An overview of Hepatitis A at Tygerberg Children’s Hospital

Abstract

Introduction: Hepatitis A is a vaccine-preventable infection, often seen in children in the Western Cape.

Objectives: To describe childhood Hepatitis A morbidity and mortality at Tygerberg Children’s Hospital (TCH), a level two and three referral hospital in the Western Cape, South Africa

Methods: A retrospective chart review was conducted in children younger than 13 at TCH. Patients with positive Hepatitis A IgM were identified from the Tygerberg Hospital virology laboratory database. The cases were cross-referenced with the paediatric gastroenterology database. Data collected included demographics, clinical and laboratory information, outcome, notification and primary prophylaxis.

Results. 184 subjects were identified, comprising 117 males and 67 females with a median age of 69 (5 to 152) months. Two had hepatic failure and both died. Ten (5%) had known Hepatitis A contacts but received no post-exposure prophylaxis and only thirty-one (17%) were notified. A small percentage of patients were Hepatitis B, Hepatitis C and HIV positive, i.e. 2%, 0.5% and 0.5% respectively. The median population incidence was 45.4 per 100 000, higher than the 20 per 100 000 advocated as a threshold for introducing vaccination into the immunization schedule.

Conclusions. This study emphasises that Hepatitis A is a serious public health issue and a risk to young children. It is not a benign disease, but has significant high morbidity and mortality. In addition, a sizeable number of cases were preventable, and only a small number were notified. These results suggest that Hepatitis A vaccination should be introduced for children in the Western Cape attending public health facilities.