Hepatitis A Infection

From Anvita Health Wiki

Contents 1 Etiology 2 Epidemiology 3 Clinical-manifestations 4 Laboratory 5 Complications 6 Management 7 More General Terms 8 Additional Terms 9 References

Etiology

• hepatitis A virus

Epidemiology

• accounts for 1/3 of cases of acute viral hepatitis
• fecal-oral transmission

• contaminated food: rasberries, scallions [1]

• generally transmitted by household & intimate contact
• common source outbreaks are infrequent
• infects 1 in 50 unimmunized travelers [2]

Clinical-manifestations

• acute, but NOT chronic hepatitis
• children generally have asymptomatic or mild infection
• adults are generally symptomatic & jaundiced
• fever
• fatigue
• nausea, vomiting, diarrhea
• dark urine
• right upper quadrant pain

Laboratory

• IgM anti-hepatitis A

• unexplained acute hepatitis or acute liver failure
• IgM may persist for 4-6 months

• IgG is protective

• indicates past infection
• may take 4-6 months to appear in serum

• PCR/southern blot/ISH for hepatitis A virus

Complications

• relapsing course of hepatitis
• prolonged cholestasis
• fulminant hepatitis (rare)
• patients with underlying chronic hepatitis B have increased mortality from HAV

Management

• infection is self-limited
• full recovery in 99% of patients
• prophylaxis:

• single dose of HAV vaccine is protective in 90% of patients within 2-4 weeks of inoculation

• booster at 6-12 months
• susceptible persons traveling to endemic area

• 4 weeks prior to departure

• injection drug users
• men who have sex with men
• patients with chronic liver disease
• patients with clotting factor disorders [1]

• immune globulin within 2 weeks of exposure

• household, sexual, day care contacts of patients with hepatitis A
• individuals that have consumed hepatitis A contaminated food
• unvaccinated persons departing within < 2 weeks to an endemic area [1]

• adhere to careful handwashing
• avoid work that involves food handling or close personal contact for 2-3 weeks after resolution of disease
• post-exposure, including household contacts

• HAV vaccine works as well as immune serum globulin [4]

More General Terms

• viral hepatitis

Additional Terms

• hepatitis A vaccine (Harvix, VAQTA)
• hepatitis A virus (HAV)
• PCR/southern blot/in-situ hybridization for hepatitis A virus

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
2. Prescriber's Letter 9(7):40 2002
3. Advisory Committee on Immunization Practices (ACIP); Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006 May 19;55(RR-7):1-23. PMID: [1] Corresponding NGC guideline withdrawn Dec 2011 [2]
4. Victor JC et al, Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med 2007, 357:1685 PMID: [3]
5. What I need to know about Hepatitis A [4]
6. National Guideline Clearinghouse United Kingdom national guideline on the management of the viral hepatitides A, B, and C 2008. (British Association of Sexual Health and HIV) ngc-guideline: [5]
   - Hepatitis A virus. New York State Department of Health ngc-guideline: [6]

hepatitis A infection