Sex: M
Vaccine: HEPA
Symptoms: Abdominal pain, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood bilirubin increased, Hepatitis A
Clinical narrative: This case was reported in a literature article and described the occurrence of suspected vaccination failure in a elderly male subject who received Hepatitis A vaccine for prophylaxis. Concurrent medical conditions included hepatitis C and hepatitis A exposure (The patient was in close contact with patient A, shared living quarters and hospital unit restroom.). On an unknown date, unknown after receiving Hepatitis A vaccine, the subject developed vaccination failure. Serious criteria included hospitalization and GSK medically significant. Additional event(s) included viral hepatitis A with serious criteria of hospitalization, vomiting with serious criteria of hospitalization, lethargy with serious criteria of hospitalization, abdominal pain with serious criteria of hospitalization and jaundice with serious criteria of hospitalization. The outcome of vaccination failure was unknown. The outcome(s) of the additional event(s) included viral hepatitis A (unknown), vomiting (unknown), lethargy (unknown), abdominal pain (unknown) and jaundice (unknown). The investigator considered that there was a reasonable possibility that the vaccination failure, viral hepatitis A, vomiting, lethargy, abdominal pain and jaundice may have been caused by Hepatitis A vaccine. Relevant Tests: Lab tests were performed on an unspecified dates in 2017. The patient was diagnosed with acute hepatitis A virus (HAV) infection. Diagnostic results (unless otherwise stated, normal values were not provided):  In 2017, Alanine aminotransferase result was 2419 UI/L, Aspartate aminotransferase result was 1176 UI/L and Blood bilirubin result was 10.1 mg/dL. Additional information was provided. This case was reported in a literature and described the suspected vaccination failure in man aged between 65 and 69 year who was vaccinated with unspecified hepatitis A vaccine (manufacturer unknown) for prophylaxis. The patient was a part of the study which was conducted by County Department of Public Health (DPH) to confirm the suspected cases, and to assess the risk for HAV transmission to hospitalized patients, and to assess the environmental conditions, to conduct active case surveillance, and to discuss the enhanced infection control practices with infection control staff in July 2017 after reporting of 2 persons (patient A and patient B) with immunoglobulin M (IgM) antibodies to hepatitis A virus (HAV). The surveillance period was maintained for 50 days after the onset of symptoms of the last case, during which time the unit was closed to any new admissions or discharges. The patient had hepatitis C coinfection. The patient was in close contact with patient A, shared living quarters and hospital unit restroom. No information on patient medical or family history or concomitant medication was provided. On an unspecified date, the patient received unspecified hepatitis A vaccine (administration route and site unspecified; dosage unknown, batch number not provided). The age of vaccination was not provided. On an unspecified date in July or August 2017, an unknown period after vaccination and day 26 after reporting of index case (patient A), the patient had vomiting, lethargic, had abdominal pain and jaundice. Subsequently, the patient was admitted to hospital. The patent's laboratory tests revealed: aspartate aminotransferase (AST)- 1,176 U/L, alanine aminotransferase (ALT)- 2,419U/L and bilirubin- 10.1 (mg/dL). Subsequently, the patient was diagnosed with acute hepatitis A virus (HAV) infection. The patient was admitted in hospital for 2 days. This case has been considered as suspected vaccination failure being full schedule and time of onset was unknown. This case has been considered serious due to suspected vaccination failure and hospitalisation. Treatment was unknown. The outcome of the event was not provided. The author did not comment on the relationship between of acute HAV infection and unspecified hepatitis A vaccine. The author stated, "Maintaining a clean and safe environment for this patient population is challenging. The spread of HAV in this hospital was likely due to both close contact with the index patient and contaminated living quarters and hospital unit restroom of the index case. Although similar outbreaks have been identified among adults with developmental disabilities and disabled patients in congregate living situations, outbreaks in mental health facilities are rare. Screening patients in mental hospitals who lack the ability to adhere to hygienic practices and vaccinating susceptible persons on admission may reduce the risk for outbreaks of acute HAV infection in these facilities." The article corresponding to this case is not available for submission due to copyright restriction. Lab Comments: Lab tests were performed on an unspecified dates in 2017. The patient was diagnosed with acute hepatitis A virus (HAV) infection.