Hepatitis A

Definition:
Hepatitis A is a liver disease caused by the hepatitis A virus (HAV).
This form of viral hepatitis also known as infectious hepatitis, due to its ability to be spread through personal contact. Hepatitis A is a milder liver disease than hepatitis B, and asymptomatic infections are very common, especially in children.

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According to the World Health Organisation, there are an estimated 1.5 million new cases of illness due to hepatitis A each year worldwide, and many more people become infected without developing symptoms. It’s particularly common in less developed countries where poverty or poor sanitation are important factors.

Africa, northern and southern Asia, parts of South America, and southern and eastern Europe all have high rates of the disease. In these countries almost every adult carries antibodies to hepatitis A suggesting that it is quite usual for people to be exposed to the infection, usually in childhood, and to develop immunity.

The infection isn’t common in the UK, although it’s still the main type of infective hepatitis seen. (There are several other types of viral hepatitis, such as hepatitis B and hepatitis C.) In 2005, for example, there were 457 laboratory reports of confirmed hepatitis A virus (HAV) infection in England and Wales.

The majority of people from the UK who become infected with hepatitis A contract it when abroad in a country where it is very common.

Hepatitis A is an acute infection, rather than chronic (long-term). Rarely, it can cause life-threatening liver damage.Hepatitis A does not cause a carrier state or chronic liver disease. Once the infection ends, there is no lasting phase of illness.  However, it is not uncommon to have a second episode of symptoms about a month after the first; this is called a relapse.

Symptoms :
The incubation period of the virus before symptoms develop is between two and six weeks. How severely someone is affected varies from person to person. Some may not have any symptoms at all, while others may have just mild symptoms similar to those of a flu-like illness. This is particularly common among infants and young children.

The older someone is, the more severe the infection and symptoms are likely to be.

 

Possible symptoms include weakness, tiredness, headache, fever, loss of appetite, nausea and vomiting, abdominal pain and diarrhoea and dehydration. These may all occur for a week or more before jaundice appears.

Jaundice occurs in hepatitis infections because the liver becomes unable to remove a substance called bilirubin from the blood. This is a pigment that builds up in the body, causing the skin and whites of the eyes to turn yellow.

Causes:
HAV is found in the stool (feces) of persons infected with hepatitis A. HAV is usually spread from person to person by putting something in the mouth that has been contaminated with the stool of a person infected with hepatitis A. This is called fecal-oral transmission. Thus, the virus spreads more easily in areas where there are poor sanitary conditions or where good personal hygiene is not observed. Most infections result from contact with a household member who has hepatitis A. Blood-borne infection has been documented but is rare in the United States. The common modes of transmission of hepatitis A are as follows:

•consuming food made by someone who touched infected feces
•drinking water that is contaminated by infected feces (a problem in communities with poor sewage treatment facilities)
•touching an infected person’s feces, which may occur with poor hand washing
•having direct contact in large daycare centers, especially where there are children in diapers
•being a resident of states in which hepatitis A is more common
•sexual contact with an infected person.

Risk Factors:
*Eating food that was prepared by someone who is infected with hepatitis A and poor hygiene.
*Consuming raw or undercooked shellfish (like oysters or clams).
*Eating raw foods (such as unpeeled fruits or vegetables) and drinking tap water or well water while traveling to countries where hepatitis A is common.
*Living in a community where hepatitis A is common and outbreaks occur (largely a risk factor for young children).
*Living in a house with someone who has hepatitis A.

Lifestyle factors that increase the risk of hepatitis A include:
* Travel to countries where hepatitis A is common.
* Be a man having sex with men.

Diagnosis
Hepatitis A symptoms often go unrecognized because they are not specific to hepatitis A, thus a blood test (IgM anti-HAV) is required to diagnose HAV infection. This test detects a specific antibody, called hepatitis A IgM, that develops when HAV is present in the body.

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Treatment:
No specific treatment is available for hepatitis A. However, the following guidelines are often recommended:

•Fluids and diet. The best treatment is to make sure that the child drinks a lot of fluids and eats well.
•Rest. The child should rest while he or she has fever or jaundice. When fever and jaundice are gone, activity may be gradually increased as with the healthcare provider’s approval.
•Medications. The body’s immune system fights the HAV infection. Once the child recovers from hepatitis A, the virus leaves the body. Medications, prescription or nonprescription, should not be given without consulting the doctor.

About 15% of people will have a prolonged or relapsing illness lasting up to 9 months. Tragically, a small number of people die when the infection overwhelms the body. This is more likely to happen to people over the age of 60.

A person with hepatitis A should avoid drinking alcohol until their liver is completely back to normal, as alcohol is toxic to liver cells and will slow its recovery.

Ensuring good personal hygiene practices – washing your hands after using the toilet and maintaining good food preparation – is essential in avoiding infection with hepatitis A, especially if you visit a high risk area.

When visiting high-risk countries, it’s a good idea to avoid eating raw or inadequately cooked salads and vegetables, ice cream, unpeeled fruit and shellfish. Also avoid unpasteurised milk and drinks with ice, and check whether tap water is safe to drink before you go.

There’s an effective vaccination to protect people from hepatitis A infection. It’s available from your GP or high street travel centres, who will be able to advise you whether you need it for the country you are visiting. It’s recommended for anyone travelling to the high-risk regions of the world.

Those people who have already had hepatitis A usually have life long immunity.

Prognosis:
Viral hepatitis symptoms usually last three weeks to two months but may last up to six months. Children may return to daycare one week after symptoms first appear, with the doctor’s permission. Most children with hepatitis get better naturally without liver problems later in life. However, some children do have subsequent liver problems. For this reason, it is important to keep in close touch with the treating physician and to keep all followup appointments. Chronic, or relapsing, infection does not occur with hepatitis A. In the United States, serious complications are infrequent, and deaths are very rare.

Prevention:
According to the Centers for Disease Control and Prevention (CDC), routine vaccination of children is the most effective way to lower the incidence of hepatitis A nationwide. The CDC encourages implementation of routine hepatitis A vaccination programs for children in the 17 states which have the highest rates of hepatitis A. Hepatitis A vaccine has been licensed in the United States for use in persons two years of age and older. The vaccine is recommended (before exposure to hepatitis A virus) for persons who are more likely to get hepatitis A virus infection or are more likely to get seriously ill if they do get hepatitis A. The vaccines licensed in the United States as of 2004 were HAVRIX(r) (manufactured by Glaxo SmithKline) and VAQTA(r) (manufactured by Merck & Co., Inc).

 

Parents should teach their children always to wash their hands with soap and water after using the bathroom and before preparing and eating food. Travelers should avoid water and ice if unsure of their purity, or they can boil water for one minute before drinking it.

Short-term protection against hepatitis A is available from immune globulin, a preparation of antibodies that can be given before exposure for short-term protection against hepatitis A and for persons who have already been exposed to HAV. It can be given before and within two weeks after suspected contact with the virus.

Parental Concerns
The best way to prevent exposure to HAV is good habits in washing hands. Children should wash their hands every time they go to the bathroom. Good handwashing should be enforced at home and at daycare facilities. It is also very important to keep a clean environment, such as clean toilets, bathrooms, and clothing. If a child is diagnosed with HAV, other family members should be treated to prevent spread of the disease. The healthcare provider can help parents to plan treatment for the entire family.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.answers.com/topic/hepatitis-a
http://www.bbc.co.uk/health/physical_health/conditions/hepatitisa1.shtml

http://nationalnursingreview.com/tag/hepatitis-a-sign/
http://www.utmedicalcenter.org/your-health/encyclopedia/general/image/9394/
http://medicalsin.com/risk-factors-hepatitis-a-symptoms-increase/
http://www.fehd.gov.hk/english/safefood/library/prevent_hepatitis_A/2.html

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