Hepatitis A virus - Revision history

Aidan: /* Clinical Manifestations */

2025-02-25T16:07:50Z

Clinical Manifestations

← Older revision		Revision as of 16:07, 25 February 2025
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	*Children are usually asymptomatic		*Children are usually asymptomatic
	*Symptoms include non-specific influenza-like illness followed eventually by bilirubinuria, pale stools, jaundice, and scleral icterus		*Symptoms include non-specific influenza-like illness followed eventually by bilirubinuria, pale stools, jaundice, and scleral icterus
	*May have hepatomegaly and splenomegaly, may have rash or arthralgia		*May have [[hepatomegaly]] and [[splenomegaly]], may have rash or arthralgia
	*Rarely have bradycardia		*Rarely have [[bradycardia]]
	*Self-limited, usually starting to resolve by the third week of illness with full recovery often taking several months		*Self-limited, usually starting to resolve by the third week of illness with full recovery often taking several months
	*Other manifestations:		*Other manifestations:
	**Acute liver failure (about 1 in 300)		**[[Acute liver failure]] (about 1 in 300)
	**Relapsing hepatitis with recurrence within 6 months		**Relapsing hepatitis with recurrence within 6 months
	**Prolonged cholestasis		**Prolonged cholestasis
	**Hemolysis (<5%), particularly in patients with [[glucose-6-phosphate dehydrogenase deficiency]], aplastic anemia, autoimmune thrombocytopenic purpura, and pure red cell aplasia		**[[Hemolysis]] (<5%), particularly in patients with [[glucose-6-phosphate dehydrogenase deficiency]], [[aplastic anemia]], [[autoimmune thrombocytopenic purpura]], and [[pure red cell aplasia]]
	**Acalculous cholecystitis (<5%)		**[[Acalculous cholecystitis]] (<5%)
	**Acute kidney injury (rare)		**[[Acute kidney injury]] (rare)
	**Pleural or pericardial effusion (rare)		**[[Pleural effusion\|Pleural]] or [[pericardial effusion]] (rare)
	**Reactive arthritis (rare)		**[[Reactive arthritis]] (rare)
	**Pancreatitis (rare)		**[[Pancreatitis]] (rare)
	**Neurological associations include mononeuritis, [[mononeuritis multiplex]], [[Guillain-Barré syndrome]], postviral encephalitis, and transverse myelitis, though causation remains unclear)		**Neurological associations include [[mononeuritis]], [[mononeuritis multiplex]], [[Guillain-Barré syndrome]], postviral encephalitis, and transverse myelitis, though causation remains unclear)

	==Diagnosis==		==Diagnosis==

Aidan at 16:06, 25 February 2025

2025-02-25T16:06:45Z

← Older revision		Revision as of 16:06, 25 February 2025
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	===Microbiology===		===Microbiology===

	*Non-enveloped RNA virus within the [[~~Family~~::~~Picornaviridae~~]] family		*Non-enveloped RNA virus within the genus [[Genus::Hepatovirus]] and family [[Family::Picornaviridae]]
	*Three genotypes, I through III		*Three genotypes, I through III
	*Difficult to kill: needs higher temperatures and lower pH than other viruses, or bleach- or ammonium-based cleaners		*Difficult to kill: needs higher temperatures and lower pH than other viruses, or bleach- or ammonium-based cleaners
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	*Symptoms include non-specific influenza-like illness followed eventually by bilirubinuria, pale stools, jaundice, and scleral icterus		*Symptoms include non-specific influenza-like illness followed eventually by bilirubinuria, pale stools, jaundice, and scleral icterus
	*May have hepatomegaly and splenomegaly, may have rash or arthralgia		*May have hepatomegaly and splenomegaly, may have rash or arthralgia
			*Rarely have bradycardia
	*Self-limited, usually starting to resolve by the third week of illness with full recovery often taking several months		*Self-limited, usually starting to resolve by the third week of illness with full recovery often taking several months
			*Other manifestations:
			**Acute liver failure (about 1 in 300)
			**Relapsing hepatitis with recurrence within 6 months
			**Prolonged cholestasis
			**Hemolysis (<5%), particularly in patients with [[glucose-6-phosphate dehydrogenase deficiency]], aplastic anemia, autoimmune thrombocytopenic purpura, and pure red cell aplasia
			**Acalculous cholecystitis (<5%)
			**Acute kidney injury (rare)
			**Pleural or pericardial effusion (rare)
			**Reactive arthritis (rare)
			**Pancreatitis (rare)
			**Neurological associations include mononeuritis, [[mononeuritis multiplex]], [[Guillain-Barré syndrome]], postviral encephalitis, and transverse myelitis, though causation remains unclear)

	==Diagnosis==		==Diagnosis==

Aidan at 18:12, 19 September 2024

2024-09-19T18:12:40Z

← Older revision		Revision as of 18:12, 19 September 2024
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	* IgM and IgG antibodies are usually detectable by onset of symptoms		* IgM and IgG antibodies are usually detectable by onset of symptoms
	* IgM becomes undetectable by about 6 months while IgG persist lifelong and are protective~~<ref>Jack T. Stapleton, Host Immune Response To Hepatitis A Virus, ''The Journal of Infectious Diseases'', Volume 171, Issue Supplement_1, March 1995, Pages S9–S14, https~~:~~//doi.org/10.1093/infdis/171.Supplement_1.S9</ref>~~		* IgM becomes undetectable by about 6 months while IgG persist lifelong and are protective[[CiteRef::stapleton1995ho]]

	{\| class="wikitable"		{\| class="wikitable"

Aidan: /* Serology */

2023-10-11T13:24:26Z

Serology

← Older revision		Revision as of 13:24, 11 October 2023
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	==Diagnosis==		==Diagnosis==
	===Serology===		===Serology===

			* IgM and IgG antibodies are usually detectable by onset of symptoms
			* IgM becomes undetectable by about 6 months while IgG persist lifelong and are protective<ref>Jack T. Stapleton, Host Immune Response To Hepatitis A Virus, ''The Journal of Infectious Diseases'', Volume 171, Issue Supplement_1, March 1995, Pages S9–S14, https://doi.org/10.1093/infdis/171.Supplement_1.S9</ref>

	{\| class="wikitable"		{\| class="wikitable"
	!IgM!!IgG!!Interpretation		!IgM!!IgG!!Interpretation

Aidan: /* Vaccination */

2021-02-28T20:30:08Z

Vaccination

← Older revision		Revision as of 20:30, 28 February 2021
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	*Rare transmission by blood transfusion		*Rare transmission by blood transfusion

	=== Risk Factors ===		===Risk Factors===

	* Outbreak		*Outbreak
	* Close contact with a hepatitis A-infected person, including household, sexual, or other		*Close contact with a hepatitis A-infected person, including household, sexual, or other
	* Travel to endemic country		*Travel to endemic country
	* Men who have sex with men		*Men who have sex with men
	* Homelessness		*Homelessness
	* Injection drug use		*Injection drug use

	==Clinical Manifestations==		==Clinical Manifestations==
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	**People who use recreational drugs		**People who use recreational drugs
	**People living in communities with outbreaks or endemic hepatitis A		**People living in communities with outbreaks or endemic hepatitis A
	**Close contacts of children adopted from endemic ~~countires~~		**Close contacts of children adopted from endemic countries
	**Military personnel and humanitarian relief workers		**Military personnel and humanitarian relief workers
	**People receiving repeated doses of plasma-derived clotting factors		**People receiving repeated doses of plasma-derived clotting factors
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	*Vaccination requires two doses spaced at least 6 months apart		*Vaccination requires two doses spaced at least 6 months apart
	*It provides immunity for decades, and possibly for life		*It provides immunity for decades, and possibly for life

			==== Coformulation with Hepatitis B Vaccine ====

	*Often given combined with [[hepatitis B vaccine]] (HAHB)		*Often given combined with [[hepatitis B vaccine]] (HAHB)
	**HAHB is given as three doses (for the hepatitis B component)		*HAHB is given as three doses (for the hepatitis B component)
	**The hepatitis A component contains a full dose of hepatitis A vaccine, so a HAHB series essentially contains an extra unnecessary dose of hepatitis A vaccine		*The hepatitis A component contains a full dose of hepatitis A vaccine, so a HAHB series essentially contains an extra unnecessary dose of hepatitis A vaccine

			==== High Risk Groups Who Cannot Receive Vaccine ====

	*In people with contraindications or who are expected to have suboptimal response to vaccination, consider using immunoglobulin as preexposure prophylaxis		*In people with contraindications or who are expected to have suboptimal response to vaccination, consider using immunoglobulin as preexposure prophylaxis
	**Groups include:		*Groups include:
	***Infants less than 6 months of age		**Infants less than 6 months of age
	***Immunocompromised people in whom the vaccine may not be as effective (though they should also still be vaccinated)		**Immunocompromised people in whom the vaccine may not be as effective (though they should also still be vaccinated)
	***Anaphylaxis after previous hepatitis A vaccination or component thereof		**Anaphylaxis after previous hepatitis A vaccination or component thereof
	**Adminitering just before travel can confer immunity for up to 6 months of travel		*Administering just before travel can confer immunity for up to 6 months of travel
	**Dose is IMIg (GamaSTAN) 0.02 mL/kg for 3 months of protection, or 0.06 mL/kg every 6 months		*Dose is IMIg (GamaSTAN) 0.02 mL/kg for 3 months of protection, or 0.06 mL/kg every 6 months
	***CDC recommends a dose of IMIg (GamaSTAN S/D) 0.2 mL/kg q2mo due to decreases in hepatitis A IgG among donors		**CDC recommends a dose of IMIg (GamaSTAN S/D) 0.2 mL/kg q2mo due to decreases in hepatitis A IgG among donors

			==== Publicly Funded in Ontario ====

			* Only a subset of patients are publicly funded in Ontario:
			** Intravenous drug use
			** Chronic liver disease, including hepatitis B and C
			** Men who have sex with men

	===Post-Exposure Prophylaxis===		===Post-Exposure Prophylaxis===

Aidan at 20:08, 2 November 2020

2020-11-02T20:08:44Z

← Older revision		Revision as of 20:08, 2 November 2020
Line 2:		Line 2:
	===Microbiology===		===Microbiology===

	*Non-enveloped RNA virus within the ~~Picornavirus~~ family		*Non-enveloped RNA virus within the [[Family::Picornaviridae]] family
	*Three genotypes, I through III		*Three genotypes, I through III
	*Difficult to kill: needs higher temperatures and lower pH than other viruses, or bleach- or ammonium-based cleaners		*Difficult to kill: needs higher temperatures and lower pH than other viruses, or bleach- or ammonium-based cleaners
Line 11:		Line 11:
	*Can be transmitted by contaminated food and water, as well		*Can be transmitted by contaminated food and water, as well
	*Most often linked to travel or to household contacts		*Most often linked to travel or to household contacts
			*Rare transmission by blood transfusion

			=== Risk Factors ===

			* Outbreak
			* Close contact with a hepatitis A-infected person, including household, sexual, or other
			* Travel to endemic country
			* Men who have sex with men
			* Homelessness
			* Injection drug use

	==Clinical Manifestations==		==Clinical Manifestations==

	*Incubation period is from [[Usual incubation period::15 to 50 days]], with an average of 28 days		*Incubation period is from [[Usual incubation period::15 to 50 days]], with an average of 28 days
			*Children are usually asymptomatic
			*Symptoms include non-specific influenza-like illness followed eventually by bilirubinuria, pale stools, jaundice, and scleral icterus
			*May have hepatomegaly and splenomegaly, may have rash or arthralgia
			*Self-limited, usually starting to resolve by the third week of illness with full recovery often taking several months

	==Diagnosis==		==Diagnosis==
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	\|}		\|}

	== Prevention ==		==Prevention==

	=== Vaccination ===		===Vaccination===

	* Vaccination is indicated for people at increased risk of acquiring hepatitis A, or at increased risk of severe disease		*Vaccination is indicated for people at increased risk of acquiring hepatitis A, or at increased risk of severe disease
	** Travellers to endemic countries		**Travellers to endemic countries
	** People with chronic liver disease		**People with chronic liver disease
	** Men who have sex with men		**Men who have sex with men
	** People who use recreational drugs		**People who use recreational drugs
	** People living in communities with outbreaks or endemic hepatitis A		**People living in communities with outbreaks or endemic hepatitis A
	** Close contacts of children adopted from endemic countires		**Close contacts of children adopted from endemic countires
	** Military personnel and humanitarian relief workers		**Military personnel and humanitarian relief workers
	** People receiving repeated doses of plasma-derived clotting factors		**People receiving repeated doses of plasma-derived clotting factors
	** Laboratory workers studying hepatitis A		**Laboratory workers studying hepatitis A
	** Zookeepers, veterinarians, and researchers who interact with non-human primates		**Zookeepers, veterinarians, and researchers who interact with non-human primates
	* Vaccination requires two doses spaced at least 6 months apart		*Vaccination requires two doses spaced at least 6 months apart
	* It provides immunity for decades, and possibly for life		*It provides immunity for decades, and possibly for life
	* Often given combined with [[hepatitis B vaccine]] (HAHB)		*Often given combined with [[hepatitis B vaccine]] (HAHB)
	** HAHB is given as three doses (for the hepatitis B component)		**HAHB is given as three doses (for the hepatitis B component)
	** The hepatitis A component contains a full dose of hepatitis A vaccine, so a HAHB series essentially contains an extra unnecessary dose of hepatitis A vaccine		**The hepatitis A component contains a full dose of hepatitis A vaccine, so a HAHB series essentially contains an extra unnecessary dose of hepatitis A vaccine
	* In people with contraindications or who are expected to have suboptimal response to vaccination, consider using immunoglobulin as preexposure prophylaxis		*In people with contraindications or who are expected to have suboptimal response to vaccination, consider using immunoglobulin as preexposure prophylaxis
	** Groups include:		**Groups include:
	*** Infants less than 6 months of age		***Infants less than 6 months of age
	*** Immunocompromised people in whom the vaccine may not be as effective (though they should also still be vaccinated)		***Immunocompromised people in whom the vaccine may not be as effective (though they should also still be vaccinated)
	*** Anaphylaxis after previous hepatitis A vaccination or component thereof		***Anaphylaxis after previous hepatitis A vaccination or component thereof
	** Adminitering just before travel can confer immunity for up to 6 months of travel		**Adminitering just before travel can confer immunity for up to 6 months of travel
	** Dose is IMIg (GamaSTAN) 0.02 mL/kg for 3 months of protection, or 0.06 mL/kg every 6 months		**Dose is IMIg (GamaSTAN) 0.02 mL/kg for 3 months of protection, or 0.06 mL/kg every 6 months
	*** CDC recommends a dose of IMIg (GamaSTAN S/D) 0.2 mL/kg q2mo due to decreases in hepatitis A IgG among donors		***CDC recommends a dose of IMIg (GamaSTAN S/D) 0.2 mL/kg q2mo due to decreases in hepatitis A IgG among donors

	=== Post-Exposure Prophylaxis ===		===Post-Exposure Prophylaxis===

	* Post-exposure prophylaxis is indicated for susceptible contacts including:		*Post-exposure prophylaxis is indicated for susceptible contacts including:
	** Household members and close contacts of people infected with hepatitis A		**Household members and close contacts of people infected with hepatitis A
	** Contacts in group childcare centres and kindergartens		**Contacts in group childcare centres and kindergartens
	** Co-workers and clients of infected food handlers		**Co-workers and clients of infected food handlers
	* Prophylaxis is with monovalent hepatitis A vaccine		*Prophylaxis is with monovalent hepatitis A vaccine
	* In people with contraindications or who are expected to have suboptimal response to vaccination, immunogloulin should be given		*In people with contraindications or who are expected to have suboptimal response to vaccination, immunogloulin should be given
	** Groups include:		**Groups include:
	*** Infants less than 6 months of age		***Infants less than 6 months of age
	*** Immunocompromised people and people with liver disease, who should receive both vaccine and immunoglobulin		***Immunocompromised people and people with liver disease, who should receive both vaccine and immunoglobulin
	**** If they have received IVIg ≥400 mg/kg within the 3 weeks before exposure, then they do not require further immunoglobulin		****If they have received IVIg ≥400 mg/kg within the 3 weeks before exposure, then they do not require further immunoglobulin
	*** Elderly susceptible adults age 60 years and older may also receive both		***Elderly susceptible adults age 60 years and older may also receive both
	** It should be given as soon as possible, and can be given until 14 days after last exposure		**It should be given as soon as possible, and can be given until 14 days after last exposure
	** Dose is IMIg (GamaSTAN) 0.02 mL/kg body weight		**Dose is IMIg (GamaSTAN) 0.02 mL/kg body weight
	*** CDC recommends a dose of IMIg (GamaSTAN S/D) 0.1 mL/kg body weight due to decreases in hepatitis A IgG among donors		***CDC recommends a dose of IMIg (GamaSTAN S/D) 0.1 mL/kg body weight due to decreases in hepatitis A IgG among donors

	[[Category:Picornaviridae]]		[[Category:Picornaviridae]]

Aidan at 00:33, 18 September 2020

2020-09-18T00:33:34Z

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-=== Microbiology ===
+===Microbiology===
 {| class="wikitable"
-! IgM !! IgG !! Interpretation
+!IgM!!IgG!!Interpretation
 |-
-|  –  ||  –  || No recent infection (unless in the incubation period). No prior infection or vaccination.
+|–||–||No recent infection (unless in the incubation period). No prior infection or vaccination.
 |-
-|  –  ||  +  || No infection. Prior infection or vaccination.
+|–||+||No infection. Prior infection or vaccination.
 |-
-|  ?  ||  +  || Cannot rule out active infection. Prior infection or vaccination.
+|?||+||Cannot rule out active infection. Prior infection or vaccination.
 |-
-|  +  || +/– || Acute or recent infection. IgM positive from 2 weeks until 3-12 months. IgG positive from 8-12 weeks and remains positive for lifetime.
+| +||+/–||Acute or recent infection. IgM positive from 2 weeks until 3-12 months. IgG positive from 8-12 weeks and remains positive for lifetime.
 |}
 [[Category:Picornaviridae]]

Aidan: /* Serology */

2020-08-07T14:32:04Z

Serology

← Older revision		Revision as of 14:32, 7 August 2020
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	\|}		\|}

	[[Category:~~RNA viruses~~]]		[[Category:Picornaviridae]]
			[[Category:Gastrointestinal infections]]
			[[Category:Viral hepatitis]]

Aidan: /* Clinical Manifestations */

2020-08-05T13:36:32Z

Clinical Manifestations

← Older revision		Revision as of 13:36, 5 August 2020
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	== Clinical Manifestations ==		== Clinical Manifestations ==
	* Incubation period is from 15 to 50 days, with an average of 28 days		* Incubation period is from [[Usual incubation period::15 to 50 days]], with an average of 28 days

	== Diagnosis ==		== Diagnosis ==

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-14T23:22:34Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 23:22, 14 July 2020
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	* Most often linked to travel or to household contacts		* Most often linked to travel or to household contacts

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	* Incubation period is from 15 to 50 days, with an average of 28 days		* Incubation period is from 15 to 50 days, with an average of 28 days