Can hepatitis A be subclinical?

From the Guidelines

Yes, hepatitis A can be subclinical, with the majority of infections in children under 6 years of age being asymptomatic or mild. According to the most recent and highest quality study 1, the likelihood of having symptoms with HAV infection increases with age, with fewer than 10% of infections among children aged 0--4 years resulting in jaundice. This percentage increases to 30%--40% among children aged 5--9 years, 60%--80% among youths aged 10--17 years, and 80%--90% among adults aged ≥18 years.

Key Points

• Hepatitis A infections can be subclinical, especially in young children, with approximately 70% of infections in children being subclinical 1.
• Even without symptoms, infected individuals can still transmit the virus to others through the fecal-oral route, with peak infectivity occurring during the 2-week period before onset of jaundice or elevation of liver enzymes 1.
• The immune system still responds to subclinical infections by producing antibodies, which provide lifelong immunity against future hepatitis A infections 1.
• No specific treatment is needed for subclinical hepatitis A infections as they resolve on their own, but vaccination remains the most effective prevention strategy 1.

Transmission and Prevention

• Hepatitis A virus is primarily transmitted by the fecal-oral route, by either person-to-person contact or through consumption of contaminated food or water 1.
• Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection, including international travelers, household or sexual contacts, and persons with chronic liver disease 1.

From the Research

Hepatitis A Infection

• Hepatitis A is a common viral infection worldwide that is transmitted via the fecal-oral route 2.
• The disease is usually self-limited, supportive care is often sufficient for treatment, and chronic infection or chronic liver disease does not occur 2.

Subclinical Hepatitis A

• Infection is often asymptomatic in children 3.
• Hepatitis A can be subclinical, particularly in children, as they are more likely to have asymptomatic infections 3.

Clinical Manifestations

• Adults with hepatitis A often present with jaundice, abdominal pain, hepatitis, and hyperbilirubinemia 3.
• Classic symptoms of hepatitis A include fever, malaise, dark urine, and jaundice, and are more common in older children and adults 2.

Prevention and Treatment

• Vaccination is the mainstay of prevention and should be given before exposure whenever possible 3.
• Treatment mainly consists of supportive measures, while the available evidence for aetiological treatment and additional agents in severe disease is limited in quantity and quality 4.