The clinical picture ranges from asymptomatic infection through a spectrum to fulminant hepatitis. Unlike HBV and HCV, HAV does not persist or progress to chronic liver damage. Infection in childhood is often mild or asymptomatic but in adults tends to be more severe.

After an incubation period of 15-50 days (mean 28 days) symptomatic infection starts with the abrupt onset of jaundice anything from 2 days to 3 weeks after the anicteric phase. It lasts for approximately the same length of time and is often accompanied by a sudden onset of fever.

HAV infection can lead to hospital admission in all age groups but is more likely with increasing age as is the duration of stay.

The overall mortality is less than 1%, but 15% of people will have a prolonged or relapsing illness within 6-9 months (CDC fact sheet). Fulminant hepatitis occurs in less than 1% of people but is more likely to occur in individuals older than 65 years or in those with pre-existing liver disease. In patients who are hospitalized, case fatality ranges from 2% in 50-59 years olds to nearly 13% in those older than 70 years (84).

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