St. Luke's Family Medicine Residency Program, Sacred Heart Campus, Allentown, PA, USA.
St. Luke's Family Medicine Residency Program, Anderson Campus, Easton, PA, USA.
Am Fam Physician. 2021 Oct 1;104(4):368-374.
Hepatitis A is a common viral infection worldwide that is transmitted via the fecal-oral route. The incidence of infection in the United States decreased by more than 90% after an effective vaccine was introduced, but the number of cases has been increasing because of large community outbreaks in unimmunized individuals. Classic symptoms include fever, malaise, dark urine, and jaundice and are more common in older children and adults. People are most infectious 14 days before and seven days after the development of jaundice. Diagnosis of acute infection requires the use of serologic testing for immunoglobulin M anti-hepatitis A antibodies. The disease is usually self-limited, supportive care is often sufficient for treatment, and chronic infection or chronic liver disease does not occur. Routine hepatitis A immunization is recommended in children 12 to 23 months of age. Immunization is also recommended for individuals at high risk of contracting the infection, such as persons who use illegal drugs, those who travel to areas endemic for hepatitis A, incarcerated populations, and persons at high risk of complications from hepatitis A, such as those with chronic liver disease or HIV infection. The vaccine is usually recommended for pre- and postexposure prophylaxis, but immune globulin can be used in patients who are too young to be vaccinated or if the vaccine is contraindicated.
甲型肝炎是一种常见的全球病毒性感染，通过粪-口途径传播。在美国，一种有效的疫苗问世后，感染的发病率降低了 90%以上，但由于未免疫人群中发生了大规模的社区暴发，病例数一直在增加。典型症状包括发热、乏力、深色尿和黄疸，在年龄较大的儿童和成人中更为常见。人在出现黄疸前 14 天和出现黄疸后 7 天内最具传染性。急性感染的诊断需要使用血清学检测来检测针对甲型肝炎的免疫球蛋白 M 抗体。该疾病通常是自限性的，支持性治疗通常足以治疗，不会发生慢性感染或慢性肝病。建议在 12 至 23 个月大的儿童中常规接种甲型肝炎疫苗。建议对有感染高风险的人群进行免疫接种，例如使用非法药物的人、前往甲型肝炎流行地区的人、被监禁的人群以及有甲型肝炎并发症高风险的人群，如慢性肝病或 HIV 感染者。该疫苗通常建议用于暴露前和暴露后的预防，但对于年龄太小不能接种疫苗或疫苗有禁忌的患者，可以使用免疫球蛋白。
