hepatitis-a (LH Indholdsside)

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    <Content>
      <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2>
<h3>Diagnostiske kriterier</h3>
<ul>
    <li>Prodromal-symptomer og biokemiske &aelig;ndringer (ALAT typisk 8 - 10 gange &oslash;vre normalniveau)</li>
    <li>Anti-HAV (IgM) bliver positiv allerede ved sygdomsdebut og forbliver positiv i 3-6 m&aring;neder</li>
    <li>Anti-HAV (IgG) tyder p&aring; en tidligere gennemg&aring;et infektion og&nbsp;immunitet mod nye HAV infektioner</li>
    <li>Hepatitis A er individuelt anmeldelsespligtig</li>
</ul>
<h3>Sygehistorie</h3>
<ul>
    <li>Pr&aelig;ikterisk fase
    <ul>
        <li>Varer 5-7 dage med hurtig udvikling af prodromal-symptomer</li>
        <li>Prodromal-symptomer f&oslash;r evt. ikterus: slaphed, tr&aelig;thed, feber, nedsat appetit, v&aelig;gttab, vedvarende ubehag i h&oslash;jre hypochondrium, ledsmerter og diarr&eacute;</li>
    </ul>
    </li>
    <li>Ikteriske fase
    <ul>
        <li>Varer 4-30 dage</li>
        <li>Begynder med m&oslash;rkfarvning af urinen (konjugeret bilirubinuri). Efter nogle dage bliver aff&oslash;ringen affarvet, og ikterus opst&aring;r</li>
    </ul>
    </li>
    <li>Den akutte sygdomsfase varer typisk 1-3 uger</li>
    <li>Rekonvalescensperiode med asteni kan vare i 2-3 m&aring;neder</li>
</ul>
<h4>Afklar f&oslash;lgende risikofaktorer:</h4>
<ul>
    <li>N&aelig;r personlig kontakt med&nbsp;hepatitis A smittet&nbsp;person</li>
    <li>Kendt madb&aring;ret udbrud&nbsp;&nbsp;</li>
    <li>Rejse udenfor Skandinavien</li>
    <li>Homoseksuel kontakt</li>
    <li>Stofbrug&nbsp;</li>
    <li>T&aelig;t kontakt med b&oslash;rn som kan v&aelig;re asymptomatiske smitteb&aelig;rere</li>
</ul>
<h3>Kliniske fund</h3>
<ul>
    <li>Ikterus?</li>
    <li>Forst&oslash;rret lever?</li>
    <li>Fysiske tegn kan v&aelig;re &oslash;m hepatomegali, splenomegali, bradykardi og lymfadenopati bagtil p&aring; halsen<a title="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" href="%20" data-value-piped="Cuthbert JA|Hepatitis A: old and new|Clin Microbiol Rev|2001|14|38-58" data-type="journal-reference" data-value="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" data-url="reference-link"><sup>1</sup></a></li>
</ul>
<h3>Supplerende unders&oslash;gelser i almen praksis</h3>
<p><img alt="Hepatits A forløbskurve" src="D62DFB3F2F6D4FF1AB13BC88F391EB0F-200-0" text="Hepatits A forløbskurve" title="Hepatits A forløbskurve" height="0" width="200"></p>
<ul>
    <li>Hyperbilirubin&aelig;mi</li>
    <li>Forh&oslash;jede levertransaminaser (ALAT typisk 8 - 10 gange &oslash;vre normalniveau) eller lav faktor II, VII og X (h&oslash;j INR) evt. albumin
    <ul>
        <li>N&aring;r transaminaserne topper, er den mest smitsomme periode ovre</li>
        <li>Der er d&aring;rlig korrelation mellem transaminaseniveau og sv&aelig;rhedsgrad af sygdom<a title="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" href="%20" data-value-piped="Cuthbert JA|Hepatitis A: old and new|Clin Microbiol Rev|2001|14|38-58" data-type="journal-reference" data-value="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" data-url="reference-link"><sup>1</sup></a></li>
    </ul>
    </li>
    <li>Serologi
    <ul>
        <li>Foruden hepatitis A virus, overvej da ogs&aring; at tjekke hepatitis B og C virus status</li>
    </ul>
    </li>
    <li>Positiv serologi - anti-HAV (IgM)
    <ul>
        <li>B&aring;de IgM og IgG anti-HAV er til stede tidligt i sygdomsforl&oslash;bet</li>
        <li>IgM anti-HAV er ofte positiv fra 5-10 dage, f&oslash;r den kliniske sygdom manifesterer sig - og varer i 3-6 m&aring;neder</li>
        <li>IgG anti-HAV n&aring;r topv&aelig;rdi efter et par m&aring;neder og holder sig livslangt forh&oslash;jet
        <ul>
            <li>P&aring;visning af anti-HAV (IgG) alene tyder p&aring; tidligere gennemg&aring;et infektion og&nbsp;immunitet mod nye HAV infektioner</li>
        </ul>
        </li>
    </ul>
    </li>
</ul>
<h3>Andre unders&oslash;gelser hos specialist eller unders&oslash;gelse p&aring; sygehus</h3>
<ul>
    <li>Ingen yderligere unders&oslash;gelser</li>
</ul>
<h3>Differentialdiagnoser</h3>
<ul>
    <li>Andre virusinfektioner (hepatotrope virus)
    <ul>
        <li><a href="~/link.aspx?_id=4D630BBD45DC4733B9F1B100C9A40985&amp;_z=z">Hepatitis B</a></li>
        <li><a href="~/link.aspx?_id=167256D2AFAE46B08CFEFD608010732C&amp;_z=z">Hepatitis C</a></li>
        <li><a href="~/link.aspx?_id=195BC124F9CB4E60A966007D9AA1C3DB&amp;_z=z">Hepatitis D</a></li>
        <li><a href="~/link.aspx?_id=C520F98EF7F04950B3A6381BD3CFDD10&amp;_z=z">Hepatitis E</a></li>
        <li><a href="~/link.aspx?_id=2B78B198119C40AC9F5D226503C93C4B&amp;_z=z">EBV-hepatitis</a></li>
    </ul>
    </li>
    <li>Medikamentel hepatitis
    <ul>
        <li>F.eks. paracetamol, antiepileptika, isoniazid, p-piller, rifampicin og sulfonamider</li>
    </ul>
    </li>
    <li>Toksisk hepatitis
    <ul>
        <li>Evt. reaktion p&aring; alkohol og karbontetraklorid</li>
    </ul>
    </li>
    <li>Autoimmune sygdomme
    <ul>
        <li><a href="~/link.aspx?_id=A66FE392D12A45619D44C32ACE4ACCFF&amp;_z=z">Autoimmun hepatitis</a></li>
        <li><a href="~/link.aspx?_id=68262A579C404E3B83DEDB66EB738254&amp;_z=z">Systemisk lupus erytematosus</a></li>
    </ul>
    </li>
    <li>Bakterielle infektioner
    <ul>
        <li><a href="~/link.aspx?_id=B2867B7E34034FA8A838A8B3C3B44D07&amp;_z=z">Leptospirose</a>,&nbsp;<a href="~/link.aspx?_id=6EC019CFA8A144CBB817DAFF7F290305&amp;_z=z">Q-feber</a>, sekund&aelig;r syfilis, sepsis samt tyfus og paratyfus - er sj&aelig;ldent aktuelle i Danmark</li>
    </ul>
    </li>
</ul>
<h2>Behandling</h2>
<h3>Behandlingsm&aring;l</h3>
<ul>
    <li>Symptomatisk</li>
    <li>Forhindre smitte</li>
</ul>
<h3>Generelt om behandlingen</h3>
<ul>
    <li>Det findes ingen specifik behandling</li>
    <li>Behandlingen er st&oslash;ttende og inkluderer om n&oslash;dvendigt hvile, en balanceret kost og et stop for indtagelse af stoffer, der er levertoksiske f.eks. alkohol og paracetamol</li>
    <li>Sygehusindl&aelig;ggelse
    <ul>
        <li>Er aktuelt for ca. 20-30 % af de symptomatiske patienter p&aring; grund af dehydrering, afkr&aelig;ftelse, koagulopati, encefalopati eller andre tegn p&aring; hepatisk dekompensering</li>
    </ul>
    </li>
    <li>Forebyggelse foreg&aring;r ved
    <ul>
        <li>Smittebeskyttende foranstaltninger overfor patienter og risikogrupper</li>
        <li>God vand- og f&oslash;devarehygiejne</li>
        <li>[DliActiveSubstance;6323;Vaccinering]&nbsp;af s&aelig;rligt smitteudsatte personer</li>
    </ul>
    </li>
</ul>
<h3>H&aring;ndtering i almen praksis</h3>
<ul>
    <li>Kontakt til egen l&aelig;ge ved behov</li>
</ul>
<h3>R&aring;d til patienten</h3>
<ul>
    <li>Undg&aring; alkohol, ellers ingen di&aelig;trestriktioner</li>
    <li>Omhyggelig personlig hygiejne hos den syge med henblik p&aring; at undg&aring; smittespredning
    <ul>
        <li>Almindelig h&aring;nd- og toilethygiejne er tilstr&aelig;kkelig</li>
        <li>Ikke n&oslash;dvendigt med eget toilet</li>
    </ul>
    </li>
    <li>Hvis den syge arbejder i f&oslash;devareindustrien eller med madservering, er sygemelding p&aring;kr&aelig;vet under sygdomsfasen</li>
</ul>
<h3>Medicinsk behandling</h3>
<ul>
    <li>Der findes ingen specifik medicinsk behandling</li>
</ul>
<h3>Andre medicinske behandlinger</h3>
<ul>
    <li>Der findes ikke andre medicinske behandlinger</li>
</ul>
<h3>Forebyggende behandling</h3>
<h4>Prim&aelig;rforebyggende tiltag generelt</h4>
<ul>
    <li>Information af rejsende til h&oslash;jendemiske omr&aring;der&nbsp;</li>
    <li>Undg&aring; indtag af vand eller mad som kan v&aelig;re kontamineret. "Heat it, peel it or leave it"&nbsp;&nbsp;</li>
    <li>Gode hygiejneforhold ved madlavning</li>
    <li>Smittebeskyttende foranstaltninger blandt stofbrugere&nbsp;</li>
    <li>Bem&aelig;rk at b&oslash;rn og immunsv&aelig;kkede kan v&aelig;re smitteb&aelig;rere i op til et halvt &aring;r</li>
</ul>
<h4>Vaccination</h4>
<ul>
    <li>M&aring;lgrupper - hvor vaccination&nbsp;anbefales:
    <ul>
        <li>Rejsende til endemiske omr&aring;der&nbsp;</li>
        <li>Patienter som har kronisk leversygdom, inklusive kronisk hepatitis B og C</li>
        <li>M&aelig;nd, der har sex med m&aelig;nd&nbsp;</li>
        <li>Stofbrugere &nbsp;</li>
        <li>Postekspositionsprofylakse givet inden to uger efter eksposition - effekten synes at tilsvare brugen af&nbsp;<a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/211032">gammaglobulin</a><a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/211032" data-value-piped="Victor JC, Monto AS, Surdina TY et al|Hepatitis A vaccine versus immune globulin for postexposure prophylaxis|N Engl J Med|2007|357|1685-94" data-type="journal-reference" data-value="Victor JC, Monto AS, Surdina TY et al, Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med 2007;357: 1685-94" data-url="reference-link"><sup>2</sup></a></li>
    </ul>
    </li>
    <li>Vacciner
    <ul>
        <li>Ovenn&aelig;vnte m&aring;lgrupper</li>
        <li>Se doseringsdetaljer for tilg&aelig;ngelige&nbsp;<a href="~/link.aspx?_id=4FDD2968B00B45FDB969FE1F7EB6DD96&amp;_z=z">hepatitis A vacciner</a></li>
        <li>Dosering ved tidsn&oslash;d
        <ul>
            <li>En i.m. dosis lige op til afrejse er tilstr&aelig;kkelig, uden samtidig&nbsp;<a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/211032">gammaglobulin</a></li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Immunitet
    <ul>
        <li>F&oslash;rste dosis
        <ul>
            <li>Giver immunitet til knap 40 % indenfor to uger, hos 90 % indenfor fire uger og hos 100 % efter 26 uger<a title="Sonder GJ, vanSteenbergen JE, Boovee LP, Peerbooms PG, Coutinho RA, van den Hoek A, Hepatitis A virus immunity and seroconversion among contacts of acute hepatitis A patients in Amsterdam, 1996-2000: an evaluation of current prevention policy. Am J Public Health 2004;94: 1620-6" href="%20" data-value-piped="Sonder GJ, vanSteenbergen JE, Boovee LP, Peerbooms PG, Coutinho RA, van den Hoek A|Hepatitis A virus immunity and seroconversion among contacts of acute hepatitis A patients in Amsterdam, 1996-2000: an evaluation of current prevention policy|Am J Public Health|2004|94|1620-6" data-type="journal-reference" data-value="Sonder GJ, vanSteenbergen JE, Boovee LP, Peerbooms PG, Coutinho RA, van den Hoek A, Hepatitis A virus immunity and seroconversion among contacts of acute hepatitis A patients in Amsterdam, 1996-2000: an evaluation of current prevention policy. Am J Public Health 2004;94: 1620-6" data-url="reference-link"><sup>3</sup></a></li>
        </ul>
        </li>
        <li>Anden dosis
        <ul>
            <li>Giver vedvarende immunitet i mindst 40 &aring;r - og formentligt livslangt</li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Senere booster-dosis
    <ul>
        <li>Booster-dosis efter prim&aelig;r vaccination med 2 doser hos en rask person er ikke relevant</li>
    </ul>
    </li>
    <li>Korttidsprofylakse ved rejse?
    <ul>
        <li>Ved kontraindikation for regelret vaccination gives
        <ul>
            <li><a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/211032">Gammaglobulin</a>&nbsp;intramuskul&aelig;rt</li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Postekspositions profylakse
    <ul>
        <li>Generelt anbefales vaccination<a title="Hepatitis A-postekspositionsprofylakse (leverbetændelse-) (Senest redigeret den 25. februar 2019)" href="https://www.ssi.dk/vaccinationer/post-eksposure/hepatitis-a-profylakse" data-type="other-reference" data-value="Hepatitis A-postekspositionsprofylakse (leverbetændelse-) (Senest redigeret den 25. februar 2019)" data-url="https://www.ssi.dk/vaccinationer/post-eksposure/hepatitis-a-profylakse"><sup>4</sup></a>, hvor der ikke er kontraindikationer - der gives prim&aelig;r&nbsp;[DliActiveSubstance;6323;hepatitis A vaccination]&nbsp;(der foreligger ikke data for personer over 40 &aring;r)</li>
        <li>Til b&oslash;rn under 1 &aring;r, immunsv&aelig;kkede, individer med kronisk leversygdom samt personer, hvor vaccination er kontraindiceret, anbefales&nbsp;<a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/211032">gammaglobulin</a>&nbsp;intramuskul&aelig;rt</li>
    </ul>
    </li>
</ul>
<h4><a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/211032">Immunglobulin</a></h4>
<ul>
    <li>Effekt
    <ul>
        <li><a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/211032">Gammaglobulin</a>&nbsp;givet intramuskul&aelig;rt giver kortvarig beskyttelse (3-5 m&aring;neder) gennem passiv overf&oslash;rsel af hepatitis A-virus antistof<a href="EditorPage.aspx?da=core&amp;id=%7BA4001500-7B2C-49F3-9CA2-7DD6668C0C5D%7D&amp;ed=FIELD29397720283&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H29397720341&amp;us=sitecore%5CTins&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Brundage SC, Fitzpatrick AN, Hepatitis A.. Am Fam Physician 2006;73: 2162-8" data-value-piped="Brundage SC, Fitzpatrick AN|Hepatitis A.|Am Fam Physician|2006|73|2162-8|16848078" data-url="reference-link" data-pubmedid="16848078" title="Brundage SC, Fitzpatrick AN, Hepatitis A.. Am Fam Physician 2006;73: 2162-8"><sup>5</sup></a></li>
        <li>Givet indenfor to uger efter eksponering er behandlingen 70-90 % effektiv med henblik p&aring; at forhindre symptomatisk infektion<a title="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" href="%20" data-value-piped="Cuthbert JA|Hepatitis A: old and new|Clin Microbiol Rev|2001|14|38-58" data-type="journal-reference" data-value="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" data-url="reference-link"><sup>1</sup></a></li>
        <li>N&aring;r infektion ikke forhindres, vil gammaglobulinet mildne symptomerne og reducere den videre overf&oslash;rsel af virus</li>
        <li>Effekten, n&aring;r gammoglobulin gives f&oslash;r en eksponering, er 80-85 %<a href="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" data-type="other-reference" data-value="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014" data-url="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" title="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014"><sup>6</sup></a></li>
    </ul>
    </li>
    <li>Forsigtighed
    <ul>
        <li>Intramuskul&aelig;r injektion af gammaglobulin b&oslash;r undg&aring;s i 2-3 uger efter at levende, sv&aelig;kket vaccine er givet, fordi dette sv&aelig;kker immunogeniciteten</li>
        <li>Injektion af evt. m&aelig;slinge-, f&aring;resyge- og rubella-vacciner b&oslash;r uds&aelig;ttes i tre m&aring;neder og for varicella-vaccine i fem m&aring;neder efter, at gammaglobulin er givet intramuskul&aelig;rt</li>
    </ul>
    </li>
</ul>
<h4>Postekspositionsprofylakse</h4>
<ul>
    <li>Indikationer:
    <ul>
        <li>Husstandsmedlemmer og seksualpartnere til patienter med hepatitis A, og eventuelt andre n&aelig;re kontakter</li>
        <li>B&oslash;rn og personale i daginstitutioner med et tilf&aelig;lde af hepatitis A</li>
        <li>N&aelig;re kontakter til identificerede patienter ved udbrud i skoler, f&aelig;ngsler eller sygehuse</li>
    </ul>
    </li>
    <li><a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/211032">Immunglobulin</a>&nbsp;eller&nbsp;[DliActiveSubstance;6323;vaccine]?
    <ul>
        <li>I et&nbsp;non-inferiority studie fandt forskere, at vaccine var et&nbsp;ligev&aelig;rdigt alternativ til immunglobulin<a title="Victor JC, Monto AS, Surdina TY, et al, Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med 2007;357: 1685-94" href="%20" data-value-piped="Victor JC, Monto AS, Surdina TY, et al|Hepatitis A vaccine versus immune globulin for postexposure prophylaxis|N Engl J Med|2007|357|1685-94" data-type="journal-reference" data-value="Victor JC, Monto AS, Surdina TY, et al, Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med 2007;357: 1685-94" data-url="reference-link"><sup>7</sup></a></li>
        <li>Fordele&nbsp;ved vaccination er l&aelig;ngerevarende immunitet; vaccinen er ikke et blodprodukt, og injektionen er mindre smertefuld. Ulempen er en h&oslash;jere pris</li>
    </ul>
    </li>
    <li>Anbefalet behandling<a href="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" data-type="other-reference" data-value="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014" data-url="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" title="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014"><sup>6</sup></a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    <ul>&nbsp;&nbsp;&nbsp;
        <li>Generelt anbefales vaccination<a title="Hepatitis A-postekspositionsprofylakse (leverbetændelse-) (Senest redigeret den 25. februar 2019)" href="https://www.ssi.dk/vaccinationer/post-eksposure/hepatitis-a-profylakse" data-type="other-reference" data-value="Hepatitis A-postekspositionsprofylakse (leverbetændelse-) (Senest redigeret den 25. februar 2019)" data-url="https://www.ssi.dk/vaccinationer/post-eksposure/hepatitis-a-profylakse"><sup>4</sup></a>, hvor der ikke er kontraindikationer; der gives prim&aelig;r&nbsp;[DliActiveSubstance;6323;hepatitis A vaccination]&nbsp;(der foreligger ikke data for personer over 40 &aring;r)</li>
        <li>Til b&oslash;rn under 1 &aring;r, immunsv&aelig;kkede, individer med kronisk leversygdom samt personer, hvor vaccination er kontraindiceret, anbefales&nbsp;<a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/211032">gammaglobulin</a>&nbsp;intramuskul&aelig;rt</li>
    </ul>
    </li>
</ul>
<h4>Sekund&aelig;rprofylaktiske tiltag</h4>
<ul>
    <li>Sanit&aelig;re tiltag
    <ul>
        <li>Grundig h&aring;ndvask efter aff&oslash;ring eller bleskift samt h&aring;ndvask f&oslash;r m&aring;ltider</li>
        <li>God affaldsh&aring;ndtering</li>
        <li>Tilsikre tryg h&aring;ndtering af mad, s&aelig;rligt dem som arbejder i restaurant og f&oslash;devareindustrien</li>
    </ul>
    </li>
    <li>Kasus-opf&oslash;lgning</li>
</ul>
<h2>Henvisning</h2>
<ul>
    <li>Virker patienten syg, b&oslash;r vedkommende indl&aelig;gges p&aring; sygehus for at f&aring; verificeret diagnosen</li>
    <li>Enkelte patienter skal indl&aelig;gges til intraven&oslash;s v&aelig;skebehandling grundet udtalt kvalme og opkastningstendens</li>
</ul>
<h2>Opf&oslash;lgning</h2>
<ul>
    <li>N&aring;r sygdommen er overst&aring;et, er der ikke behov for yderligere opf&oslash;lgning</li>
</ul>
<h2>Sygdomsforl&oslash;b, komplikationer og prognose</h2>
<h3>Sygdomsforl&oslash;b</h3>
<ul>
    <li>Infektionen kan forl&oslash;be asymptomatisk, subklinisk eller med klare kliniske symptomer</li>
</ul>
<h3>Komplikationer</h3>
<ul>
    <li>Langvarigt forl&oslash;b
    <ul>
        <li>Hos 10-15 % tr&aelig;kker forl&oslash;bet ud i flere m&aring;neder med vedvarende feber, kraftig kl&oslash;e, ikterus, diarr&eacute;, v&aelig;gttab og malabsorption<a title="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" href="%20" data-value-piped="Cuthbert JA|Hepatitis A: old and new|Clin Microbiol Rev|2001|14|38-58" data-type="journal-reference" data-value="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" data-url="reference-link"><sup>1</sup></a></li>
        <li>Leverenzymerne normaliseres efterh&aring;nden, men bilirubinniveauet forbliver h&oslash;jt. Disse patienter b&oslash;r betragtes som potentielle smitteb&aelig;rere<a href="EditorPage.aspx?da=core&amp;id=%7BA4001500-7B2C-49F3-9CA2-7DD6668C0C5D%7D&amp;ed=FIELD29397720602&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H29397720660&amp;us=sitecore%5CTins&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Brundage SC, Fitzpatrick AN, Hepatitis A.. Am Fam Physician 2006;73: 2162-8" data-value-piped="Brundage SC, Fitzpatrick AN|Hepatitis A.|Am Fam Physician|2006|73|2162-8|16848078" data-url="reference-link" data-pubmedid="16848078" title="Brundage SC, Fitzpatrick AN, Hepatitis A.. Am Fam Physician 2006;73: 2162-8"><sup>5</sup></a></li>
    </ul>
    </li>
    <li>Ekstrahepatiske manifestationer
    <ul>
        <li>Kan opst&aring; hos nogle f&aring; patienter<a href="EditorPage.aspx?da=core&amp;id=%7BA4001500-7B2C-49F3-9CA2-7DD6668C0C5D%7D&amp;ed=FIELD29397720602&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H29397720660&amp;us=sitecore%5CTins&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Brundage SC, Fitzpatrick AN, Hepatitis A.. Am Fam Physician 2006;73: 2162-8" data-value-piped="Brundage SC, Fitzpatrick AN|Hepatitis A.|Am Fam Physician|2006|73|2162-8|16848078" data-url="reference-link" data-pubmedid="16848078" title="Brundage SC, Fitzpatrick AN, Hepatitis A.. Am Fam Physician 2006;73: 2162-8"><sup>5</sup></a></li>
    </ul>
    </li>
    <li>Fulminant hepatitis
    <ul>
        <li>F&aelig;rre end 1 % vil opleve et fulminant forl&oslash;b med udvikling af encefalopati</li>
        <li>H&oslash;j alder og komorbide tilstande som kronisk leversygdom &oslash;ger risikoen. Tilstanden kan i yderst sj&aelig;ldne tilf&aelig;lde ende fatalt</li>
    </ul>
    </li>
</ul>
<h3>Prognose</h3>
<ul>
    <li>Gennemg&aring;et sygdom giver varig immunitet</li>
    <li>Ingen overgang til kronisk hepatitis eller kronisk b&aelig;rertilstand</li>
    <li>Den totale d&oslash;delighed er 0,3 %, men &oslash;ges til 2 % hos voksne over 40 &aring;r</li>
</ul>
<h2>Baggrundsoplysninger</h2>
<h3>Definition</h3>
<ul>
    <li>Hepatitis A er inflammation i leveren for&aring;rsaget af hepatitis A virus (HAV)<a href=" " data-type="journal-reference" data-value="Brundage SC, Fitzpatrick AN, Hepatitis A.. Am Fam Physician 2006;73: 2162-8" data-value-piped="Brundage SC, Fitzpatrick AN|Hepatitis A.|Am Fam Physician|2006|73|2162-8|16848078" data-url="reference-link" data-pubmedid="16848078" title="Brundage SC, Fitzpatrick AN, Hepatitis A.. Am Fam Physician 2006;73: 2162-8"><sup>5</sup></a> </li>
    <li>Mennesket er reservoir for hepatitis A virus
    <ul>
        <li>Smittevej: F&aelig;kal/oral </li>
        <li>Smittem&aring;de: Fra person til person ved n&aelig;rkontakt (er sandsynligvis vigtigst) eller via mad og vand</li>
    </ul>
    </li>
</ul>
<h3>Forekomst</h3>
<ul>
    <li>Kan optr&aelig;de som epidemi, men forekommer oftest sporadisk </li>
    <li>Der anmeldes omkring 30 til 40 nye tilf&aelig;lde om&nbsp;&aring;ret&nbsp;af hepatitis A infektion i Danmark. Mange af de smittede personer&nbsp;er af udenlandsk herkomst og n&aelig;sten halvdelen under 20 &aring;r. Identificerede smittekilder er husstandskontakt, b&oslash;rneinstitutioner,&nbsp;hetero- og homoseksuelle kontakter. Det antages, at anmeldelsesprocenten er 50 % af det faktiske antal tilf&aelig;lde</li>
    <li>Der blev&nbsp;i 2013&nbsp;anmeldt 120 tilf&aelig;lde af akut hepatitis A-infektion i Danmark sammenlignet med 32 tilf&aelig;lde i 2014. Det h&oslash;je&nbsp;antal i 2013 skyldtes smitte via frosne jordb&aelig;r fra Nordafrika<a title="Müller L, Ethelberg S, Vestergaard H, Fischer TK, Midgley S, Hepatitis A 2014. Epi-Nyt 2015;uge 48: 1" href="%20" data-value-piped="Müller L, Ethelberg S, Vestergaard H, Fischer TK, Midgley S|Hepatitis A 2014|Epi-Nyt|2015|uge 48|1" data-type="journal-reference" data-value="Müller L, Ethelberg S, Vestergaard H, Fischer TK, Midgley S, Hepatitis A 2014. Epi-Nyt 2015;uge 48: 1" data-url="reference-link"><sup>8</sup></a>&nbsp; &nbsp; &nbsp; &nbsp;
    </li>
    <li>Internationalt &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
    <ul>
        <li>Forekomsten af hepatitis A synes at f&oslash;lge indkomstforhold. H&oslash;j-indkomst lande som lande i Vesteuropa, Australien, New Zealand, USA, Canada, Japan o. a.&nbsp;har&nbsp;meget lav pr&aelig;valens af hepatitis A, mens lav-indkomst lande is&aelig;r landene&nbsp;omkring &AElig;kvator i Afrika og Asien&nbsp;har h&oslash;j pr&aelig;valens. I mellem-indkomst lande er pr&aelig;valensen mellem til lav. Dette betyder samtidigt, at i h&oslash;j-indkomst lande vil en meget stor del af befolkningen v&aelig;re modtagelige for hepatitis A, mens i lav-indkomst lande&nbsp;har stort set hele den voksne befolkning haft hepatitis A<a title="Jacobsen KH, Wiersma ST, Hepatitis A virus seroprevalence by age and world region, 1990 and 2005. Vaccine 2010;28: 6653-7" href="%20" data-value-piped="Jacobsen KH, Wiersma ST|Hepatitis A virus seroprevalence by age and world region, 1990 and 2005|Vaccine|2010|28|6653-7" data-type="journal-reference" data-value="Jacobsen KH, Wiersma ST, Hepatitis A virus seroprevalence by age and world region, 1990 and 2005. Vaccine 2010;28: 6653-7" data-url="reference-link"><sup>9</sup></a> </li>
    </ul>
    </li>
</ul>
<h3>&AElig;tiologi og patogenese</h3>
<h4>&AElig;tiologi</h4>
<ul>
    <li>Hepatitis A virus (HAV) er et 27 nm RNA hepatovirus, der tilh&oslash;rer picornavirus familien</li>
    <li>Det er et modstandsdygtigt virus, som kan overleve p&aring; menneskets hud. Det kr&aelig;ver en temperatur over 85&deg;C for at inaktiveres<a title="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" href="%20" data-value-piped="Cuthbert JA|Hepatitis A: old and new|Clin Microbiol Rev|2001|14|38-58" data-type="journal-reference" data-value="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" data-url="reference-link"><sup>1</sup></a> </li>
    <li>Hepatitis A virus overlever i l&aelig;ngere perioder (op til 10 m&aring;neder) i vand. Hepatitis A overlever udenfor kroppen i t&oslash;r tilstand i ca. 1 uge<a title="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" href="%20" data-value-piped="Cuthbert JA|Hepatitis A: old and new|Clin Microbiol Rev|2001|14|38-58" data-type="journal-reference" data-value="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" data-url="reference-link"><sup>1</sup></a></li>
    <li>Virus er resistent mod nedfrysning, reng&oslash;ringsmidler og syrer, men det inaktiveres af formalin og klor</li>
</ul>
<h4>Smitte</h4>
<ul>
    <li>Replikation
    <ul>
        <li>Hepatitis A virus replikeres i hepatocytter, frigives til blod og galde og udskilles i store m&aelig;ngder i aff&oslash;ringen</li>
    </ul>
    </li>
    <li>Overf&oslash;rsel af virus<a href="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" data-type="other-reference" data-value="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014" data-url="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" title="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014"><sup>6</sup></a>
    <ul>
        <li>F&oslash;lger som regel en f&aelig;kal-oral rute efter person-til-person kontakt. Spredningen &oslash;ges i t&aelig;tte bof&aelig;llesskaber og ved d&aring;rlige sanit&aelig;re forhold </li>
        <li>Udbrud kan ogs&aring; skyldes kontamineret vand eller mad </li>
        <li>Udbrud blandt intraven&oslash;se stofbrugere ses. Smitten er her formentlig parenteral</li>
    </ul>
    </li>
    <li>Inkubationstiden
    <ul>
        <li>Er 15-50 dage, gennemsnitligt 28 dage<a title="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" href="%20" data-value-piped="Cuthbert JA|Hepatitis A: old and new|Clin Microbiol Rev|2001|14|38-58" data-type="journal-reference" data-value="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" data-url="reference-link"><sup>1</sup></a></li>
    </ul>
    </li>
    <li>Smitsom
    <ul>
        <li>Blodet og aff&oslash;ringen er infekti&oslash;st i inkubationstiden, dvs. i ca. 2-3 uger f&oslash;r sygdomsdebut og i den tidlige sygdomsfase </li>
        <li>Maksimal infekti&oslash;sitet korrelerer med perioden med den h&oslash;jeste virusudskillelse i aff&oslash;ringen, dvs. ca. to uger f&oslash;r debut af ikterus og/eller ved stigning i leverenzymerne </li>
        <li>Efterh&aring;nden som transaminasev&aelig;rdierne topper, reduceres smitterisikoen </li>
        <li>Vir&aelig;mi optr&aelig;der hurtigt efter en etableret infektion og vedvarer gennem perioden med leverenzymstigning. Undtagelsesvis kan hepatitis A smitte via blod, hvis blodet overf&oslash;res i en vir&aelig;misk fase</li>
    </ul>
    </li>
    <li>Ekskretion af HAV
    <ul>
        <li>Sker fra 2-3 uger f&oslash;r sygdommen manifesterer sig, og findes sj&aelig;ldent i f&aelig;ces efter den f&oslash;rste uge med sygdom, dog ofte noget l&aelig;ngere hos mindre b&oslash;rn</li>
    </ul>
    </li>
</ul>
<h4>Patologi</h4>
<ul>
    <li>Inflammation i leveren giver skade p&aring; levercellerne og p&aring;f&oslash;lgende celled&oslash;d </li>
    <li>Levercellerne &oslash;del&aelig;gges af et celle-medieret immunrespons<a title="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" href="%20" data-value-piped="Cuthbert JA|Hepatitis A: old and new|Clin Microbiol Rev|2001|14|38-58" data-type="journal-reference" data-value="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" data-url="reference-link"><sup>1</sup></a></li>
</ul>
<h3>Disponerende faktorer</h3>
<ul>
    <li>Alder
    <ul>
        <li>Tilstedev&aelig;relse og sv&aelig;rhedsgrad af symptomer er relateret til patientens alder<a href="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" data-type="other-reference" data-value="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014" data-url="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" title="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014"><sup>6</sup></a></li>
        <li>Ca. 70 % af inficerede voksne udvikler symptomer, inklusiv ikterus<a title="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" href="%20" data-value-piped="Cuthbert JA|Hepatitis A: old and new|Clin Microbiol Rev|2001|14|38-58" data-type="journal-reference" data-value="Cuthbert JA, Hepatitis A: old and new. Clin Microbiol Rev 2001;14: 38-58" data-url="reference-link"><sup>1</sup></a>,<a href="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" data-type="other-reference" data-value="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014" data-url="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" title="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014"><sup>6</sup></a></li>
        <li>Blandt b&oslash;rn under 6 &aring;r forl&oslash;ber sygdommen subklinisk, idet kun ca. 30 % udvikler symptomer, som er uspecifikke, fork&oslash;lelseslignende og uden ikterus </li>
        <li>Da subklinisk inficerede b&oslash;rn kan udskille virus i aff&oslash;ringen i op til seks m&aring;neder, kan infektioner hos b&oslash;rn ofte udl&oslash;se og vedligeholde lokale udbrud</li>
    </ul>
    </li>
    <li> Rejsende til endemiske omr&aring;der<a href="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" data-type="other-reference" data-value="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014" data-url="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" title="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014"><sup>6</sup></a></li>
    <li>B&oslash;rn (i Danmark) f&oslash;dt af 1. generationsindvandrere fra endemiske omr&aring;der<a href="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" data-type="other-reference" data-value="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014" data-url="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" title="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014"><sup>6</sup></a>&nbsp;</li>
    <li> M&aelig;nd, der har sex med m&aelig;nd<a href="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" data-type="other-reference" data-value="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014" data-url="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" title="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014"><sup>6</sup></a></li>
    <li>Stofbrugere<a href="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" data-type="other-reference" data-value="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014" data-url="https://www.sst.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" title="Fouchard J, Christensen PB, Cowan S, Gerstoft J, Krarup H, Nielsen JO, Reventlow JL, Weis N. Vejledning om forebyggelse af hepatitis A p 1-12. Sundhedsstyrelsen 2014"><sup>6</sup></a>&nbsp;</li>
    <li> D&aring;rlige hygiejniske og sanit&aelig;re forhold
    <ul>
        <li>Smitte gennem forurenede f&oslash;demidler, enten p&aring; grund af d&aring;rlige hygiejniske forhold eller forurenet vand</li>
    </ul>
    </li>
</ul>
<h3>Anmeldelsespligt</h3>
<ul>
    <li>Den l&aelig;ge, der konstaterer et tilf&aelig;lde af denne sygdom hos en patient, som vedkommende har i behandling, skal f&oslash;rstkommende hverdag anmelde tilf&aelig;ldet telefonisk til Styrelsen for Patientsikkerhed, Tilsyn og R&aring;dgivning &Oslash;st/Vest n&aelig;rmest patientens opholdssted, s&aring;fremt der er tale om et barn i dagtilbud eller en ansat i dagtilbud med t&aelig;t kontakt til b&oslash;rn. Tilf&aelig;ldet skal endvidere anmeldes skriftligt i Sundhedsdatastyrelsens Elektroniske Indberetningssystem SEI2</li>
</ul>
<h3>ICPC-2</h3>
<p>[ICPC]</p>
<h3>ICD-10/SKS-koder</h3>
<p>[ICD10]</p>
<h2>Patientinformation</h2>
<h3>Link til patientinformation</h3>
<ul>
    <li><a href="~/link.aspx?_id=579B00C7DE5E48819441F505087B7167&amp;_z=z">Information om hepatitis A</a></li>
    <li><a href="https://www.hvidovrehospital.dk/cgi/sundhedsfaglige/Sider/default.aspx">Information om hepatitis A hos gravide</a></li>
</ul>
<h3>Animation</h3>
<ul>
    <li><a href="~/link.aspx?_id=934C9FC3A69A4723BEB5E2ABF8DDDE5C&amp;_z=z">Leverbet&aelig;ndelse</a></li>
</ul>
<h2>Link til vejledninger</h2>
<li>Sundhedsstyrelsen: <a rel="noopener noreferrer" href="https://sundhedsstyrelsen.dk/~/media/AC3F7B8119B4406CBEE8548D96EE60E7.ashx" target="_blank">Vejledning om forebyggelse af hepatitis A </a>(2014)</li>
<li>Dansk selskab for infektionsmedicin guidelines: <a rel="noopener noreferrer" href="https://www.infmed.dk/site/tools/download.php?UID=f8a5b72c3d5265f625a627e2c95ef1d6aa912e93" target="_blank">Hepatitis A</a> (2013)</li>
<h2>Illustrationer</h2>
<h3>Plancher eller tegninger</h3>
<ul>
    <li><a href="~/link.aspx?_id=685F84158AE44964BFCF902C99178378&amp;_z=z">Hepatitis A forl&oslash;bskurve</a></li>
</ul>]]></HtmlField>
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<h3>
Diagnose
</h3>
<ul>
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    <li>P&aring;visning af anti-HAV (IgM)</li>
</ul>
<h3>
Behandling
</h3>
<ul>
    <li>Kun symptomatisk behandling</li>
</ul>
<h3>
Henvisning
</h3>
<ul>
    <li>Ved sv&aelig;r klinisk sygdom kan der v&aelig;re behov for sygehusindl&aelig;ggelse</li>
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