Hepatitis A in Children- Clinical Course, Complications and Laboratory Profile: Correspondence

Abstract

To the Editor: We read with great interest the article by Kumar et al. that reported the clinical course, complications and laboratory profile of Hepatitis A in children [1]. Although, they emphasized the hyperendemicity, fatal complications and cost effectiveness of Hepatitis A infection; and importance of improved sanitation and health education for its prevention, the importance of vaccination for preventing and control of Hepatitis A virus infection was not mentioned in their article. We think that vaccination against Hepatitis A would be significant part of planning for the prevention and control of viral hepatitis. Therefore, we want to make some comments on their article. Hepatitis A infection is a widespread disease, accounting for 1.4 million cases annually worldwide. In high endemic areas, the reported incidence of Hepatitis A infection may reach 150 per 100,000 per year [2]. The clinical spectrum of Hepatitis A infection ranges from asymptomatic infection to fulminant hepatitis. Clinical manifestations depend on the age of host: less than 30 % of infected young children are symptomatic, while approximately 80 % of adults manifest severe hepatitis with remarkably elevated serum aminotransferases [3]. Acute liver failure occurs in less than 1 % of cases. Hepatitis A infection is the most common detected cause of fulminant hepatitis among children in our country as well as worldwide [4]. The application of a routine Hepatitis A virus vaccine among children will reduce the potential for the development of severe complications. Hepatitis A incidence has declined 92 % with universal vaccination of young children in United States [5]. Universal Hepatitis Avirus immunization program has begun in Turkey since October 2012. Nearly 100 % of people develop protective levels of antibodies to the virus within one month after a single dose of the vaccine. Even thougha single dose of the vaccine has protectiveeffects; still, manufacturers recommend two vaccine doses to ensure a longer-term protection of about 5 to 8 y after vaccination. Hepatitis A infection is an important public health problem indevelopingcounties.Vaccinationagainst hepatitisAvirusis necessary for children older than one year. We believe that in addition to improved sanitation and food safety, the universal Hepatitis Avirus immunization programs are the most important means in effort to reduce Hepatitis A virus infection and related severe complications.