Changing epidemiology of hepatitis A infection.

7 Viral hepatitis continues to be a major public health problem in India. Since the first officially reported epidemic of viral hepatitis in 1955 at Delhi, many outbreaks of hepatitis have occurred in different parts of the country. In India, hepatitis A virus (HAV) is still a major cause of sporadic acute hepatitis in children whereas HEV is the major agent for epidemics in adults. Most of the outbreaks of waterborne hepatitis in India have been attributed to HEV, but the epidemiology of viral hepatitis is changing as outbreaks of hepatitis A are being reported with increased frequency, in the paediatric age group as well. Children with HAV tend to present with non-specific gastrointestinal symptoms and jaundice with cholestasis is common. Viral hepatitis A in adults has a more severe course than in children. In recent years children and adults with acute viral hepatitis A have been reported to have more relapses and a protracted course. A study on 37 patients with acute viral hepatitis A (20 children and 17 adults) showed that the mean hospitalization period in adults was longer (28 days as compared with 19), the average serum bilirubin value was higher (5.5 mg/dl as compared with 3 mg/dl), there were more patients with obvious jaundice (59% as compared with 30%) and the serum antibody IgM antiHAV persisted longer (19 wk as compared with 14 wk). Relapses of the disease were equally frequent (12 vs. 10%), however adults had more often a protracted course of hepatitis (23.5 vs. 10%). The observed differences were not statistically significant, suggesting that viral hepatitis A in adults takes a more severe course than in children.