Munir I Malik, Muhammad Shahid, Salma Naheed, Ali Yawar Alam, Ejaz A Khan.
Are there reasons for universal immunization for hepatitis A virus infection?.
Rawal Med J Jan ;34(1):36-9.

Objective To determine the demographic, clinical, laboratory features and outcome of Hepatitis A Virus (HAV) infection in children and young adults seen at Shifa International Hospital, Islamabad. Method We analyzed all cases of Hepatitis A infection at Shifa International Hospital (SIH), Islamabad over a three-year period from October 2002 to December 2005. HAV immunoglobulin M (IgM) was used as a marker of acute infection. Data regarding demographic, laboratory investigations, morbidity and complications were collected. Results A total of 185 patients presented with acute HAV infection during the study period. Mean age was 11.5±7.3 years (range 2-34) with 26% >16 years of age. There were 66% males and 68% were students (including 2.5% physicians or medical students). Sixty-five percent belonged to middle socioeconomic class, 20% to high and 6% to low socioeconomic class. Eighty-one percent patients were from Rawalpindi/Islamabad area and 73% cases occurred during July to December months. Clinical symptoms included jaundice (80%), fever (45%), vomiting (62%), abdominal pain (43%), tender hepatomegaly (21%) and diarrhea (9%). Mean duration of symptoms before diagnosis was 6±4 days. There was history of contact in only 7% patients. The mean total bilirubin was 5.9±7mg/dl and serum alanine aminotransferase (ALT) 1805±1642 mg/dl. Hospitalization was required in 30% patients and 57% of these were of age >12 years. Mean duration of hospitalization was 2.9±2.6days. There was a statistically significant difference between those <15 yrs compared to those >15 yrs in terms of mean ALT (p<0.005) and hospitalization rate (p<0.006). However, there was no statistically difference for mean total bilirubin (p=0.8), duration of hospitalization (p=0.9) or fulminant hepatitis (p=0.8). Treatment included vitamins and intravenous fluids (IVF) in 13%, antibiotics 3%, steroids 1% and combination of IVF, antibiotics and steroids in 19%. There was no mortality but 2% had fulminant hepatitis and required longer hospitalization (mean 9 days). Thirty-five percent had follow-up of more than 7 days. At follow-up, complete recovery was observed in 52%, incomplete in 22%. Twenty-seven percent were lost to follow-up. Conclusions HAV infection is now more common in older children and adults. Severe hepatitis, fulminant hepatitis, higher and longer hospitalization rates can occur. Unnecessary investigations and treatment add to the cost of illness. Vaccination against HAV should be considered, especially in high risk individuals. (Rawal Med J 2009; 34: 36-39).

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