RMA instruments:

Changes from previous instruments:    

RMA SOP Bulletin 240.pdf

ICD coding:

ICD-10-AM:B15

Brief description:

Hepatitis A is a viral infection of the liver contracted through the ingestion of contaminated food or water or through direct contact with an infectious person. This virus is most prevalent in areas with poor sanitation. 

Confirming the diagnosis:

To confirm the diagnosis there needs to be both:

• evidence of acute symptoms and signs of hepatitis A infection (fever, nausea, vomiting, loss of appetite, tiredness, jaundice, enlarged liver)

AND

• blood serology positive for the hepatitis A virus with a pattern consistent with recent infection.

Either symptoms/signs alone or serological evidence alone is insufficient for diagnosis, both components must be present.

The serology during an active infection should have positive IgM antibodies.  A negative IgM in combination with a positive IgG indicates a past infection. Asymptomatic past infection is common.

The relevant medical specialist is a gastroenterologist or an infectious disease physician.

Additional diagnoses covered by these SOPs

• Nil

Conditions not covered by these SOPs   

• Hepatitis B*, C*, D*, E*
• Non-infectious hepatitis ^#                   
• Steatohepatitis *
• Viral hepatitis not due to hepatitis A –
  • Acute infectious mononucleosis *
  • Cytomegalovirus ^#
  • Herpes simplex*
  • Coxsackie viruses ^#
  • Toxoplasmosis ^#

* another SOP applies  - the SOP has the same name unless otherwise specified

^# non-SOP condition

Clinical onset

To have a clinical onset of hepatitis A there needs to be both serology testing showing recent or current infection and a clinical illness at around that time (no more than a six months before) with symptoms consistent with acute Hepatitis A infection.  The clinical onset will then be when the symptoms of that illness started.  The clinical onset is not the date of the positive serology.

Clinical worsening

Clinical worsening of hepatitis A is unlikely, as it is an acute infection which normally resolves without ongoing impairment and often does not cause death. There is no chronic form of Hepatitis A.

Further comments on diagnosis

Hepatitis A is an acute viral infection of the liver.  It resolves completely, usually within 2 months and generally no longer than 12 months.  A relapsing course over a number of months is possible, but there are no long term effects.  A claim for hepatitis A infection determined more than 1 year after disease onset should be diagnosed as “Hepatitis A – resolved”, or “No Incapacity Found”.