• Fever
• Anorexia, nausea, vomiting
• Right hypochondrial pain
• Jaundice
• Dark urine, pale stools
• Hepatomegaly

See Table for description of sequelae.

Common biochemical abnormalities shared by the viral hepatitides:

• Leucopenia
• Urine urobilin, urobilinogen
• Raised serum bilirubin and transaminase levels (ALT > AST)
• Raised gamma-GT

• Hepatitis A: IgM antibodies become detectable when jaundice develops and persist for approximately 3 months.
• Hepatitis B: In acute hepatitis B, HBsAg is present in serum. However, it is also present in long-term carriers of HBV. The diagnosis of acute disease is confirmed by demonstrating IgM anti-HBc antibody in serum. This appears 2 weeks after HBsAg and disappears a few months after uncomplicated infection.
• HCV: Diagnosis depends on the detection of antibodies to recombinant antigens and detection of viral RNA (e.g. by PCR techniques).
  

A legally notifiable disease in Singapore. Notify Ministry of Health (Form MD 131 or electronically via CD-LENS) not later than 72 hours from the time of diagnosis.

There is no specific anti-viral therapy indicated for acute viral hepatitis. Management is symptomatic and supportive. Treatment is available for chronic carriers of hepatitis B and C. Consider referral to a hepatologist.

Contact precautions should be observed for hepatitis A and E. Universal precautions should be observed for hepatitis B, C and D.

• Hepatitis A
• All susceptible persons travelling to or working in countries that have high or intermediate hepatitis A endemicity should be vaccinated.
• One dose of monovalent vaccine (HAVRIX 0.5mL for 1-18 years old and 1.0mL for ≥ 19 years old) should be administered any time before departure (ideally with IG if given ≤ 2 weeks for older adults, immunocompromised persons and persons with chronic medical condition).
• Completion of vaccination (2nd dose at 6-12 months) is necessary for long term protection.
• Travellers who are less than 12 months of age, are allergic to a vaccine component, or who otherwise elect not to receive vaccine should receive a single dose of IG (0.02mL/kg), which provides effective protection against HAV infection for up to 3 months.
• Boiling or cooking food and beverage for at least 1 minute to 85°C inactivates HAV.
• Contact tracing of the source of infection and the mode of transmission will be carried out for acute cases. In common source outbreaks of hepatitis A, special attention will be given to contaminated food, especially imported shellfish.
• Hepatitis B
• Vaccination against Hepatitis B is routinely given to all newborns  (see Childhood Immunisation Programme in Appendix 2), healthcare personnel and other population groups at risk. Seronegative contacts of acute hepatitis B cases and carriers should also be vaccinated.
• An accelerated vaccine schedule could be used for those travelling to endemic areas at short notice and facing imminent exposure because of behavioural risks or to emergency responders to disaster areas. The monovalent hepatitis B vaccine can be used at 0, 7, and 14 days. Patient should receive a booster at least 6 months after the start of the vaccination series.
• Prevention of hepatitis B requires the use of disposable needles and syringes and use of sterile equipment for parenteral injections, acupuncture, tattooing and other procedures where skin is punctured. Observing universal precautions is the cornerstone of prevention in the healthcare setting.
• Transfusion hepatitis B and C are prevented by screening of blood donors.
• Post-Exposure Management (See Table).
• Notify all childhood hepatitis B vaccinations to the National Immunisation Registry, Health Promotion Board, and post-vaccination adverse reactions to the Pharmacovigilance Branch, Health Sciences Authority.
  

HBIG - Hepatitis B Immune Globulin dose 0.06 ml/Kg intramuscularly
Adequate anti-HBs is > 10 mIU/ml
Recommended for HCW is > 100 mIU/ml
Booster is recommended if < 100 mIU/ml