Hepatitis A (patient information): Difference between revisions
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==Who is at highest risk?== | ==Who is at highest risk?== | ||
All of the following groups are recommended to get the Hepatitis A vaccination: | All of the following groups are recommended to get the Hepatitis A [[vaccination]]: | ||
*'''Children 1 year old (12-23 months).''' | *'''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. | *'''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. | ||
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*'''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 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. | *'''People with clotting-factor disorders.''' People given clotting-factor concentrates, especially solvent detergent-treated preparations, are recommended to get vaccinated. | ||
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. | 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. | ||
==When to seek urgent medical care?== | ==When to seek urgent medical care?== | ||
Revision as of 20:26, 27 July 2014
For the WikiDoc page for this topic, click here
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Hepatitis A |
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Hepatitis A On the Web |
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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. 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:
- Fever
- Malaise
- Fatigue
- Loss of appetite
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Dark urine
- Clay-colored bowel movements
- Joint pain
- Jaundice.
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?
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.
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.
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
Diagnosis is made by detecting IgM antibodies corresponding to HAV in 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.
Treatment options
Vaccine 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 from at least 10 years to at least 20 years. If the booster is delayed, one should get the booster as soon as they can; the initial dose need not be repeated. Hepatitis A vaccination 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. 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.
Prevention
If you have HAV or you live with someone who has HAV, to prevent spreading one with HAV should:
- Always wash hands thoroughly after going to the bathroom.
- Clean bathrooms often, paying attention to commonly-touched surfaces (toilet seats, faucet taps, etc.).
- Not prepare food for other people.
- Not share utensils.
- Not share any personal items that can spread HAV (toothbrushes, towels, etc.).
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