Two cases with imported hepatitis A who were presumed to have contracted the disease while visiting Indonesia based on molecular analysis of hepatitis A virus strains

Abstract

Patient 1 (30-year-old man) first visited our facility in January 2012 with chief complaints of fever, vomiting, and diarrhea, and was diagnosed with acute hepatitis A (aspartate aminotransferase [AST]/alanine aminotransferase [ALT] levels, 1141/1980 IU/L; total bilirubin [T-Bil] level, 7.55 mg/dL; and IgM hepatitis A virus [IgM-HAV] antibody-positive). He had a history of visiting Southeast Asian countries including Indonesia. Patient 2 (38-year-old man) had high fever and chills in May 2012 while traveling in Indonesia. He visited a local hospital where the symptoms remained unidentified. After returning to Japan, he was diagnosed with acute hepatitis A (AST/ALT levels, 835/1780 IU/L; T-Bil level, 2.2 mg/dL; and IgM-HAV antibody-positive). HAV RNA was detectable in the serum samples of both patients, and the implicated HAV strains shared 99.3% identities within the 481-nucleotide VP1-2B sequence. Phylogenetic analysis of HAV suggested infection during stay in Indonesia. Thus, HAV vaccination is highly recommended before visiting HAV-endemic countries/districts.