Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 464

Viral hepatitis, which is caused by hepatitis A, B, C, D, and E, has varying courses of disease and modes of transmission. Hepatitis A and E are transmitted from infected stool by contact with contaminated food or water. The incubation period of hepatitis A averages 28 days. Symptoms occur in 70% of adults and consist initially of abdominal pain, fever, fatigue, and nausea, followed in a few days by jaundice and pruritus. Laboratory values include elevation of transaminases greater than 1000 and alkaline phosphatase to less than 400. Infection does not become chronic, and 99% fully recover by six months, with 85% recovering by 2.3 months. Hepatitis A is much more likely to be symptomatic in the elderly and has a higher mortality rate in the aged. Death due to severe liver failure increased from 0.07% in the age group 15–24 to 4% in those older than 65.⁸

Vaccination for hepatitis A with two vaccinations six months apart provides 97% protection against the virus in those over 50.⁹ It is recommended that older people travelling to endemic areas, handling food, with chronic liver disease, or exposed to a case should receive HAV vaccination.

Hepatitis B and C are blood‐borne diseases, and hepatitis B is also transmitted sexually. Acute hepatitis due to these infections is not common, but chronic infections are prevalent in the elderly. Hepatitis E is similar in presentation to Hepatitis A but is far less common.