Hepatitis A (patient information)

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Hepatitis A

Overview

What are the symptoms?

What are the causes?

Who is at highest risk?

When to seek urgent medical care?

Diagnosis

Treatment options

Where to find medical care for Hepatitis A?

What to expect (Outlook/Prognosis)?

Possible complications

Hepatitis A On the Web

Ongoing Trials at Clinical Trials.gov

Images of Hepatitis A

Videos on Hepatitis A

FDA on Hepatitis A

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Directions to Hospitals Treating Hepatitis A

Risk calculators and risk factors for Hepatitis A

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Hepatitis means inflammation of the liver. Hepatitis A is a liver disease caused by the hepatitis A virus (HAV), the most common type of hepatitis in the United States, along with the types B, and C. The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the feces of an infected person. The disease is closely associated with unsafe water, inadequate sanitation and poor personal hygiene. Hepatitis A infection can cause the liver to swell, but does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is associated with high mortality. For most patients, HAV will go away on its own after several weeks. Common symptoms may include: fever, nausea, vomiting, abdominal pain and diarrhea. Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. The hepatitis A virus is one of the most frequent causes of foodborne infection. Hepatitis A viruses persist in the environment and can resist food-production processes routinely used to inactivate and/or control bacterial pathogens.

What are the symptoms of Hepatitis A?

Hepatitis A virus has an incubation period of about 28 days (anywhere from 15 to 50 is usual). Symptoms of hepatitis A range from mild to severe. Some patients, often young children, have no symptoms, 70% of children younger than 6 who have HAV have no symptoms. Old patients are usually symptomatic. The symptoms of HAV may include:

Children younger than 6 years of age typically do not get jaundiced, while more that 70% of older patients do. Adults have signs and symptoms of illness more often than children, and the severity of disease and mortality increase in older age groups.

Symptoms typically last less than 2 months, but 10-15% of patients still have symptoms or have relapses up to 6 months after the onset of the disease. Unlike other instances of hepatitis (such as Hepatitis C), HAV is always acute.

What causes Hepatitis A?

Hepatitis A is caused by the hepatitis A virus. The hepatitis A virus is transmitted primarily by the fecal-oral route; that is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water.

People with HAV are infectious from the beginning of the incubation period (about a month before symptoms) until one week after they become jaundiced

Other common ways of acquiring Hepatitis A are:

  • Direct Person-to-person transmission
    • Eating food made by someone who has HAV who did not properly wash their hands after using the bathroom.
    • Not washing hands after changing a diaper (young children often are asymptomatic).
    • Having anal or oral sex with someone who has HAV.
  • Indirect transmission
    • Eating uncooked food that is HAV-contaminated. Cooked food can also cause hepatitis if not heated to 185°F (85°C) for 1 minute after being contaminated with HAV.
    • Drinking contaminated water. This is a common route of infection in underdeveloped countries. Chlorinated water, such as tap water in developed countries, kills HAV.

Who is at highest risk?

Anyone who has not been vaccinated or previously infected can contract hepatitis A. In areas where the virus is widespread (high endemicity), most hepatitis A infections occur during early childhood. Risk factors include:

  • Poor sanitation
  • Lack of safe water
  • Injecting drugs
  • Living in a household with an infected person
  • Being a sexual partner of someone with acute hepatitis A infection
  • Travelling to areas of high endemicity without being immunized.

When to seek urgent medical care?

One should report any symptoms and concerns to one's doctor, who can preform a blood test to confirm HAV and help prevent the spreading of the disease to others. An injection is typically offered to anyone living with someone who has HAV. If given within 14 days of contact, the injection can prevent Hepatitis A, or at least make symptoms its milder. There is no cure for Hepatitis A. The best advice to get healthy quicker is to avoid alcohol and get plenty of fluids and rest. One should check with their doctor before taking medicine which may harm the liver. Hepatitis can cause liver failure and death, but this is rare and occurs mostly with people over the age of 50 and have other liver diseases as well.

Diagnosis

Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis. Specific diagnosis is made by the detection of HAV-specific IgM and IgG antibodies in the blood.

HAV is detectable using this test 1-2 weeks after infection until 14 weeks after. Presence of IgG antibody means the patient is past the acute stage of hepatitis. A diagnosis can also be reached without a test, if the patient meets enough symptoms and is linked to a person who is known to have hepatitis A.

Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA but this assay may require specialised laboratory facilities.

Treatment options

There is no specific treatment for hepatitis A.

Recovery from symptoms following infection may be slow and may take several weeks or months. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhea.

Vaccination

Anyone who has had Hepatitis A (not just the vaccination) will be protected for life by IgG antibodies against HAV. Vaccinations will provide protection for 14-20 years in children and over 25 years in adults.

Vaccination provides protection for 95% of people. The vaccine is given to the upper arm, and a booster shot is given 6-12 months after the initial dose. The booster increases protection for at least 10 to 20 years. If the booster is delayed, one should get the booster as soon as they possible; the initial dose does not need to be repeated.

Hepatitis A vaccine can be done concurrently with other vaccinations as long as the other vaccinations take place in another injection site.

The vaccine contains inactivated HAV, and therefore immunocompromised people (on hemodialysis or with AIDS) can receive the vaccine. It is not been determined whether vaccination during pregnancy endangers the fetus, but the risk is expected to be low.

No HAV vaccine is licensed for children younger than one year of age.

Prevaccination testing is recommended only to reduce costs to those who may have already had Hepatitis A. Postvaccination testing is not necessary, since diagnostic tests cannot detect low, yet effective, level of anti-HAV antibodies.

All of the following groups are recommended to get the Hepatitis A vaccination:

  • Children 1 year old (12-23 months).
  • Anyone ages 2-18 who live in areas with high HAV incidence. Vaccination was only recommended for all children 1 year old in 2006, so areas with a history of high HAV incidence are recommended to give Hepatitis A vaccinations to anyone between the ages of 2-18.
  • Travelers to countries with higher rates of Hepatitis. Even cities and high-class hotels are in danger of having HAV, and even judicious travelers are in danger of contracting HAV. Areas include South America, Mexico, Indian Subcontinent and parts of Asia, Africa, and Eastern Europe.
  • Men who have sex with men.
  • Users of illegal drugs. Outbreaks by both injection and noninjection drugs have occurred in the past two decades.
  • People with an occupational risk for HAV infection. Only researches working with HAV or HAV-infected primates are known to be at occupational risk.
  • People with chronic liver disease. These people are at a higher rate of fulminant Hepatitis A (quickly progresses to liver failure, and often death). People about to receive or who have received liver transplants are recommended to get vaccinated as well.
  • People with clotting-factor disorders. People given clotting-factor concentrates, especially solvent detergent-treated preparations, are recommended to get vaccinated.

Nearly 100% of people develop protective levels of antibodies to the virus within one month after a single dose of the vaccine. Even after exposure to the virus, a single dose of the vaccine within two weeks of contact with the virus has protective effects. Still, manufacturers recommend two vaccine doses to ensure a longer-term protection of about five to eight years after vaccination.

Millions of people have been immunized worldwide with no serious adverse events. The vaccine can be given as part of regular childhood immunizations programmes and also with other vaccines for travellers.

Prevention

Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A.

The spread of hepatitis A can be reduced by:

  • Adequate supplies of safe drinking water
  • Proper disposal of sewage within communities
  • Personal hygiene practices such as regular hand-washing with safe water.
  • Clean bathrooms often, paying attention to commonly-touched surfaces (toilet seats, faucet taps)
  • Not preparing food for other people
  • Not sharing utensils
  • Not sharing any personal items that can spread HAV (toothbrushes, towels)

It is recommended that all people with Hepatitis A not work for 1 week after they become jaundiced to prevent spreading.

Where to find medical care for Hepatitis A?

Directions to Hospitals Treating Hepatitis A

What to expect (Outlook/Prognosis)?

For most patients, HAV will go away on its own after several weeks. Hepatitis A infection can cause the liver to swell, but does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms. However, in patients with debilitated immune systems and underlying liver disease, hepatitis A may cause fulminant hepatitis (acute liver failure), which is associated with high mortality.

Possible complications

Possible complications of hepatitis A include:

Sources


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