How does it spread ?
It spreads by person to person contact and feco-oral route. Parenteral transmission is rare.
What are the clinical manifestations?
They may go unrecognised. Non-specific symptoms like nausea, vomiting, abdominal pain , leg pain , loss of appetite followed by clinical jaundice and tender hepatomegaly are seen in majority of patients .
What is the clinical course?
The disease is self-limiting. Jaundice resolves in 2-3 weeks. Some children may have a cholestatic phase. Hepatitis A does not cause a carrier state or chronic liver disease.
What are the danger signs?
Fever persisting in spite of jaundice, persistent vomiting, drowsiness and no recovery in appetite after 15 days.
Are any laboratory tests necessary?
They may be necessary if there are any danger signs. Otherwise the diagnosis remains clinical and the treatment is not altered based on liver function tests. Elevated anti HAV IgM remains the gold standard serological test.
What is the differential diagnosis?
Many other infectious diseases like typhoid, malaria especially falciparum, dengue, leptospirosis may present as jaundice but these don't have marked elevation in liver enzymes.
Is there any specific treatment?
It is a self-limiting disease. No specific treatment is available. Bed rest and restricted protein and fat intake helps in early recovery.
What about alternative medicines?
These are all anecdotal and based on hearsay evidence and not proven in medical literature.
Is prevention possible?
Immune serum globulin 0.02 ml /kg intramuscular may be given to contacts and to travellers to endemic region. HAV vaccine is available but currently is an optional vaccine as per IAP recommendations as India is an endemic area. A practical approach would be to do anti HAV IgG titres by the time the child is 6 -7 years old and if found negative to give the vaccine. Vaccine is available as 2 doses to be given 6 months apart.
