Hospitalization and mortality due to hepatitis A in Taiwan: a 15‐year nationwide cohort study

Chen, C.‐M.; Chen, S. C.‐C.; Yang, Hsin-Yi; Yang, Su-Jau; Wang, C.‐M.

doi:10.1111/jvh.12564

Cited by 33 publications

(33 citation statements)

References 22 publications

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“…In acute hepatitis C, women are more likely to clear the virus, but the sex‐difference severity is unknown . Contrarily, acute hepatitis A was more severe in male patients . It is possible that a hormonal factor plays some role and that the pathogenesis is different between acute infection with different hepatitis virus.…”

Section: Discussionmentioning

confidence: 99%

“…Along this line, women are more likely to clear the hepatitis C virus infection spontaneously . However, male patients with acute hepatitis A had a higher case fatality rate with an age adjusted odds ratio of 2.35 in a recent Taiwan study of 3,990 hospitalized patients . There seems no data on the sex difference in the severity of acute hepatitis B virus (HBV) infection.…”

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confidence: 99%

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Overt acute hepatitis B is more severe in female patients

Chang

Liaw

2017

Hepatology

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Overt acute hepatitis B is more severe in female patients

Chang

Liaw

2017

Hepatology

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“…This was a single-center study in which the studied population may not represent the entire population of the country. This difference can be observed by the higher positive HBsAg prevalence (17.9%) in the studied population compared to the estimated number of HBV carriers in the entire population (10–13%, between 2.5 and 3 million people in Taiwan [20]) and a higher mortality rate (3.9%) compared to previous reports (1.68% [18], 0.3–0.6% [21]). This is, in part, related to the study center, which was a tertiary referral hospital with patients potentially bearing more co-morbidities.…”

Section: Discussionmentioning

confidence: 56%

“…The risks of mortality and complications of acute hepatitis A increase with age, pre-existing chronic liver disease and medical co-morbidities [18, 22, 23]. Our study reports that MSM and HIV-positive populations are also at increased risk of developing a more icteric and protracted course.…”

Section: Discussionmentioning

confidence: 76%

“…The average age of acute hepatitis A cases was quite young in our study, which may reflect the lack of immunity to HAV in young people and recapitulate the infectiousness of HAV in a sensitive otherwise healthy population. The pre-existing male predominance during the pre-outbreak period may reflect the fact that more males are engaged in international business/travel in this society, which was also observed (62%) in a recently published report based on the Taiwan National Health Insurance Research Database [18]. Previous reviews on relapsing hepatitis A have suggested an association between continuing viremia as well as shedding of the virus in stools during the relapse and an interaction between viral infection and immune mechanisms [19].…”

Section: Discussionmentioning

confidence: 85%

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Clinical characteristics of acute hepatitis A outbreak in Taiwan, 2015–2016: observations from a tertiary medical center

et al. 2017

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BackgroundAcute hepatitis A is a fecal-oral transmitted disease related to inadequate sanitary conditions. In addition to its traditional classification, several outbreaks in the men who have sex with men (MSM) population have resulted in acute hepatitis A being recognized as a sexually transmitted disease. However, few studies have clarified the clinical manifestations in these outbreaks involving the MSM population.MethodsBeginning in June 2015, there was an outbreak of acute hepatitis A involving the MSM population in Northern Taiwan. We conducted a 15-year retrospective study by recruiting 207 patients with the diagnosis of acute hepatitis A that included the pre-outbreak (January 2001 to May 2015) and outbreak (June 2015 to August 2016) periods in a tertiary medical center in Northern Taiwan. Using risk factors, comorbidities, presenting symptoms, laboratory test results and imaging data, we aimed to evaluate the clinical significance of acute hepatitis A in the MSM population, where human immunodeficiency virus (HIV) coinfection is common.ResultsThere was a higher prevalence of reported MSM (p < 0.001), HIV (p < 0.001) and recent syphilis (p < 0.05) coinfection with acute hepatitis A during the outbreak period. The outbreak population had more prominent systemic symptoms, was more icteric with a higher total bilirubin level (p < 0.05) and had a 7-times higher tendency (p < 0.05) to have a hepatitis A relapse.ConclusionsThe clinical course of acute hepatitis A during an outbreak involving the MSM and HIV-positive population is more symptomatic and protracted than in the general population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2555-x) contains supplementary material, which is available to authorized users.

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Factors Associated With Hepatitis A Mortality During Person‐to‐Person Outbreaks: A Matched Case–Control Study—United States, 2016‐2019

et al. 2021

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Background and Aims During 2016‐2020, the United States experienced person‐to‐person hepatitis A outbreaks that are unprecedented in the vaccine era, during which case–fatality ratios reported by some jurisdictions exceeded those historically associated with hepatitis A. Approach and Results To identify factors associated with hepatitis A–related mortality, we performed a matched case–control study (matched on age [±5 years] and county of residence in a 1:4 ratio) using data collected from health department and hospital medical records of outbreak‐associated patients in Kentucky, Michigan, and West Virginia. Controls were hepatitis A outbreak–associated patients who did not die. There were 110 cases (mean age 53.6 years) and 414 matched controls (mean age 51.9 years); most cases (68.2%) and controls (63.8%) were male. Significantly (P < 0.05) higher odds of mortality were associated with preexisting nonviral liver disease (adjusted odds ratio [aOR], 5.2), history of hepatitis B (aOR, 2.4), diabetes (aOR, 2.2), and cardiovascular disease (aOR, 2.2), as well as initial Model for End‐Stage Liver Disease (MELD) score ≥ 30 (aOR, 10.0), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio > 2 (aOR, 10.3), and platelet count < 150,000/μL (aOR, 3.7) among hepatitis A outbreak–associated patients in the independent multivariable conditional logistic regression analyses (each model adjusted for sex). Conclusions Preexisting liver disease, diabetes, cardiovascular disease, and initial MELD score ≥ 30, AST/ALT ratio ≥ 1, and platelet count < 150,000/μL among hepatitis A patients were independently associated with higher odds of mortality. Providers should be vigilant for such features and have a low threshold to escalate care and consider consultation for liver transplantation. Our findings support the recommendation of the Advisory Committee on Immunization Practices to vaccinate persons with chronic liver disease, though future recommendations to include adults with diabetes and cardiovascular disease should be considered.

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Hospitalization and mortality due to hepatitis A in Taiwan: a 15‐year nationwide cohort study

Abstract: SummaryHepatitis A virus (HAV) is the most common food-borne hepatitis in the world. The study objectives were (i) to describe the epidemiology of HAV-related hospitalizations

Cited by 33 publications

References 22 publications

Overt acute hepatitis B is more severe in female patients

Overt acute hepatitis B is more severe in female patients

Clinical characteristics of acute hepatitis A outbreak in Taiwan, 2015–2016: observations from a tertiary medical center

Factors Associated With Hepatitis A Mortality During Person‐to‐Person Outbreaks: A Matched Case–Control Study—United States, 2016‐2019

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