Hepatitis A

Virology and Etiology

Hepatitis A virus is a nonenveloped 27-nm,
heat-, acid-, and ether-resistant RNA virus in the
Hepatovirus genus of the picornavirus family
Inactivation of viral activity boiling for 1
minute, by contact with formaldehyde and
chlorine, or by ultraviolet irradiation
Incubation period of 4 weeks
Persistence of virus in the liver, viral shedding in
feces, viremia infectivity diminish rapidly once
jaundice becomes apparent

Scheme of typical clinical and

laboratory features of hepatitis A

Epidemiology and Global

Features

Incubation (days): 1545, mean 30

Onset: acute
Age preference: Children, young adults
Transmission: fecal-oral (poor personal hygiene and
overcrowding; large outbreaks as well as sporadic cases
have been traced to contaminated food, water, milk, frozen
raspberries and strawberries, green onions imported from
Mexico, and shellfish), sexual
Severity: mild
Fulminant: 0,1%
Progression to chronicity: Carier: Cancer: Prognosis: exellent

Symptoms and Signs

prodromal symptoms
Constitutional symptoms of anorexia, nausea
and vomiting, fatigue, malaise, arthralgias,
myalgias, headache, photophobia, pharyngitis,
cough, and coryza may precede the onset of
jaundice by 12 weeks.
A low-grade fever between 38 and 39C
(100102F) is more often present in hepatitis
A.
Dark urine and clay-colored stools may be
noticed by the patient from 15 days before the
onset of clinical jaundice

Symptoms and Signs

clinical jaundice
Prodromal symptoms usually
diminish, but in some patients mild
weight loss (2.55 kg)
The liver becomes enlarged and
tender right upper quadrant pain
and discomfort
Splenomegaly and cervical
adenopathy are present in 1020% of
patients with acute hepatitis

Symptoms and Signs

recovery phase
Constitutional symptoms disappear, but usually some
liver enlargement and abnormalities in liver biochemical
tests are still evident
The duration of the posticteric phase is variable, ranging
212 weeks, and is usually more prolonged in acute
hepatitis B and C
Complete clinical and biochemical recovery is to be
expected 12 months after all cases of hepatitis A and E
and 34 months after the onset of jaundice in threequarters of uncomplicated
Self-limited cases of hepatitis B and C (among healthy
adults, acute hepatitis B is self-limited in 9599% while
hepatitis C is self-limited in only 15%)

Laboratory Features
AST and ALT variable increase during the prodromal
phase of acute viral hepatitis and precede the rise in
bilirubin level
Peak levels vary from 4004000 IU or more
Jaundice sclera or skin when the serum bilirubin
value is >43 mol/L (2.5 mg/dL)
Neutropenia and lymphopenia are transient and are
followed by a relative lymphocytosis
Measurement of the prothrombin time (PT)
Hypoglycemia
Serum albumin
Serologic marker

Complication
Relapsing hepatitis weeks to
months after apparent recovery from
acute hepatitis recurrence of
symptoms, aminotransferase
elevations, occasionally jaundice,
and fecal excretion of HAV
Cholestatic hepatitis unusual
Fulminant hepatitis (massive hepatic
necrosis)

Prophylaxis
Passive immunization with IG and active
immunization with killed vaccines
IG contain anti HAV 0.02 mL/kg as early after
exposure as possible; it may be effective even when
administered as late as 2 weeks after exposure
Traveler to endemic area travel lasted <3
months, 0.02 mL/kg was given; for longer travel or
residence in these areas, a dose of 0.06 mL/kg
every 46 months was recommended
Prophylaxis is not necessary for those who have
already received hepatitis A vaccine

 Formalin-inactivated vaccines made from strains

of HAV attenuated
At least one year old
Provide adequate protection beginning 4 weeks
after a primary inoculation
Pre-exposure immunoprophylaxis

A combination of this hepatitis A vaccine and hepatitis B vaccine, TWINRIX, is licensed for simultaneous protection
against both of these viruses among adults (age >18 years). Each 1-mL dose contains 720 ELU of hepatitis A vaccine and 20 ug of hepatitis B vaccine.