Abstract
Objective: To determine the demographic, clinical, laboratory features and outcome of
Hepatitis A Virus (HAV) infection in children and young adults seen at Shifa
International Hospital, Islamabad, Pakistan.
Methods: We analyzed all cases of Hepatitis A infection at Shifa International Hospital
(SIH), Islamabad over a three-year period from October 2002 to December 2005. HAV
immunoglobulin M (IgM) was used as a marker of acute infection. Data regarding
demographic, laboratory investigations, morbidity and complications were collected.
Results: A total of 185 patients presented with acute HAV infection during the study
period. Mean age was 11.5±7.3 years (range 2-34) with 26% >16 years of age. There
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were 66% males and 68% were students (including 2.5% physicians or medical students).
Sixty-five percent belonged to middle socioeconomic class, 20% to high and 6% to low
socioeconomic class. Eighty-one percent patients were from Rawalpindi/Islamabad area
and 73% cases occurred during July to December months. Clinical symptoms included
jaundice (80%), fever (45%), vomiting (62%), abdominal pain (43%), tender
hepatomegaly (21%) and diarrhea (9%). Mean duration of symptoms before diagnosis
was 6±4 days. There was history of contact in only 7% patients. The mean total bilirubin
was 5.9±7mg/dl and serum alanine aminotransferase (ALT) 1805±1642 mg/dl.
Hospitalization was required in 30% patients and 57% of these were of age >12 years.
Mean duration of hospitalization was 2.9±2.6days. There was a statistically significant
difference between those <15 yrs compared to those >15 yrs in terms of mean ALT
(p<0.005) and hospitalization rate (p<0.006). However, there was no statistically
difference for mean total bilirubin (p=0.8), duration of hospitalization (p=0.9) or
fulminant hepatitis (p=0.8). Treatment included vitamins and intravenous fluids (IVF) in
13%, antibiotics 3%, steroids 1% and combination of IVF, antibiotics and steroids in
19%. There was no mortality but 2% had fulminant hepatitis and required longer
hospitalization (mean 9 days). Thirty-five percent had follow-up of more than 7 days. At
follow-up, complete recovery was observed in 52%, incomplete in 22%. Twenty-seven
percent were lost to follow-up.
Conclusions: HAV infection is now more common in older children and adults. Severe
hepatitis, fulminant hepatitis, higher and longer hospitalization rates can occur.
Unnecessary investigations and treatment add to the cost of illness. Vaccination against
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HAV should be considered, especially in high risk individuals (Rawal Med J 2009;34:36-
39).

Key words: Hepatitis A virus, hepatitis, children.