Memphis and Shelby County, Tennessee, experienced an epidemic of hepatitis A in 1994 and 1995. More than 1700 cases were reported. The objective of this study was to characterize the clinical features of patients hospitalized during this large urban epidemic of hepatitis A. The design used was a Retrospective chart review. The study took place at 15 acute care hospitals in Shelby County, Tennessee.
A total of 256 patients were hospitalized with acute hepatitis A. The measurements used were laboratory findings (such as prothrombin time and bilirubin level), complications, and mortality. The median patient age was 26 yr. Thirty-nine complications occurred in 35 patients. Twenty patients (8%) had extrahepatic complication and five (2%) died. Patients 40 yr of age and older were more likely to have serious complications, including death (p= 0.014). Sixty-seven patients (26%) presented with coagulopathy (prothrombin time ≥ prolonged). Fifty-four patients (21%) had a bilirubin level greater than 170 μmol/L (10 mg/dL).
In conclusion, during this epidemic, hepatitis A caused serious illness and death. Complications were more frequent in patients 40 yr of age and older, but young, healthy persons were also at risk for severe complications. (Am J Gastroenterol 1998;93:2305–2306. © 1998 by Am. Coll. of Gastroenterology)
Hepatitis A virus (HAV) infection rarely causes fulminant hepatic failure in people with no underlying liver disease. There are limited data on the course of this infection in patients with chronic hepatitis B and chronic hepatitis C. The authors prospectively followed, from June 1990 to July 1997, 595 adults with biochemical and histological evidence of chronic hepatitis B (163 patients) or chronic hepatitis C (432 patients) who were seronegative for HAV antibodies. All were tested every 4 months for serum IgM and IgG antibodies to HAV.
Twenty-seven patients acquired HAV superinfection, 10 of whom had chronic hepatitis B and 17 of whom had chronic hepatitis C. One of the patients with chronic hepatitis B, who also had cirrhosis, had marked cholestatis (peak serum bilirubin level, 28 mg per deciliter [479 μmol per liter]); the other nine had uncomplicated courses of hepatitis A. Fulminant hepatic failure developed in seven of the patients with chronic hepatitis C, all but one of whom died. The other 10 patients with chronic hepatitis C had uncomplicated courses of hepatitis A.
In conclusion, although most patients with chronic hepatitis B who acquired HAV infection had an uncomplicated course, patients with chronic hepatitis C had a substantial risk of fulminant hepatitis and death associated with HAV superinfection. Our data suggest that patients with chronic hepatitis C should be vaccinated against hepatitis A. (Am J Gastroenterol 1998;93:2305–2306. © 1998 by Am. Coll. of Gastroenterology)
1Indiana University School of Medicine Indianapolis, IN
2Emory University School of Medicine Atlanta, GA
Willner IR, Mark D, Uhl MD, et al. Serious Hepatitis A: An Analysis of Patients Hospitalized During an Urban Epidemic in the United States Ann Intern Med 1998;128:111–4
Vento S, Garofano T, Renzini C, et al. Fulminant Hepatitis Associated With Hepatitis A Virus Superinfection in Patients With Chronic Hepatitis C, N Engl J Med 1998;338:286–90