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Indian Pediatr 2009;46: 642-643 |
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Profile of Viral Hepatitis A in Chennai |
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Shrishu R Kamath, Malathi Sathiyasekaran, T Eswara Raja and Sudha,
From Mehta Children Hospital, Chennai and Department of
Pediatrics, Kanchi Kamakoti CHILDS Trust Hospital,
Chennai, India.
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Abstract
This retrospective study compares the clinical
features, laboratory profile and complications of anti HAV IgM positive
acute viral hepatitis A in 138 children between 1-15 year (1-5 year:
n=31; 5-10 year: n=85; and 10-15year: n=22). We found
that older children presented with HAV (hepatitis A virus) infection
with more atypical manifestations (ascites and splenomegaly) and
complications.
Key words: Children, Hepatitis A, India.
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We conducted this study to analyze the clinical profile
of type A virus infection in a tertiary referral centre in Chennai
catering to children from middle and high socioeconomic group. A total of
138 consecutive hospitalized/outpatient children (age 1m-15 y), from the
Kachi Kamakoti CHILDS trust Hospital with the clinical and biochemical
manifestations of acute hepatitis, and positive for antiHAV IgM were
included in the study over a period of three years (December 2002-December
2005). The age distribution, presenting complaints, laboratory
investigations, and ultrasonographic findings are summarized in
Table I. All children improved with conservative management.
TABLE I
Clinical, Biochemical, and Ultrasonographic Findings in Children with Hepatitis A Virus Infection (N=138)
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1-5 years (n=31) |
5-10 years (n=85) |
10-15 years
(n=22) |
P value |
| No. of
children |
28 (22.5%) |
85 (61.6%) |
22 (15.9%) |
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| Fever |
28 (90.3%) |
66 (77.6%) |
20 (90.9%) |
0.15 |
| Jaundice |
28 ( 90.3%) |
83 (97.6% ) |
21 ( 95.5%) |
0.14 |
| Vomiting |
27 (87.1%) |
64 (75.3%) |
19 (86.4%) |
0.26 |
| Pain
abdomen |
11 (35.5%) |
35 (41.2%) |
13 (59.1%) |
0.21 |
| Ascites |
0 |
8 (9.4%) |
4 (18.2%) |
0.07 |
| Pale
stools |
11 (35.5%) |
15 (17.6%) |
7 (31.8%) |
0.09 |
|
Splenomegaly |
16 (57.1%) |
9 (10.5%) |
19 (86.3%) |
0.18 |
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Complications |
0 |
0 |
8 (5.8%)* |
– |
| Free
fluid on USG (n=30) |
8(25.8%) |
12 (15.3%) |
10 (34.4%) |
0.564 |
| Age
(years) |
3.36 (3.0-3.6) |
7.24 (6.9-7.5) |
12.39 (11.6-13.1) |
<0.0001 |
| Total
bilirubin (mg/dL) |
4.83 (4.1-5.4) |
5.56 (4.9-6.2) |
5.72 (4.6-6.7) |
0.36 |
| Direct
bilirubin (mg/dL) |
3.82 (3.3-4.2) |
4.19 (3.6-4.6) |
4.36 (3.4-5.3) |
0.61 |
| SGOT (IU/dL) |
1497.6 (994.6-2000.6) |
1468.0 (1133.3-1802.7) |
1417.0 (776.7-2057.2) |
0.98 |
| SGPT (IU/dL) |
1665.6 (1211.9-2119.3) |
1633.0 (1372.6-1893.4) |
1600.8 (1137.2-2064.4) |
0.98 |
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Prothrombin time (s) |
7.39 (4.01-10.7) |
14.54 (13.1-15.9) |
12.92 (12.0-13.7) |
<0.0001 |
| Albumin
(g/dL) |
1.9 (1.23-2.6) |
3.5 (3.4-3.6) |
3.6 (3.4-3.8) |
<0.0001 |
*Complications include major gastrointestinal bleed, intracerebral bleed, and hypoglycemia in 1 child each,
grade I encephalopathy in 2 children, and acute liver cell failure in 4. Three children had prolonged
cholestasis (>12 wk); USG: ultrasonography.
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We noted an increased incidence of HAV (21%) in the
older children as compared to previous studies(1-4). The increase could be
attributed to either more older children being infected or lesser number
of younger children being infected due to the introduction of HAV
immunization. Several workers have documented the shift in epidemiology of
HAV infection with peak age of seroprevalance shifting from first decade
to third decade of life(2). In a study from Chennai, the mean prevalance
rate in children for HAV was 83.2% with the infection achieving
seroprevalance of 96.9% by the age of 12 years(3). The increase in number
of children in the age group of 10-15 years compared to study by Malathi,
et al.(1) could be possibly due to above cited reasons and possibly
the occurrence of this epidemiological shift in Chennai(1). At this point,
the reasons only be postulated as the present study was not done at the
community level. Another notable point is the increased incidence of
complications in older children. Probably our HAV vaccination policy needs
a review.
References
1. Malathi S, Mohanavalli B, Menon T, Srilatha P,
Sankaranarayanan VS, Bhaskar Raju B, et al. Clinical and viral
markers pattern of acute sporadic hepatitis in children at Madras, South
India. J Trop Pediatr 1998; 44: 275-278.
2. Mall ML, Rai RR, Philip M, Naik G, Parekh P,
Bhawnani SC, et al. Seroepidemiology of hepatitis A in India:
changing pattern. Indian J Gastroenterol 2001; 20: 132-135.
3. Mohanavalli B, Dhevahi E, Menon T, Malathi S,
Thyagarajan SP. Prevalence of antibodies to hepatitis A and hepatitis E
virus in urban school children in Chennai. Indian Pediatr 2003; 40:
328-331.
4. Poddar U, Thapa BR, Prasad A, Singh K. Changing
spectrum of sporadic acute viral hepatitis in Indian children. J Trop
Pediatr 2002; 48: 210-213. |
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