Clinical Features and Transmission Pattern of Hepatitis A: An Experience from a Hepatitis A Outbreak Caused by Two Cocirculating Genotypes in Sri Lanka

Abstract

Abstract. Sri Lanka is one of the intermediate-endemic areas for hepatitis A virus (HAV), and concerns exist about the increasing HAV-susceptible population. In fact, Sri Lanka recorded a large hepatitis outbreak, possibly hepatitis A, around the end of the Sri Lankan war. It included more than 14,000 patients consisting of local residents, internally displaced personnel, and military personnel in the main combat zone. The outbreak had slowed down by October 2009; however, acute viral hepatitis continued to occur sequentially among military personnel. We obtained clinical information and serum samples from 222 patients with acute hepatitis who visited the Military Hospital Anuradhapura between January and September 2010. Samples were subjected to laboratory testing including HAV-immunoglobulin M and genotyping. Most patients (98.2%) were confirmed as having hepatitis A belonging to two subgenotypes: IA and IIIA. We did not observe any differences in clinical or biochemical features among patients with subgenotypes IA and IIIA except for pale stools and upper abdominal discomfort. During the investigation period, we observed a serial outbreak caused by identical HAV strains with an interval in line with that of typical HAV incubation periods. Most patients in the first outbreak were found in the training center, and patients in the second outbreak were found in multiple places where soldiers were assigned after the training center. These findings indicate that a strain of HAV diffused from one place to another along with movement of infected persons among the HAV-susceptible population. HAV vaccination for high-risk groups, such as young soldiers, is necessary.

Increasing Burden of Hepatitis A in Adolescents and Adults and the Need for Long-Term Protection: A Review from the Indian Subcontinent

“…Typical clinical presentation, including adolescent and adult cases, was reported in detail in five studies, from India [18, 30, 31], Pakistan [32] and Sri Lanka [33]. All of these studies reported patients with jaundice (80–100%), abdominal pain (26–82%) and fever (45–91%).…”

“…Several HAV outbreaks were reported across India between 2004 and 2017 [4, 31, 38–43] as well as one in Sri Lanka in 2009–2010 [33, 44] (Table S2). It was noted that men were more affected as were adolescents and young adults (16–30 years, 142 cases) [42, 43].…”

“…Furthermore, the literature makes evident that the older age groups could present with more hepatomegaly [18, 32, 33], splenomegaly [18, 30, 33] and acute renal injury [35]. The recovery time in most cases without complications was 4–10 weeks and for acute liver failure 16 weeks [11] with extended hospital stays [32].…”

Comparison of the Clinical Features of Hepatitis A in People Living with HIV between Pandemics in 1999–2000 and 2017–2018 in the Metropolitan Area of Japan

“…1), the derived strains were different. However, it is known that the virulence of HAV is similar between different genotypes of strains (21,22). Therefore, the virulence of the strain between the 1999-2000 and 2017-2018 groups was considered to be similar.…”

Liver Disease in Sri Lanka

“…As a result, Sri Lanka experiences outbreaks of hepatitis A, which has become a significant health problem. 8 Random blood sampling in healthy individuals living in Colombo in 1975 showed prevalence of hepatitis A immunoglobulin G to be 76.9%; age-specific analysis indicated that infections were acquired during child-hood. 9 In 2001, a study conducted in Lady Ridgeway Children’s Hospital in Colombo among 288 children showed only 11.6% seroprevalence of hepatitis A antibody among children aged less than 10 years, and 78% of them were from families earning less than 10,000 rupees a month.…”