Elsevier

Vaccine

Volume 18, Supplement 1, 18 February 2000, Pages S71-S74
Vaccine

Clinical course and consequences of hepatitis A infection

https://doi.org/10.1016/S0264-410X(99)00470-3Get rights and content

Abstract

Hepatitis A virus (HAV) is a small, non-enveloped RNA virus belonging to the Picornaviridae, for which only one serotype has been identified. Transmission is usually through the faecal–oral route by person-to-person contact. The most common risk factors are household or sexual contact with a sufferer, attendance or working at a day-care centre, international travel, and association with food or waterborne outbreaks; 55% of cases have no identifiable risk factors. HAV infection may be symptomatic or asymptomatic, and shows three phases. Virus is shed during the incubation phase, anti-HAV IgM appears during the symptomatic phase and can be used for diagnosis, and anti-HAV IgG appears at the same time but persists lifelong. Unusual clinical manifestations of hepatitis A include cholestatic, relapsing and fulminant hepatitis. Hepatitis A accounts for 93% of cases of acute hepatitis in Argentina, including 7% of atypical clinical cases. Hepatitis A is the major cause of fulminant hepatitis, and has been reported to account for 10% of liver transplants in children in France and 20% in Argentina. One-year survival after liver transplantation is 64%. Prevention must be considered as the main means of averting this severe illness.

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Transmission and risk factors

Over 95% of HAV infections are transmitted by the faecal–oral route, and crowded or insanitary conditions are commonly implicated. This infection can be easily spread by person-to-person contact, mainly within families, day-care centres, elementary schools or similar institutions. Although it is rare, parenteral transmission of HAV is possible due to use of contaminated blood products or needles during blood transfusion. This type of transmission has been documented in Italian patients

Clinical course

The disease is expressed in two major forms—symptomatic and asymptomatic—representing a broad spectrum of infection. Jaundice may (icteric) or may not (anicteric) be a feature in patients with symptomatic hepatitis. The likelihood of showing symptoms related to HAV infection is related to the age of the patient. Thus, most infections in children aged under 6 years are asymptomatic, whereas those in older children and adults are usually symptomatic, with jaundice occurring in more than 70% of

Treatment of fulminant hepatitis A

Few reports have been published of the treatment of liver failure related to hepatitis A in children. However, a recent study from the Hôpital de Bicêtre, which is the main paediatric liver transplantation centre in France, included 24 children with hepatitis A over a 15-year period. At this centre, hepatitis A is the main cause of fulminant liver failure (23%) in children and accounts for 10% of the liver transplants performed at the centre [11]. The Juan P. Garrahan Hospital is the largest

Outcome

The reasons for the development of liver failure and eventual progression to fulminant hepatitis in some children with hepatitis A are not clear. Host factors, as well as the virulence and the quantity of viral inoculum, may be important. Whether a genetic predisposition is also involved is not known.

Survival at 1 year following liver transplantation is 64%, compared with 43% in patients given medical treatment alone.

Overall in Argentina, the case fatality rate of fulminant hepatitis A in

Conclusions

HAV infection is the predominant aetiology of acute hepatitis and fulminant hepatic failure in children in Argentina, and probably elsewhere in the world. Hepatitis A accounts for 20% of liver transplantations performed in our centres, but this approach is appropriate only in some cases and mortality is still quite high. Prevention must be considered as the main means of averting this catastrophic illness.

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