Hepatitis A: clinical manifestations and management

Area of Science:

• Hepatology
• Infectious Diseases
• Public Health

Background:

• Improved living conditions have altered hepatitis A epidemiology, leading to increased disease burden in many regions.
• Recent large-scale outbreaks in Korea highlight the resurgence and public health impact of hepatitis A virus (HAV) infection.
• The clinical presentation of HAV infection varies widely, from asymptomatic cases to severe hepatitis, influenced by host age.

Purpose of the Study:

• To summarize the current epidemiology, clinical spectrum, and management strategies for hepatitis A.
• To emphasize the importance of age-dependent clinical manifestations and rare extrahepatic complications.
• To advocate for adaptive vaccination programs based on regional disease burden and epidemiology.

Main Methods:

• Review of existing literature on hepatitis A epidemiology, clinical features, and management.
• Analysis of clinical data regarding age-specific manifestations and outcomes.
• Synthesis of information on supportive care, vaccination strategies, and potential prognostic factors.

Main Results:

• Hepatitis A severity and symptoms are strongly age-dependent, with adults experiencing more severe illness and elevated aminotransferases compared to young children.
• Rare but serious complications include fulminant hepatitis, relapsing disease, cholestasis, acute kidney injury, and various extrahepatic manifestations.
• While supportive care is standard, active vaccination is the primary management strategy, requiring regional adaptation.

Conclusions:

• Hepatitis A poses a growing public health challenge, characterized by diverse clinical presentations and age-related severity.
• Effective management hinges on understanding its epidemiology, recognizing atypical and extrahepatic manifestations, and implementing targeted vaccination strategies.
• Further research into prognostic predictors is needed to guide critical decisions, such as liver transplantation.