title: Severe manifestation of acute hepatitis A recently found in Gunma, Japan.
abstract: BACKGROUND
  The incidence of acute hepatitis A infection in Japan peaked 10 years ago and has been decreasing since then. However, an increase in severe cases of the disease has been documented recently. We experienced an outbreak in 1998-1999, and compared the clinical features of the disease in 1998-1999 (recent outbreak) and in 1987-1988 (past outbreak) in our prefecture (Gunma).
  
  
  METHODS
  Forty patients with acute hepatitis A were admitted to nine Gunma hospitals from October 1998 to September 1999. Their clinical features were compared with those of 100 patients with acute hepatitis A admitted to the same hospitals in 1987-1988.
  
  
  RESULTS
  Both outbreaks occurred mostly during the winter-spring season. Secondary familial infection was significantly decreased in the recent outbreak. Patients in the recent outbreak were 7 years older than those in the past outbreak. Laboratory findings, such as serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels and prothrombin time, were worse in the recent than in the past outbreak. Severe-type hepatitis and fulminant hepatitis occurred in 5 patients (12.5%) in the recent outbreak but in only 2 patients (2.0%) in the past outbreak.
  
  
  CONCLUSIONS
  Clinical data and manifestations were more severe in the recent outbreak than in the past outbreak of acute hepatitis A. It is important to be aware of hepatitis A virus infection and to take into account the available vaccination against hepatitis A virus in Japan.
authors.affiliation: The First Department of Internal Medicine, Gunma University School of Medicine, Showa, Maebashi, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kanda
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takagi
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamazaki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Matsui
authors.forename: Takashi
authors.initials: T
authors.lastname: Kosone
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Arai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakajima
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Otsuka
authors.forename: Akira
authors.initials: A
authors.lastname: Kojima
authors.forename: Ken
authors.initials: K
authors.lastname: Sato
authors.forename: Satoru
authors.initials: S
authors.lastname: Kakizaki
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Matsuzaki
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Ryuya
authors.initials: R
authors.lastname: Shimoda
authors.forename: Mieko
authors.initials: M
authors.lastname: Kaneko
authors.forename: Hisashi
authors.initials: H
authors.lastname: Takayama
authors.forename: Hitomi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Takehiko
authors.initials: T
authors.lastname: Abe
authors.forename: Jiro
authors.initials: J
authors.lastname: Takezawa
authors.forename: Masatomo
authors.initials: M
authors.lastname: Mori
mesh_terms: D000208:Acute Disease; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D001219:Aspartate Aminotransferases / Q000097:blood; D004196:Disease Outbreaks; D005260:Female; D006506:Hepatitis A / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D017093:Liver Failure / Q000821:virology; D008297:Male; D010125:Ostreidae / Q000821:virology; D011517:Prothrombin Time; D012758:Shellfish / Q000821:virology
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase