Pediatric Hepatitis A Clinical Presentation

  • Author: Nicholas John Bennett, MB, BCh, PhD; Chief Editor: Russell W Steele, MD   more...
 
Updated: May 21, 2012
 

History and Physical Examination

History

The incubation period from the time of exposure to hepatitis A virus (HAV) to the appearance of symptoms is around 28 days (range 2 wk to 6 mo). The patient’s initial symptoms during the prodromal period include low-grade fever, nausea, vomiting, decreased appetite, and abdominal pain. Older children and adults are more likely to report pain in the right upper quadrant.

Diarrhea may occur in young children, whereas constipation is more common in adults. If present, jaundice, dark urine, and light-colored stool develop several days to a week after the onset of systemic symptoms. Anicteric infections are common in young children.

Physical examination

The general appearance is that of mild-to-moderate illness. A patient who appears severely ill is likely to have hepatitis of another cause or an atypical course. Mild hepatomegaly and right upper quadrant tenderness may be present. Clinical jaundice is present in two thirds of symptomatic patients. Splenomegaly may occur in 10-20% of patients.

Complications

Complications are few. Fulminant hepatitis with massive hepatic necrosis and liver failure due to HAV infection is rare. Cholestatic hepatitis occurs in a small percentage of patients. It is identified by persistent hyperbilirubinemia, pruritus, and constitutional symptoms that last for 12-16 weeks in the absence of biliary obstruction on sonograms.

Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Nicholas John Bennett, MB, BCh, PhD,  Assistant Professor in Pediatrics, Division of Infectious Diseases, Connecticut Children's Medical Center

Nicholas John Bennett, MB, BCh, PhD, is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Leslie L Barton, MD  Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

  1. Feinstone SM, Kapikian AZ, Purceli RH. Hepatitis A: detection by immune electron microscopy of a viruslike antigen associated with acute illness. Science. Dec 7 1973;182(116):1026-8. [Medline].

  2. Todd EC, Greig JD, Bartleson CA, Michaels BS. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 4. Infective doses and pathogen carriage. J Food Prot. Nov 2008;71(11):2339-73. [Medline].

  3. Wasley A, Grytdal S, Gallagher K. Surveillance for acute viral hepatitis--United States, 2006. MMWR Surveill Summ. Mar 21 2008;57(2):1-24. [Medline]. [Full Text].

  4. Wasley A, Samandari T, Bell BP. Incidence of hepatitis A in the United States in the era of vaccination. JAMA. Jul 13 2005;294(2):194-201. [Medline].

  5. Klevens RM, Miller JT, Iqbal K, Thomas A, Rizzo EM, Hanson H, et al. The evolving epidemiology of hepatitis a in the United States: incidence and molecular epidemiology from population-based surveillance, 2005-2007. Arch Intern Med. Nov 8 2010;170(20):1811-8. [Medline].

  6. CDC. Notice to readers: FDA approval of Havrix (hepatitis A vaccine, inactivated) for persons aged 1-18 years. MMWR. December 9, 2005;54(48):1235-1236. [Full Text].

  7. CDC. Notice to readers: FDA approval of VAQTA (hepatitis A vaccine, inactivated) for children aged >1 year. MMWR. October 14, 2005;54(40):1026. [Full Text].

  8. Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. May 19 2006;55:1-23. [Medline]. [Full Text].

  9. Victor JC, Monto AS, Surdina TY, Suleimenova SZ, Vaughan G, Nainan OV, et al. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med. Oct 25 2007;357(17):1685-94. [Medline]. [Full Text].

  10. [Guideline] Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. Oct 19 2007;56(41):1080-4. [Medline].

  11. AAP. Hepatitis A vaccine recommendations. Pediatrics. Jul 2007;120(1):189-99. [Medline].

  12. Ahmed M, Munshi SU, Nessa A, Ullah MS, Tabassum S, Islam MN. High prevalence of hepatitis A virus antibody among Bangladeshi children and young adults warrants pre-immunization screening of antibody in HAV vaccination strategy. Indian J Med Microbiol. Jan-Mar 2009;27(1):48-50. [Medline].

  13. Hammitt LL, Bulkow L, Hennessy TW, Zanis C, Snowball M, Williams JL, et al. Persistence of antibody to hepatitis A virus 10 years after vaccination among children and adults. J Infect Dis. Dec 15 2008;198(12):1776-82. [Medline].

  14. Sharapov UM, Bulkow LR, Negus SE, Spradling PR, Homan C, Drobeniuc J, et al. Persistence of hepatitis A vaccine induced seropositivity in infants and young children by maternal antibody status: 10-year follow-up. Hepatology. Feb 28 2012;[Medline].

 
Previous
Next
 
Incidence of acute hepatitis A virus in the United States from 1982-2006. (Image from "Surveillance for Acute Viral Hepatitis --- United States, 2006." MMWR March 21, 2008. 57(SS02);1-24)
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.