Hepatitis A natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Natural History

Peak infectivity occurs during the 2-week period before onset of jaundice or elevation of liver enzymes, when concentration of virus in stool is highest[1].

The likelihood of having symptoms with HAV infection increases with age. Fewer than 10% of infections among children aged 0-4 years result in jaundice; this percentage increases to 30%-40% among children aged 5-9 years, 60%-80% among youths aged 10-17 years, and 80%-90% among adults aged ≥18 years[2].

When signs and symptoms occur, typically they last <2 months, although 10%-15% of symptomatic persons have prolonged or relapsing disease lasting up to 6 months[3].

Complications

There are usually no complications. One in a thousand cases becomes fulminant hepatitis, which can be life threatening.

Prognosis

  • Young children who are infected with hepatitis A typically have a milder form of the disease, usually lasting from 1-3 weeks, whereas adults tend to experience a much more severe form of the disease.
  • Adults are often confined to bed and minimal activity for about 4 weeks and have to stop their work for one to three months or longer.
  • Many adults take up to 36 months and occasionally longer to recover entirely.
  • Symptoms that may be experienced after the first month or two are low immunity: It is much easier to catch minor infections and for these infections to linger longer than they normally would.
  • Many people experience a slow but sure improvement, over this later period.
  • They are generally able to function fairly normally, still needing more sleep and reduced athletic activity.
  • It is common for recovering patients to experience occasional "off" days, during which they need to rest more.
  • Hepatitis A can be sexually transmitted, especially during oral-anal contact, but not after the patient has recovered.
  • Approximately 15% of people diagnosed with hepatitis A may experience one or more symptomatic relapse(s) for up to 24 months after contracting this disease.

References

  1. Tassopoulos NC, Papaevangelou GJ, Ticehurst JR, Purcell RH (1986). "Fecal excretion of Greek strains of hepatitis A virus in patients with hepatitis A and in experimentally infected chimpanzees". The Journal of Infectious Diseases. 154 (2): 231–7. PMID 3014009. Retrieved 2012-02-28. Unknown parameter |month= ignored (help)
  2. Armstrong GL, Bell BP (2002). "Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization". Pediatrics. 109 (5): 839–45. PMID 11986444. Retrieved 2012-02-28. Unknown parameter |month= ignored (help)
  3. Glikson M, Galun E, Oren R, Tur-Kaspa R, Shouval D (1992). "Relapsing hepatitis A. Review of 14 cases and literature survey". Medicine. 71 (1): 14–23. PMID 1312659. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

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