Abstract：
BACKGROUND: Hepatitis A Virus (HAV) is the most common cause of Acute Viral Hepatitis (AVH) in children. It causes self-limiting illness and rarely acute liver failure. The shifting pattern in HAV endemicity is rendering adolescents and adults vulnerable to infection.
METHODS: In this retrospective study, samples received from 14,807 patients with acute onset icteric illness from January 2014-December 2022 were analyzed. HAV infection was detected by anti-HAV IgM positivity. The cases were divided into 3 age groups, pediatric, adolescents and adults, and clinical presentations were compared.
RESULTS: Overall, 7.72%(1144) were positive for anti-HAV IgM. Of these, 60%(690) were finally included in the study. The positive cases were divided into adults, ≥18 years (44%, 304); pediatric, <12 years (31%, 212) and adolescents (25%,174) age groups. Overall males were predominant [72.4%(500)], with a median age of 16 (IQR:9-21) years. Cases were characterised into AVH (68.1%, 470/690), Acute Liver Failure (ALF) (31.4%, 217/690) and Acute-on-Chronic Liver Failure (0.43%, 3/690). AVH in the pediatric age group was 69%(146/212), adolescents was 67%(117/174), and adults was 68%(207/304). ALF cases among the 3 groups were 30%(65/212), 33%(57/174), and 31%(95/304) respectively. Overall mortality was seen in 6.52%(45/690), maximum in adolescents with ALF presentation [10.3%(18/174)]. On molecular characterization of infection, viremia was seen in 28.9%(200/690) and all the isolates were Genotype IIIA.
CONCLUSIONS: The number of adults experiencing symptomatic HAV infection was seen to increase over the years in the present study. Infection in adolescents was associated with higher mortality and ALF as the clinical presentation.
METHODS: In this retrospective study, samples received from 14,807 patients with acute onset icteric illness from January 2014-December 2022 were analyzed. HAV infection was detected by anti-HAV IgM positivity. The cases were divided into 3 age groups, pediatric, adolescents and adults, and clinical presentations were compared.
RESULTS: Overall, 7.72%(1144) were positive for anti-HAV IgM. Of these, 60%(690) were finally included in the study. The positive cases were divided into adults, ≥18 years (44%, 304); pediatric, <12 years (31%, 212) and adolescents (25%,174) age groups. Overall males were predominant [72.4%(500)], with a median age of 16 (IQR:9-21) years. Cases were characterised into AVH (68.1%, 470/690), Acute Liver Failure (ALF) (31.4%, 217/690) and Acute-on-Chronic Liver Failure (0.43%, 3/690). AVH in the pediatric age group was 69%(146/212), adolescents was 67%(117/174), and adults was 68%(207/304). ALF cases among the 3 groups were 30%(65/212), 33%(57/174), and 31%(95/304) respectively. Overall mortality was seen in 6.52%(45/690), maximum in adolescents with ALF presentation [10.3%(18/174)]. On molecular characterization of infection, viremia was seen in 28.9%(200/690) and all the isolates were Genotype IIIA.
CONCLUSIONS: The number of adults experiencing symptomatic HAV infection was seen to increase over the years in the present study. Infection in adolescents was associated with higher mortality and ALF as the clinical presentation.
摘要：
背景：甲型肝炎病毒（HAV）是儿童急性病毒性肝炎（AVH）的最常见原因。它会导致自限性疾病和罕见的急性肝功能衰竭。HAV流行的转变模式使青少年和成年人容易受到感染。
方法：在这项回顾性研究中，我们分析了2014年1月至2022年12月期间14,807例急性发作性黄疸患者的样本.通过抗HAVIgM阳性检测HAV感染。病例分为3个年龄组,儿科,青少年和成人，并对临床表现进行比较。
结果：总体而言，7.72％（1144）的抗HAVIgM阳性。其中,60％（690）最终被纳入研究。阳性病例分为成人，≥18岁(44%，304)；儿科，<12年（31%，212）和青少年（25%，174)年龄组。总体上男性占主导地位[72.4％（500）]，年龄中位数为16（IQR：9-21）岁。病例以AVH为特征(68.1%，470/690），急性肝衰竭（ALF）（31.4%，217/690）和慢性急性肝衰竭（0.43%，3/690）。小儿年龄组的AVH为69％（146/212），青少年为67%(117/174)，成年人占68%(207/304)。3组ALF例数为30%(65/212),33%(57/174)，分别为31%(95/304)。总死亡率为6.52％（45/690），有ALF表现的青少年最高[10.3%(18/174)]。关于感染的分子特征，病毒血症占28.9%(200/690)，所有分离株均为基因型IIIA。
结论：在本研究中，经历有症状的HAV感染的成人数量多年来有所增加。青少年感染与较高的死亡率和作为临床表现的ALF相关。
方法：在这项回顾性研究中，我们分析了2014年1月至2022年12月期间14,807例急性发作性黄疸患者的样本.通过抗HAVIgM阳性检测HAV感染。病例分为3个年龄组,儿科,青少年和成人，并对临床表现进行比较。
结果：总体而言，7.72％（1144）的抗HAVIgM阳性。其中,60％（690）最终被纳入研究。阳性病例分为成人，≥18岁(44%，304)；儿科，<12年（31%，212）和青少年（25%，174)年龄组。总体上男性占主导地位[72.4％（500）]，年龄中位数为16（IQR：9-21）岁。病例以AVH为特征(68.1%，470/690），急性肝衰竭（ALF）（31.4%，217/690）和慢性急性肝衰竭（0.43%，3/690）。小儿年龄组的AVH为69％（146/212），青少年为67%(117/174)，成年人占68%(207/304)。3组ALF例数为30%(65/212),33%(57/174)，分别为31%(95/304)。总死亡率为6.52％（45/690），有ALF表现的青少年最高[10.3%(18/174)]。关于感染的分子特征，病毒血症占28.9%(200/690)，所有分离株均为基因型IIIA。
结论：在本研究中，经历有症状的HAV感染的成人数量多年来有所增加。青少年感染与较高的死亡率和作为临床表现的ALF相关。
