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n South African Journal of Child Health - An overview of hepatitis A at Tygerberg Children's Hospital
Introduction. Hepatitis A is a vaccine-preventable infection, common in children in the Western Cape.
Objectives. To describe childhood hepatitis A morbidity and mortality at Tygerberg Children's Hospital, a level two and three referral hospital in the Western Cape, South Africa.
Methods. Serological tests with positive hepatitis A IgM were identified from the Tygerberg Hospital virology laboratory database from 2001 to 2004. Medical records were reviewed if identified sera came from children younger than 13 years. 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 (range 5 - 152) months. Two patients had hepatic failure and both died. Ten (5%) had known hepatitis A contacts but received no post-exposure prophylaxis, and only 31 (17%) were notified. A small percentage of patients were also positive for hepatitis B, hepatitis C and HIV. The median population incidence of serologically proven hepatitis A infection was 45.4/100 000/year, higher than the 20/100 000 advocated as a threshold for introducing vaccination into the immunisation schedule.
Limitations. Incidence data calculated from prospective studies are usually more reliable than those from retrospective studies.
Conclusions. This study confirms that hepatitis A is a serious risk to young children in the Western Cape, with significant morbidity and mortality. In addition, a sizeable number of cases were preventable. In order to determine the burden of disease and make recommendations about vaccination, the national incidence of hepatitis A must be assessed.
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