis E virus, suggesting our region has certain differences. Overall, 16% developed complications with a 9% mortality. Those with hepatitis B had the poorest outcome. Hepatitis C virus was not detected. 2% had mixed infection. Non-A,B,C,E cases were high. History of herbal/unknown folk medicine intake was present in a large number of patients. Conclusion: North-east India, although relatively underdeveloped, is showing a shift of hepatitis A viral sero-epidemiology. Adults are affected as equally by hepatitis E. The reasons may be multi-factorial. Non-viral acute hepatitis is common here. The consumption of unidentified non-allopathic medications may influence outcome, and requires further evaluation.