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Section 3. Summaries of Infectious Diseases
Hepatitis A
Clinical ManifestationsEtiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
Recommendations for Immunoprophylaxis
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CLINICAL MANIFESTATIONS
Hepatitis A characteristically is an acute, self-limited illness associated with fever, malaise, jaundice, anorexia, and nausea. Symptomatic hepatitis A virus (HAV) infection occurs in approximately 30% of infected children younger than 6 years of age; few of these children will have jaundice. Among older children and adults, infection usually is symptomatic and typically lasts several weeks, with jaundice occurring in 70% or more. Signs and symptoms typically last less than 2 months, although 10% to 15% of symptomatic people have prolonged or relapsing disease lasting as long as 6 months. Fulminant hepatitis is rare but is more common in people with underlying liver disease. Chronic infection does not occur.
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ETIOLOGY
HAV is an RNA virus classified as a member of the picornavirus group.
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EPIDEMIOLOGY
The most common mode of transmission is person to person, resulting from fecal contamination and oral ingestion (ie, the fecal-oral route). In developing countries, where infection is endemic, most people are infected during the first decade of life. In the United States, hepatitis A was one of the most frequently reported vaccine-preventable diseases in the prevaccine era, but incidence of disease attributable to HAV has declined since hepatitis A vaccine was licensed in 1995. In 2007, 2979 cases were reported to the Centers for Disease Control and Prevention (CDC), compared with 22 000 to 36 000 hepatitis A cases reported annually from 1980 through 1995. These declining rates have been accompanied by a shift in age-specific rates. Historically, the highest rates occurred among children 5 to 14 years of age, and the lowest rates occurred among adults older than 40 years of age. Beginning in the late 1990s, national
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