Hepatitis A Infections Signs and Symptoms Robert L. Brawley, MD, MPH, FSHEA Chief, Infectious Disease Branch Division of Epidemiology and Health Planning Department for Public Health

Acute Hepatitis – Clinical Symptoms Asymptomatic > Symptomatic > Fulminant Liver Failure > Death Symptoms (if present) are similar, regardless of cause (e.g., A, B, C, other viruses, toxins) Nausea, vomiting Abdominal pain Loss of appetite Fever Light (clay) colored stools Dark urine Jaundice (yellowing of eyes, skin) Diarrhea (more common in children with hepatitis A) Cabinet for Health and Family Services

Acute Infection with Hepatitis A Symptoms Jaundice 84% Weight loss 82% Malaise 80% Fever 76% Nausea 69% Vomiting 47% Abd pain 37% Arthralgias 6% Clinical Findings Hepatomegaly 87% Splenomegaly 9% Skin rashes 3% Mild edema 2% Petechiae 2% Cardiac <1% arrhythmias 1988 Shanghai epidemic, 8647 hospitalized patients Cabinet for Health and Family Services

Acute Infection with Hepatitis A Symptoms Anorexia 71-85% N / V 67-79% Malaise 76-80% Fever 18-58% Headache 19-73% Abd pain 26-54% Dark urine 68-94% Pale stool 52-58% Arthralgias 6-19% Signs Hepatomegaly 14-78% Hep. tenderness 39-46% Splenomegaly 3-13% Jaundice 40-80% Bradycardia 17% Lymphadenopathy 4% Skin rash 14% Epidemic and sporadic cases of hepatitis A Cabinet for Health and Family Services

Events In Hepatitis A Virus Infection 1 2 3 4 5 6 7 8 9 10 11 12 13 Week Response Clinical illness ALT IgM IgG HAV in stool Infection Viremia Cabinet for Health and Family Services

Hepatitis A Infections Hepatitis A Virus Transmission Fecal-oral Close personal contact (e.g., household contact, sexual contact, child day care centers) Contaminated food, water (e.g., infected food handlers, raw or undercooked mollusks harvested from contaminated water, contaminated produce [lettuce, strawberries]) Blood exposure (rare) (e.g., injecting drug use, rarely by transfusion and clotting factor concentrates) Hepatitis A Virus Transmission Transmission of HAV generally occurs as a result of a susceptible person ingesting virus that has been shed in the feces of an infected person. Close personal contact is the most common mode of HAV transmission as demonstrated by high rates of infection among household and sex contacts of persons with hepatitis A and among children in day care center outbreaks. Contaminated food and water can also serve as vehicles of HAV transmission; the vehicles of transmission in foodborne outbreaks are most often uncooked foods or foods touched by human hands after cooking, but outbreaks have been reported in association with foods contaminated before wholesale distribution. Because HAV can survive for 12 weeks or more in water, infection can occur by ingestion of a variety of raw shellfish harvested from sewage-contaminated areas. Waterborne outbreaks have occasionally been associated with drinking fecally contaminated water and with swimming in contaminated swimming pools and lakes. In addition, HAV transmission can occur as a result of blood exposures such as injecting drug use or blood transfusion because viremia can occur prior to onset of illness in infected persons; however, such transmission is rare. Cabinet for Health and Family Services