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
- The United States Centers for Disease Control and Prevention (CDC) in 1991 reported a low mortality rate of 4 deaths per 1000 cases for the general population but a higher rate of 17.5 per 1000 in those aged 50 and over.
- 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
- ↑ 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) - ↑ 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) - ↑ 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)