therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids lost from vomiting and diarrhea. prognosis in the united states in 1991, the mortality rate for hepatitis a was estimated to be 0.015% for the general population, but ranged up to 1.8–2.1% for those aged 50 and over who were hospitalized with icteric hepatitis. the risk of death from acute liver failure following hav infection increases with age and when the person has underlying chronic liver disease. young children who are infected with hepatitis a typically have a milder form of the disease, usually lasting 1–3 weeks, whereas adults tend to experience a much more severe form of the disease. epidemiology hepatitis a distribution 2005 high: prevalence higher than 8% intermediate: between 2% and 7% low : less than 2% globally, symptomatic hav infections are believed to occur in around 1.4 million people a year. about 114 million infections (asymptomatic and symptomatic) occurred all together in 2015. acute hepatitis a resulted in 11,200 deaths in 2015. developed countries have low circulating levels of hepatovirus a, while developing countries have higher levels of circulation. most adolescents and adults in developing countries have already had the disease, thus are immune. adults in midlevel countries may be at risk of disease with the potential of being exposed. countries over 30,000 cases of hepatitis a were reported to the cdc in the us in 1997, but the number has since dropped to less than 2,000 cases reported per year. the most widespread hepatitis a outbreak in the united states occurred in 2018, in the state of kentucky. the outbreak is believed to have started in november 2017. by july 2018 48% of the state's counties had reported at least one case of hepatitis a, and the total number of suspected cases was 969 with six deaths (482 cases in louisville, kentucky). by july 2019 the outbreak had reached 5,000 cases and 60 deaths, but had slowed to just a few new cases per month. another widespread outbreak in the united states, the 2003 us hepatitis outbreak, affected at least 640 people (killing four) in northeastern ohio and southwestern pennsylvania in late 2003. the outbreak was blamed on tainted green onions at a restaurant in monaca, pennsylvania. in 1988, more than 300,000 people in shanghai, china, were infected with hav after eating clams (anadara subcrenata) from a contaminated river. in june 2013, frozen berries sold by us retailer costco and purchased by around 240,000 people were the subject of a recall, after at least 158 people were infected with hav, 69 of whom were hospitalized. in april 2016, frozen berries sold by costco were once again the subject of a recall, after at least 13 people in canada were infected with hav, three of whom were hospitalized. in australia in february 2015, a recall of frozen berries was issued after at least 19 people contracted the illness following their consumption of the product. in 2017, california (particularly around san diego), michigan, and utah reported outbreaks of hepatitis a that have led to over 800 hospitalizations and 40 deaths.