Rationale:

• Hospitalization may be required to monitor disease severity.
• Hospitalization may be required to differentiate azotemia due to dehydration from azotemia due to hepatorenal syndrome.

Evidence:

• An estimated 33% of reported cases of hepatitis A require hospitalization (76).
• Persons with acute liver failure may require evaluation for transplantation (98).

Comments:

• Pregnant patients may need to be hospitalized to correct dehydration and malnutrition (99).
• A retrospective review of records of 79,458 pregnancy admissions found 13 cases of second and third trimester HAV infection. Nine of these women developed gestational complications, 8 of whom had preterm labor. Pregnant women with acute HAV infection have a high risk of gestational complications (100).
• There are currently no universally accepted criteria for the diagnosis of acute liver failure (98).
• Symptomatic disease is more likely to occur in older children and adults (3; 79), and serious disease may be more likely to occur in older adults (101), particularly those with chronic liver disease (64; 65).