Dr.Shobika,Dr.Praveena,DrC Jayakumar
Dept of Pediatrics
AIMS KOCHI
Sixteen years old male child presented with complaints of fever associated with 2-3 episodes of vomiting,abdominal pain of 3 days duration,h/o passing high coloured urine of 1 day duration,with h/o hepatitis A outbreak in school
No h/o altered sensorium,bleeding manifestations alteration of sleep rhythm
No h/o previous hospital admissions in past.
At presentation,he was febrile,tired looking
General examination revealed icterus of eyes.
On clinical examination right hypochondriac tenderness,liver palpable 2cms below RCM,liver span 11cm.
DD
Investigations:TLC-4.47,N/L-38.4/51.2,LFT showed transaminitis (SGOT-793.7,SGPT-893.5)
IgM HAV done was positive
USG abdomen showed hepatomegaly, gall bladder edema,minimal perihepatic fluid.
The child was started on inj.NAC,IVF fluids + MVT,udiliv and other supportives.
Serial monitoring of LFT done were on improving trends.
Discharged with stable vitals.
Hepatitis A:
Inflammation of liver caused hepatitis A virus.
Transmission:
Faecal oral route
Symptoms:
Incubation period: 14-28 days
Symptoms of hepatitis A: Fever,malaise,loss of appetite,diarrhoea,nausea,abdominal discomfort,dark coloured urine and jaudice
Diagnosis: IgM HAV
Treatment: There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and can take several weeks or months. It is important to avoid unnecessary medications that can adversely affect the liver, e.g. acetaminophen, paracetamol.
Prevention
Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A.
The spread of hepatitis A can be reduced :
adequate supplies of safe drinking water;
proper disposal of sewage within communities; and
personal hygiene practices such as regular handwashing before meals and after going to the bathroom.
IAP recommendations: Hepatitis A vaccine schedule.
Routine vaccination:
• Inactivated vaccines: >12 months: Two doses administered intramuscular (IM) at 0 and 6–18 months
• Live vaccines: >12 months: Single dose administered subcutaneous (SC)
-up vaccination:
• Inactivated vaccines: Two doses administered IM at 0 and 6–18 months
• Live vaccines: single dose administered SC
• For catch-up vaccination, prevaccination screening for hepatitis A
antibody is recommended in children >10 years, as at this age the estimated seropositive rates exceed 50%
Hepatitis A Vaccines for Postexposure Prophylaxis
Hepatitis A vaccines are preferred for PEP, as vaccines have several advantages compared with IGIM, including the induction of active immunity, longer duration of protection, ease of administration, and greater availability. A single dose of Hepatitis A should be offered, within 2 weeks of exposure, to those between 1 and 40 years of age. This is as effective as IMIg, in preventing clinical hepatitis A disease.
or those <1 year or >40 years, IMIg in a dose of 0.1 mL/kg may be offered. This offers protection for 1 month.
World Health Organization concludes that both inactivated and live-attenuated hepatitis A vaccines are safe and highly immunogenic and that in most cases, these vaccines will generate long-lasting, possibly life-long protection against hepatitis A both in children and adults.8 Immunocompromised subjects can receive only the inactivated vaccines.