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A 3-year-old boy with fever
A 3-year-old boy is brought to the office because of a 2-day history of fever, nausea, weakness, and "yellow skin." He has always been a healthy child, rarely having more that a sore throat or ear infection. The family has not traveled recently and no other family members are sick. A couple of children in his childcare center are sick and a parent of one of the other children has similar symptoms. His temperature is 38.1 C (100.6 F). Physical examination shows icteric skin and conjunctiva but is otherwise unremarkable. Laboratory studies show:
IgM Anti-HAV Positive
HbsAg Negative
HCV-Ag Negative
You should advise the mother that:
A. Hepatitis vaccination that is routinely recommended for all children in the United States would have prevented this illness
B. Her son can return to childcare 5 days after the onset of symptoms
C. Household contacts should receive immune globulin within 2 weeks after last exposure
D. It is likely that her child was sexually abused by his friend's father
E. There is a 30% chance that her son will develop chronic hepatitis
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