J Korean Med Assoc.  2009 Oct;52(10):996-1004. 10.5124/jkma.2009.52.10.996.

Hepatitis A: Past and Present

• Park SH

• KMID: 2188081
• DOI: http://doi.org/10.5124/jkma.2009.52.10.996

Abstract

HAV is a small, non-enveloped, and single-stranded RNA virus. The virus is transmitted from person to person through the fecal-oral route and through the ingestion of contaminated food. HAV infection normally affects children without producing symptoms but in adults it causes clinically apparent disease. The virus can spread easily from asymptomatic children to other children and to adult contacts. Children are thus considered to be a principal reservoir and dominant source of transmission in the community. Infection is maintained by serial transmission from infected individuals to those who are susceptible. While almost acute hepatitis A patients subside without progress to chronic liver disease, some patients may have relapsing, prolonged, cholestatic and fulminant hepatitis. Hepatitis A vaccine has been used successfully to prevent hepatitis A infection worldwide since mid-1990s. The sero-positivity pattern of anti-hepatitis A virus antibody (anti-HAV) has been changing rapidly from the intermediate to the low during the past 30 years in Korea. Thus adulthood acute hepatitis A became widespread in last 10 years in Korea due to decreased seroprevalence of anti-HAV. It can be recognized that acute hepatitis A is a "growing and living", not a "fading and dying" disease. The changes in seroepidemiologic pattern may cause sporadic and large community outbreaks and lead to increased healthcare cost. In this situation, we should have our own vaccination strategy to prevent and future eradication of hepatitis A infection.

Keyword

Hepatitis A virus; Hepatitis A; Seroepidemiology; Vaccine; Korea

MeSH Terms

Adult
Child
Disease Outbreaks
Eating
Health Care Costs
Hepatitis
Hepatitis A
Hepatitis A Antibodies
Hepatitis A Vaccines
Hepatitis A virus
Humans
Korea
Liver Diseases
RNA Viruses
Seroepidemiologic Studies
Vaccination
Viruses
Hepatitis A Antibodies
Hepatitis A Vaccines

Figure

• 

  Figure 1 Natural course of hepatitis A.

Reference

1. Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through active or passive immunization: Recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2006. 55:1–23.

2. Hong WS, Kim CY. Seroepidemiology of type A and type B hepatitis in Seoul area. Korean J Med. 1982. 25:19–27.

3. Dienstag JL, Szmuness W, Stevens CE, Purcell RH. Hepatitis A virus infection: New insights from seroepidemiologic studies. J Infect Dis. 1978. 137:328–340.

4. Hadler SC, Webster HM, Erben JJ, Swanson JE, Maynard JE. Hepatitis A in day-care centers. A community-wide assessment. N Engl J Med. 1980. 302:1222–1227.

5. Lednar WM, Lemon SM, Kirkpatrick JW, Redfield RR, Fields ML, Kelley PW. Frequency of illness associated with epidemic hepatitis A virus infections in adults. Am J Epidemiol. 1985. 122:226–233.

6. Yang DW, Lee YA, Shim JY, Park JY, Jung HL, Park MS, Lee YA, Shim JY, Park JY, Jung HL, Park MS, Keum DH. A seroepide-miologic study on hepatitis A in Seoul, Korea. J Korean Pediatr Soc. 1999. 42:180–185.

7. Lee CH, Chung KW, Moon YM. An outbreak of hepatitis A in Korean young adults in 1998. Korean J Gastroenterol. 1998. 32:S. 105A.

8. Kang HM, Jeong SH, Kim JW, Lee D, Choi CK, Park YS, Hwang JH, Kim N, Lee DH. Recent etiology and clinical features of acute viral hepatitis in a single center of Korea. Korean J Hepatol. 2007. 13:495–502.

9. Feinstone SM, Kapikian AZ, Purceli RH. Hepatitis A: Detection by immune electron microscopy of a viruslike antigen associated with acute illness. Science. 1973. 182:1026–1028.

10. Gust ID, Coulepis AG, Feinstone SM, Locarnini SA, Moritsugu Y, Najera R, Siegl G. Taxonomic classification of hepatitis A virus. Intervirology. 1983. 20:1–7.

11. Rueckert RR, Wimmer E. Systematic nomenclature of picornavirus proteins. J Virol. 1984. 50:957–959.

12. Probst C, Jecht M, Gauss-Muller V. Intrinsic signals for the assembly of hepatitis A virus particles. Role of structural proteins VP4 and 2A. J Biol Chem. 1999. 274:4527–4531.

13. Martin A, Lemon SM. Hepatitis A virus: From discovery to vaccines. Hepatology. 2006. 43:164–172.

14. Lemon SM, Binn LN. Antigenic relatedness of two strains of hepatitis A virus determined by cross-neutralization. Infect Immun. 1983. 42:418–420.

15. Robertson BH, Jansen RW, Khanna B, Totsuka A, Nainan OV, Siegl G, Widell A, Margolis HS, Isomura S, Ito K, et al. Genetic relatedness of hepatitis A virus strains recovered from different geographical regions. J Gen Virol. 1992. 73(Pt 6):1365–1377.

16. Park SH, Byun KS, Song JW, Kim JH, Song KJ, Baek LJ, et al. Molecular epidemiology of Korean strains of hepatitis A virus. Korean J Hepatol. 2000. 6:276–286.

17. Yun H, Kim S, Lee H, Byun KS, Kwon SY, Yim HJ, Jeong SH, Jee Y. Genetic analysis of HAV strains isolated from patients with acute hepatitis in Korea, 2005~2006. J Med Virol. 2008. 80:777–784.

18. Dotzauer A, Gebhardt U, Bieback K, Gottke U, Kracke A, Mages J, Lemon SM, Vallbracht A. Hepatitis A virus-specific immunoglobulin A mediates infection of hepatocytes with hepatitis A virus via the asialoglycoprotein receptor. J Virol. 2000. 74:10950–10957.

19. Blank CA, Anderson DA, Beard M, Lemon SM. Infection of polarized cultures of human intestinal epithelial cells with hepatitis A virus: Vectorial release of progeny virions through apical cellular membranes. J Virol. 2000. 74:6476–6484.

20. Cuthbert JA. Hepatitis A: Old and new. Clin Microbiol Rev. 2001. 14:38–58.

21. Song YB, Lee JH, Choi MS, Koh KC, Paik SW, Yoo BC, et al. The age-specific seroprevalence of hepatitis A virus antibody in Korea. Korean J Hepatol. 2007. 13:27–33.

22. Kwon YO, Choi IJ, Jung JW, Park JH. An epidemiologic study on the seropositive rate of hepatitis A virus among a selected group of children and adults in Pusan. Korean J Pediatr. 2007. 50:262–267.

23. Kim JH. Recent epidemiological status and vaccination of hepatitis A in Korea. J Korean Med Assoc. 2008. 51:110–118.

24. Koff RS. Hepatitis A. Lancet. 1998. 351:1643–1649.

25. Lemon SM. The natural history of hepatitis A: The potential for transmission by transfusion of blood or blood products. Vox Sang. 1994. 67:Suppl 4. 19–23. discussion 24-16.

26. Lee SG, Lee JH, Paik SW, Koh KC, Choi MS, Rhee PL, Kim JJ, Rhee JC, Choi KW, Sohn CI, Park CY, Cheon WK, Kim BI, Jung ES, Cheon SG, Park KH, Hwang IS, Kim EJ, Kang IK, Lee BW, Hur C. Clinical features of hepatitis A in Korean adults. Korean J Med. 1999. 56:685–690.

27. Lee TH, Kim SM, Lee GS, Im EH, Huh KC, Choi YW, Kang YW. Clinical features of acute hepatitis A in the western part of Daejeon and Chungnam province: Single center experience. Korean J Gastroenterol. 2006. 47:136–143.

28. Han SH, Lee SH, Roh BJ, Shim SC, Cho SC, Sohn JH, et al. An outbreak of hepatitis A in South Korean military personnel: A clinical and epidemiologic study. Korean J Hepatol. 2001. 7:392–400.

29. Park JY, Lee JB, Jeong SY, Lee SH, Lee MA, Choi HJ. Molecular characterization of an acute hepatitis A outbreak among healthcare workers at a Korean hospital. J Hosp Infect. 2007. 67:175–181.

30. Tassopoulos NC, Papaevangelou GJ, Ticehurst JR, Purcell RH. Fecal excretion of Greek strains of hepatitis A virus in patients with hepatitis A and in experimentally infected chimpanzees. J Infect Dis. 1986. 154:231–237.

31. Fujiwara K, Yokosuka O, Ehata T, Imazeki F, Saisho H, Miki M, Omata M. Frequent detection of hepatitis A viral RNA in serum during the early convalescent phase of acute hepatitis A. Hepatology. 1997. 26:1634–1639.

32. Kwon OS, Byun KS, Yeon JE, Park SH, Kim JS, Kim JH, Bak YT, Kim JH, Lee CH. Detection of hepatitis A viral RNA in sera of patients with acute hepatitis A. J Gastroenterol Hepatol. 2000. 15:1043–1047.

33. Liaw YF, Yang CY, Chu CM, Huang MJ. Appearance and persistence of hepatitis A IgM antibody in acute clinical hepatitis A observed in an outbreak. Infection. 1986. 14:156–158.

34. Hirata R, Hoshino Y, Sakai H, Marumo F, Sato C. Patients with hepatitis A with negative IgM-HA antibody at early stages. Am J Gastroenterol. 1995. 90:1168–1169.

35. Stapleton JT. Host immune response to hepatitis A virus. J Infect Dis. 1995. 171:Suppl 1. 9–14.

36. Ochnio JJ, Scheifele DW, Ho M, Mitchell LA. New, ultrasensitive enzyme immunoassay for detecting vaccine-and disease-induced hepatitis A virus-specific immunoglobulin G in saliva. J Clin Microbiol. 1997. 35:98–101.

37. LaBrecque FD, LaBrecque DR, Klinzman D, Perlman S, Cederna JB, Winokur PL, Han JQ, Stapleton JT. Recombinant hepatitis A virus antigen: Improved production and utility in diagnostic immunoassays. J Clin Microbiol. 1998. 36:2014–2018.

38. Glikson M, Galun E, Oren R, Tur-Kaspa R, Shouval D. Relapsing hepatitis A Review of 14 cases and literature survey. Medicine (Baltimore). 1992. 71:14–23.

39. Kim JM, Lee YS, Lee JH, Kim W, Lim KS. Clinical outcomes and predictive factors of spontaneous survival in patients with fulminant hepatitis A. Korean J Hepatol. 2008. 14:474–482.

40. Song KS, Kim MJ, Jang CS, Jung HS, Lee HH, Kwon OS, Kim YS, Choi DJ, Kim JH, Ha SY. Clinical features of acute viral hepatitis A complicated with acute renal failure. Korean J Hepatol. 2007. 13:166–173.

41. Bae YJ, Kim KM, Kim KK, Rho JH, Lee HK, Lee YS, Suh DJ. A case of acute hepatitis A complicated by Guillain-Barre syndrome. Korean J Hepatol. 2007. 13:228–233.

42. Kim SY, Kim MG, Choi WC. Acute transverse myelitis after acute hepatitis A: Findings on magnetic resonance imaging. Clin Gastroenterol Hepatol. 2008. 6:xxviii-e1.

43. Clemens R, Safary A, Hepburn A, Roche C, Stanbury WJ, Andre FE. Clinical experience with an inactivated hepatitis A vaccine. J Infect Dis. 1995. 171:Suppl 1. 44–49.

44. Craig AS, Schaffner W. Prevention of hepatitis A with the hepatitis A vaccine. N Engl J Med. 2004. 350:476–481.

45. Wang XY, Xu ZY, Ma JC, von Seidlein L, Zhang Y, Hao ZY, Han OP, Zhang YL, Tian MY, Ouyang PY, Zhang ZY, Han CQ, Xing ZC, Chen JC. Long-term immunogenicity after single and booster dose of a live attenuated hepatitis A vaccine: Results from 8-year follow-up. Vaccine. 2007. 25:446–449.

46. Cui F, Hadler SC, Zheng H, Wang F, Zhenhua W, Yuansheng H, Gong X, Chen Y, Liang X. Hepatitis A surveillance and vaccine use in China from 1990 through 2007. J Epidemiol. 2009. 19:189–195.

47. Faridi MM, Shah N, Ghosh TK, Sankaranarayanan VS, Arankalle V, Aggarwal A, Sathiyasekaran M, Bhattacharya N, Vasanthi T, Chatterjee S, Choudhury J, Mitra M. Immunogenicity and safety of live attenuated hepatitis A vaccine: A multicentric study. Indian Pediatr. 2009. 46:29–34.

48. Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the advisory committee on immunization practices (ACIP). MMWR Morb Mortal Wkly Rep. 2007. 56:1080–1084.

49. Victor JC, Monto AS, Surdina TY, Suleimenova SZ, Vaughan G, Nainan OV, Favorov MO, Margolis HS, Bell BP. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med. 2007. 357:1685–1694.

50. Lee CS, Lee JH, Kwon KS. Outbreak of hepatitis A in Korean military personnel. Jpn J Infect Dis. 2008. 61:239–241.

51. Jee YM, Go U, Cheon D, Kang Y, Yoon JD, Lee SW, Shin YH, Kim KS, Lee JK, Jeong EK, Yang BK, Cho HW. Detection of hepatitis A virus from clotting factors implicated as a source of HAV infection among haemophilia patients in Korea. Epidemiol Infect. 2006. 134:87–93.

52. Hepatitis A vaccination coverage among children aged 24~35 months-United States, 2006 and 2007. MMWR Morb Mortal Wkly Rep. 2009. 58:689–694.

53. Jeong SH. Current status and vaccine indication for hepatitis A virus infection in Korea. Korean J Gastroenterol. 2008. 51:331–337.

54. Wasley A, Samandari T, Bell BP. Incidence of hepatitis A in the United States in the era of vaccination. JAMA. 2005. 294:194–201.

55. Dagan R, Leventhal A, Anis E, Slater P, Ashur Y, Shouval D. Incidence of hepatitis A in Israel following universal immunization of toddlers. JAMA. 2005. 294:202–210.

56. Dominguez A, Oviedo M, Carmona G, Jansa JM, Borras E, Salleras L, PlasËncia A. Epidemiology of hepatitis A before and after the introduction of a universal vaccination programme in Catalonia, Spain. J Viral Hepat. 2008. 15:Suppl 2. 51–56.

57. Dominguez A, Oviedo M, Carmona G, Batalla J, Bruguera M, Salleras L, PlasËncia A. Impact and effectiveness of a mass hepatitis A vaccination programme of preadolescents seven years after introduction. Vaccine. 2008. 26:1737–1741.

58. Lopez E, Debbag R, Coudeville L, Baron-Papillon F, Armoni J. The cost-effectiveness of universal vaccination of children against hepatitis A in Argentina: Results of a dynamic health-economic analysis. J Gastroenterol. 2007. 42:152–160.

59. Armstrong GL, Billah K, Rein DB, Hicks KA, Wirth KE, Bell BP. The economics of routine childhood hepatitis A immunization in the Uunited States: The impact of herd immunity. Pediatrics. 2007. 119:22–29.

60. Chodick G, Heymann AD, Ashkenazi S, Kokia E, Shalev V. Long-term trends in hepatitis A incidence following the inclusion of hepatitis A vaccine in the routine nationwide immunization program. J Viral Hepat. 2008. 15:Suppl 2. 62–65.

61. Anonychuk AM, Tricco AC, Bauch CT, Pham B, Gilca V, Duval B, John-Baptiste A, Woo G, Krahn M. Cost-effectiveness analyses of hepatitis A vaccine: A systematic review to explore the effect of methodological quality on the economic attractiveness of vaccination strategies. Pharmacoeconomics. 2008. 26:17–32.

62. Rein DB, Hicks KA, Wirth KE, Billah K, Finelli L, Fiore AE, Hoerger TJ, Bell BP, Armstrong GL. Cost-effectiveness of routine childhood vaccination for hepatitis A in the United States. Pediatrics. 2007. 119:12–21.

63. Hendrickx G, Van Herck K, Vorsters A, Wiersma S, Shapiro C, Andrus JK, Ropero AM, Shouval D, Ward W, Van Damme P. Has the time come to control hepatitis A globally? Matching prevention to the changing epidemiology. J Viral Hepat. 2008. 15:Suppl 2. 1–15.