LETTER
Hepatitis A: A Potentially Serious Disease
Miguel J. Rodriguez, MD;
Eugene R. Schiff, MD; and
Andreas G. Tzakis, MD
15 September 1998 | Volume 129 Issue 6 | Page 506
TO THE EDITOR:
Willner and colleagues' brief communication [1] highlights the seriousness of the threat of hepatitis A to the United States, where the incidence of immunity is 38% [2]. We describe five patients with fulminant hepatic failure secondary to hepatitis A who were referred to the University of Miami Medical Center in the past 2 years, all of whom required liver transplantation.
Four of the patients were previously healthy adults who lived in southern Florida (age range, 26 to 55 years) and denied high-risk behavior. The fifth patient was a 6-year-old boy referred from Puerto Rico. One of the adult patients had a seizure disorder treated with valproic acid for 4 months before presentation. The presenting symptoms in all patients were fatigue, malaise, jaundice, coagulopathy, and encephalopathy; in two adult patients, these symptoms progressed to coma. All adult patients underwent orthotopic liver transplantation, and the child had orthotopic auxiliary liver transplantation. One of the adult patients required retransplantation because of graft dysfunction. Pathologic examination of the explanted livers revealed submassive or massive necrosis. All the patients are alive 7 to 24 months after transplantation and have recuperated with no evidence of recurrent disease. They have acquired immunity to hepatitis A despite immunosuppression. These cases did not follow an epidemic pattern, and no family members became ill, despite the severity of the cases and close contact with the patients. Serum of the patients was sent to the Centers for Disease Control and Prevention for isolation and genetic analysis. These results are not yet available.
Although hepatitis A is a self-limited, relatively mild illness in most patients, it can cause serious and even fatal disease. Given the availability of a safe and effective vaccine, cases of fulminant hepatic failure due to hepatitis A should not occur. The current immunization guidelines for hepatitis A in the United States must be expanded. The cost of one liver transplantation can easily pay for hundreds if not thousands of immunizations.
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Author and Article Information
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University of Miami School of Medicine; Miami, FL 33136
1. Willner IR, Uhl MD, Howard SC, Williams EQ, Riely CA, Waters B. Serious hepatitis A: an analysis of patients hospitalized during an urban epidemic in the United States. Ann Intern Med. 1998; 128:111-4.
2. Alter MJ, Mast EE. The epidemiology of viral hepatitis in the United States. Gastroenterol Clin North Am. 1994; 23:437-55.
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