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Hepatitis, Viral, Acute
1995 Case Definition

Clinical Description

An acute illness with a) discrete onset of symptoms and b) jaundice or elevated serum aminotransferase levels.

Laboratory Criteria for Diagnosis

  • Hepatitis A: Immunoglobin M (IgM) antibody to hepatitis A virus (anti-HAV) positive
  • Hepatitis B:
    • IgM antibody to hepatitis B core antigen (anti-HBc) positive (if done) or hepatitis B surface antigen (HBsAg) positive, AND
    • IgM antibody to hepatitis A virus (anti-HAV) negative (if done)
  • Hepatitis C:
    • Serum aminotransferase levels >2 and 1/2 times the upper limit of normal, AND
    • IgM anti-HAV negative, AND
    • IgM anti-HBc negative (if done) or HBsAg negative, AND
    • Antibody to hepatitis C virus (anti-HCV) positive
  • Non-A, Non-B Hepatitis:
    • Serum aminotransferase levels >2 and 1/2 times the upper limit of normal, AND
    • IgM anti-HAV negative, AND
    • IgM anti-HBc negative (if done) or HBsAg-negative, AND
    • Anti-HCV negative or not done
  • Delta Hepatitis*: HBsAg or IgM anti-HBc positive and hepatitis D virus antigen (anti-HDV) positive

Case Classification

Confirmed

A case that meets the clinical case definition and is laboratory confirmed; or for hepatitis A, a case that meets the clinical case definition and occurs among a contact of a person who has a laboratory-confirmed case.

Comments

Do not report cases among persons who have chronic hepatitis or persons identified as HBsAg- or anti-HCV positive as being cases of acute viral hepatitis without evidence of an acute illness compatible with viral hepatitis (with the exception of perinatal hepatitis B virus infection [see Hepatitis, Viral, Perinatal Hepatitis B Virus Infection Acquired in the United States or U.S. Territories]). Furthermore, up to 20% of acute hepatitis C cases will be anti-HCV negative when reported and will be classified as non-A, non-B hepatitis; approximately 10% of cases are anti-HCV negative during the acute phase of illness because of a prolonged interval between onset of disease and seroconversion, and an additional 10% are anti-HCV negative even with prolonged follow-up, because the sensitivity of the antibody assay is only 90%. The only serologic test routinely available for the diagnosis of hepatitis C is total anti-HCV; therefore, excluding other causes of the acute hepatitis is necessary.

* Delta Hepatitis is not a nationally notifiable disease.



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