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In general, the prognosis is excellent. Long-term immunity accompanies HAV infection.

Recurrence and
chronic hepatitis do not usually occur. Typically, there are no lasting sequelae.
Death is rare, though it is more frequent in elderly patients and in those with underlying liver disease.
Annually, an estimated 100 people die in the United States as a result of acute liver failure due to HAV
infection. Although the case-fatalities from fulminant HAV infection have been reported in all age groups,
where overall the mortality is estimated at approximately 0.3%, the rate is 1.8% among adults older than
50 years and is also higher in persons with chronic liver diseases.
In children, liver transplantation has been performed for fulminant hepatic failure (FHF). In France, 10% of
cases of FHF in children are caused by HAV infection. The outcomes from liver transplantation are the
same as for others with fulminant disease. Recurrent disease does not occur following liver
transplantation despite immunosuppression.
In the United States, most cases are symptomatic, with the frequency of icteric cases approaching 80%.
Globally, HAV infection is often asymptomatic and subclinical. Approximately 75% of adults are
symptomatic with infection, many with jaundice. In stark contrast, 90% of those infected before age 2
years are asymptomatic.
The single most important determinant of illness severity is age; increasing age is directly correlated with
an increasing likelihood of adverse events (ie, morbidity and mortality). Most deaths from acute HAV
infection occur in persons older than 50 years, even though such infections are uncommon in this age
group. Case fatality rates approach 2%, and a vast majority of persons who acquire infection when older
than 50 years exhibit signs and symptoms of the disease.
Other populations with increased likelihood of adverse sequelae caused by acute HAV infection are those
with significant comorbidities or concurrent chronic liver disease, as highlighted by the high incidence of
hepatitis B surface antigen in persons who died in the Shanghai outbreak, [15] along with case reports of
deaths from acute HAV infection in persons with hepatitis C.
Infection in early life occurs commonly in developing countries. Therefore, symptomatic disease is
uncommon in natives of these countries and is most often observed in visitors. Seropositivity for anti-HAV
protects individuals against reinfection.
Some evidence suggests that reinfection may occur late in life in individuals in whom levels of detectable
antibody have disappeared. Although this phenomenon is reported to occur, reinfection is not associated
with clinical disease. A rapid rise in immunoglobulin G (IgG) antibody to HAV in the absence of
immunoglobulin M (IgM) is the hallmark of this event (anamnestic response).

Hepatitis A symptoms are usually mild and resolve on their own; most patients fully recover in 3 to 6