Vaccination has reduced the incidence of hepatitis by 95 percent since 1995. In 2014, the rate was 0.4 per 100,000 individuals (Centers for Disease Control and Prevention, 2016b). his 27-nm RNA picornavirus is transmitted by the fecal-oral route, usually by ingestion of contaminated food or water. The incubation period is approximately 4 weeks. Individuals shed virus in their feces, and during the relatively brief period of viremia, their blood is also infectious. Signs and symptoms are oten nonspecific and usually mild, although jaundice develops in most patients. Symptoms usually last less than 2 months, although 10 to 15 percent of patients may remain symptomatic or relapse for up to 6 months (Dienstag, 20 15a). Early serological testing identifies IgVl anti-AV antibody, which may persist for several months. During convlescence, IgG antibody predominates, and it persists and provides subsequent immunity. here is no chronic stage of hepatitis A.
Management of hepatitis A in pregnancy includes a balanced diet and diminished physical activity. Women with less severe illness may be managed as outpatients. In developed countries, the efects of hepatitis A on pregnancy outcomes are not dramatic (American College of Obstetricians and Gynecologists, 2015, 2016). Both perinatal and maternal mortality rates, however, are substantively increased in resource-poor countries. Hepatitis A virus is not teratogenic, and transmission to the fetus is negligible. Preterm birth rates may be increased, and neonatal cholestasis has been reported (Urganci, 2003). Although hepatitis A RNA has been isolated in breast milk, no cases of neonatal hepatitis A have been reported secondary to breastfeeding (Daudi, 2012).
Preventatively, vaccination during childhood with foninactivated hepatitis viral vaccine is more than 90-percent efective. HA V vaccination is recommended by the American College of Obstetricians and Gynecologists (2016) and the Advisory Committee on Immunization (Kim, 20 15a) for highrisk adults. This category includes behavioral and occupational populations and travelers to high-risk countries. These countries are listed in the CDC (2016c) Health Information for International Travel "yellow book," which is available on the CDC website. Passive immunization for the pregnant woman recently exposed by close personal or sexual contact with a person with hepatitis A is provided by a 0.02 mLlkg dose of immune globulin (Kim, 2015a). Victor and colleagues (2007) reported that a single dose of HA V vaccine given in the usual dosage within 2 weeks of contact with an afected person was as efective as immune serum globulin to prevent hepatitis A. In both groups, HA V developed in 3 to 4 percent.
This double-stranded DNA virus is found worldwide. It is endemic in Africa, Central and Southeast Asia, China, Eastern Europe, the Middle East, and certain areas of South America, where prevalence rates reach 5 to 20 percent. The World Health Organization (WHO) (2009) estimates that more than 2 billion people worldwide are infected with HBV, and of these, 370 million have
TABLE 55-3. Simplified Diagnostic Approach in Patients with Hepatitis
Acute hepatitis A with + + +
HAV = hepatitis A virus; HBc = hepatitis B core; HBsAg = hepatitis B surface antigen; HCV = hepatitis C virus.
Compiled from the Centers for Disease Control and Prevention, 2016b; Dienstag, 2015a.