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This mini-review emphasizes clinically relevant atypical patterns and their implications for pediatric 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of\u003Cbr>Virology |\n| --- | --- | --- | --- |\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Virol 2025 December 25; 14(4): 114174  \nDOI: 10.5501/wjv.v14.i4.114174 ISSN 2220-3249 (online)  \nMINIREVIEWS  \nAtypical presentation of pediatric acute hepatitis A: Is the situation alarming?  \nRubaiyat Alam  \nSpecialty type: Infectious Diseases  \nProvenance and peer review:  \nInvited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade C, Grade D  \nNovelty: Grade B, Grade C  \nCreativity or Innovation: Grade B, Grade C  \nScientific Significance: Grade B, Grade C  \nP-Reviewer: El-Karaksy H, MD, Professor, Egypt; Shamseldeen AM, MD, Assistant Professor, Egypt  \nReceived: September 15, 2025  \nRevised: November 6, 2025  \nAccepted: December 3, 2025  \nPublished online: December 25, 2025  \nProcessing time: 103 Days and 19.1 Hours  \nRubaiyat Alam, Department of Pediatric Gastroenterology and Nutrition, Bangladesh Medical University, Dhaka 1000, Bangladesh  \nCorresponding author: Rubaiyat Alam, Assistant Professor, Department of Pediatric Gastroenterology and Nutrition, Bangladesh Medical University, Shahbag, Dhaka 1000, Bangladesh.  \n[dr.rubaiyat@yahoo.com](dr.rubaiyat@yahoo.com)  \nAbstract  \nHepatitis A virus (HAV) infection remains a significant public health concern in many developing countries. The annual incidence of HAV infection is 1.5 million, though this figure may be underestimated owing to the infection’s asymptomatic nature and the presence of milder disease variants. The clinical spectrum of HAV infection now ranges from asymptomatic infection to fulminant hepatitis. Despite the availability of safe and highly effective vaccines, HAV infections remain a major contributor to acute viral hepatitis worldwide.  \nKey Words: Acute hepatitis A; Acute viral hepatitis; Atypical manifestation; Children; Prolonged cholestasis  \n©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.  \nCore Tip: Although pediatric hepatitis A is usually self-limiting, atypical presentations, such as cholestatic, relapsing, and autoimmune-triggered forms, can prolong morbidity and, occasionally, be life-threatening. This mini-review summarizes the clinical spectrum, highlights warning signs of severe disease, and outlines practical management and prevention strategies, with a particular emphasis on vaccination.  \nCitation: Alam R. Atypical presentation of pediatric acute hepatitis A: Is the situation alarming? World J Virol 2025; 14(4): 114174  \nURL: [https://www.wjgnet.com/2220-3249/full/v14/i4/114174.htm](https://www.wjgnet.com/2220-3249/full/v14/i4/114174.htm)  \nDOI: [https://dx.doi.org/10.5501/wjv.v14.i4.114174](https://dx.doi.org/10.5501/wjv.v14.i4.114174)  \n WJV  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 25, 2025  Volume 14  Issue 4   \nAlam R. Atypical manifestations of pediatric acute hepatitis A  \nINTRODUCTION  \nHepatitis A virus (HAV) is a nonenveloped, single-stranded RNA virus of the Picornaviridae family, Hepatovirus genus[1] . Transmission occurs predominantly via the fecal-oral route through contaminated food or water, with potential personto-person transmission [2] . In low-and middle-income countries, HAV is endemic, with most children being infected early in life, usually asymptomatically. In highly endemic areas, infection before the age of five leads to lifelong immunity and low rates of symptomatic disease [3] .  \nWith improvements in socioeconomic conditions, sanitation, and hygiene, several regions have transitioned from high to intermediate endemicity[4,5] . The typical pediatric presentation involves a brief prodrome of fever, malaise, anorexia, and vomiting, followed by jaundice and dark urine, resolving spontaneously within 2-6 weeks[6] . In contrast, atypical forms differ in duration, severity, or systemic involvement and include cholesta","cbCaienjCcD5T1Rw","https://ap.wps.com/l/cbCaienjCcD5T1Rw","pdf",560498,"English","# Abstract\n## Core Tip\n# Introduction\n## Epidemiology","[{\"question\":\"What makes pediatric acute hepatitis A presentations atypical?\",\"answer\":\"Atypical forms differ in duration, severity, or systemic involvement, including cholestatic, relapsing, and autoimmune-triggered hepatitis, and may include extrahepatic manifestations.\"},{\"question\":\"Why can hepatitis A incidence be underestimated in developing countries?\",\"answer\":\"Reported incidence may be underestimated because many HAV infections are asymptomatic and include milder disease variants that may not be captured as symptomatic cases.\"},{\"question\":\"What practical approach does the mini-review suggest for managing atypical pediatric HAV?\",\"answer\":\"It summarizes the clinical spectrum, highlights warning signs of severe disease, and outlines practical management and prevention strategies with emphasis on vaccination.\"}]","Atypical presentation of pediatric acute hepatitis A - Is the situation alarming? | PDF",1790568005,23]