Hepatitis A is a viral infection which can lead to inflammation of the liver. Although it is found in all countries, it is relatively uncommon in the UK and other developed countries but occurs frequently in areas where infrastructure for sanitation and sewage disposal is lacking. Such places include Africa, parts of Asia, Central America and Eastern Europe. It is spread by the faecal-oral route – this is when food or drink is contaminated with faeces from a person infected by Hepatitis A.
Hepatitis A (HAV) forms part of a group of viruses (which include hepatitis B, C, D, E and G) that mainly attack the liver. Hepatitis means “inflammation of the liver”. Other causes of hepatitis include excessive alcohol intake and certain drugs including medicines taken in overdose. The liver is a large organ located in the upper abdomen, mainly on the right side. It has many hundreds of functions which are essential for our survival and well being. Some of its major roles are summarised below;
- Storing fuel for the body in the form of glycogen which is made from sugars such as glucose. When glucose is required by body cells, the liver breaks down glycogen, releasing glucose into the bloodstream.
- Processing fats and proteins obtained from food.
- The production of clotting factors. These are proteins which enable blood to clot.
- The safe processing and removal of alcohol.
- The safe processing of many poisons and toxins from the body.
- The processing of many medicines.
- The production of bile which is used to aid fat digestion in the gut.
- The production of plasma proteins (mainly albumin) which are essential for fluid regulation within blood and the circulatory system.
- The storage of elements and vitamins such as Vitamins A, D, E, K and iron.
- The production of some antibodies to aid natural immunity.
How is Hepatitis A transmitted?
HAV is present in the stools (faeces) of infected people and is passed out through this route. It is therefore easily spread where there is poor personal hygiene, poor sanitation, poorly treated water supplies, poor disposal of sewage and in areas of overcrowding. In these areas, the local water supply and food can easily become infected with HAV. Uncooked food becomes infected when washed in contaminated water. Shellfish caught in contaminated water can carry the virus.
Therefore, in high risk areas, such as Africa, most of Asia, Central and South America and Eastern Europe, it is advisable to avoid the following:
- Uncooked foods, including raw fruit, salads and vegetables washed in contaminated water,
- Untreated drinking water,
- Ice cubes made from contaminated water,
- Shellfish.
Conversely, HAV outbreaks are infrequent in most developed countries where sanitation is good and the water supply is clean. However, even in these countries, outbreaks in schools, other institutions and amongst families do occur as the virus is easily spread with poor personal hygiene, specifically, lack of hand washing after going to the toilet.
What are the Symptoms of Hepatitis A infection?
Individuals of any age can become infected with HAV. The incubation period (this is the time from catching the virus to developing symptoms) varies from 2-6 weeks. However, even if you yourself have not developed any symptoms yet, you will still excrete the HAV infection through faeces and therefore have the potential of spreading the infection on to others if your personal hygiene is poor. Sometimes and especially in children, no symptoms may develop. For others, symptoms may include:
- Flu like symptoms such as lethargy, aches & pains, headaches, fever,
- Nausea, vomiting or diarrhoea,
- Abdominal discomfort or pains,
- Jaundice (when an individual looks yellow). Jaundice develops with a build up of bilirubin which causes the whites of eyes and skin to appear yellow. It may also turn urine very dark and faeces very pale. Jaundice can also cause itching of the skin.
The severity and duration of these symptoms will vary from person to person. The flu like symptoms and jaundice generally tend to last approximately 1 week before gradually subsiding. But the symptoms of tiredness and fatigue can last longer and may last 1-2 months. In a few individuals, symptoms can recur and may persist for up to 6 months.
The vast majority of infected individuals recover fully and without complications. They develop immunity to HAV so that they do not catch the virus again. But, in a small minority, more serious complications can occur, causing serious medical problems of liver disease and liver failure. This is commonest in the elderly population, in those with other chronic medical conditions such as diabetes, anaemia, heart failure or in those who are immunocompromised (have a weakened immune system) such as those with HIV. A few may die from the infection. If serious liver damage occurs, liver transplant may be the only option.
However, generally and for most people, infection with HAV is mild, unpleasant and acute (short lived). It therefore does not tend to have a persistent (chronic) phase.
How is Hepatitis A diagnosed?
Diagnosis of HAV is usually done by using a blood test. This blood test detects antibodies to the virus which are produced by the body’s immune system. Longer term, a different antibody can be detected from another blood test which indicates a past infection and therefore present immunity from further HAV infections.
How is Hepatitis A treated?
There is no specific treatment for HAV. The vast majority of those infected will recover completely within a few weeks. However, simple advice is usually given to infected individuals including:
- Bed rest;
- Avoidance of fatty foods to avoid nausea and vomiting;
- Avoidance of alcohol;
- Advice on personal hygiene such as washing hands after using the toilet to reduce spread to others;
- Avoiding intimate contact with others such as kissing;
- Avoiding the sharing of towels and flannels.
- Occasionally individuals may need to be admitted to hospital especially if they become dehydrated. Fluids may be given through an intravenous drip and other medication may be required.
How can Hepatitis A be prevented?
HAV infection can be prevented mainly by avoiding the behavior outlined above. Therefore, particular attention to food, water and personal hygiene should be given, especially in high risk parts of the world.
For travel abroad to these high risk areas immunisation against HAV is always recommended. An initial injection is given 4-6 weeks before traveling with a second injection (a booster dose) given 6-12 months later. Protection against HAV begins approximately 4 weeks after the first injection of vaccine. The second dose is thought to confer immunity for at least 20 years.
Short term protection lasting 3-6 months can be obtained from an injection of antibodies called immunoglobulin. This is useful if in close contact with an infected person or if immediate travel is necessary without the time for immunisation. However, the dose of immunoglobulin must be given within 2 weeks from exposure to HAV for maximum protection.
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