Serious hepatitis A: An analysis of patients hospitalized during an urban epidemic in the United States

Background: Memphis and Shelby County, Tennessee, experienced an epidemic of hepatitis A in 1994 and 1995. More than 1700 cases were reported. Objective: To characterize the clinical features of patients hospitalized during a large urban epidemic of hepatitis A. Design: Retrospective chart review. Setting: 15 acute care hospitals in Shelby County, Tennessee. Patients: 256 patients hospitalized with acute hepatitis A. Measurements: Laboratory findings (such as prothrombin time and bilirubin level), complications, and mortality. Results: The median patient age was 26 years. Thirty-nine complications occurred in 35 patients. Twenty patients (8%) had extrahepatic complications, and 5 (2%) died. Patients 40 years of age and older were more likely to have serious complications, including death (P = 0.014). Sixty-seven patients (26%) presented with coagulopathy (prothrombin time greater than or equal to 3 seconds prolonged). Fifty-four patients (21%) had a bilirubin level greater than 170 mu mol/L (10 mg/dL). Conclusions: During this epidemic, hepatitis A caused serious illness and death. Complications were more frequent in patients 40 years of age and older, but young, healthy persons were also at risk for severe complications.