Hepatitis A (patient information)

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Overview
Hepatitis means inflammation of the liver. The liver is a vital part of the body. If it does not work properly, it can cause serious illness. Viral hepatitis is the term used when the hepatitis is caused by a virus. There are several types of viral hepatitis including A, B, C, D and E; the most common types in the United States are hepatitis A, hepatitis B, and hepatitis C. All these viruses affect the liver but are spread in different ways. So the ways to prevent people from getting the virus are different too. Drinking alcohol or taking drugs (whether legal, illegal or prescription) can also cause a type of hepatitis. Hepatitis A is a contagious liver disease that results from infection with the hepatitis A virus (also known as HAV). One can acquire HAV by ingesting food contaminated with the virus. Typically, HAV can cause the liver to swell, but does not cause any permanent damage. Patients may feel flu-like symptoms or have no symptoms at all. For most patients, HAV will go away on its own after several weeks.

What are the symptoms of Hepatitis A?
HAV has an incubation period of about 28 days (anywhere from 15 to 50 is usual). 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 are: 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 symptoms. Unlike other instances of Hepatitis (such as Hepatitis C), HAV is always acute.
 * Fever
 * Fatigue
 * Loss of appetite
 * Nausea
 * Vomiting
 * Abdominal pain
 * Dark urine
 * Clay-colored bowel movements
 * Joint pain
 * Jaundice. Younger children (<6 yrs) typically do not get Jaundiced, while older patients often (>70%) do.

What causes Hepatitis A?
Hepatitis A is spread through ingesting food or water contaminated by the feces of an infected person. People with HAV are infectious from the beginning of the incubation period (about a month before symptoms) until one week after they become jaundiced. Common ways of acquiring Hepatitis A are: If you have HAV or you live with someone who has HAV, to prevent spreading one with HAV should: It is recommended that all people with Hepatitis A not work for 1 week after they become jaundiced to prevent spreading.
 * Direct Person-to-person transmission
 * Eating food made by someone who has HAV who did not properly wash their hands after using the bathroom.
 * Having anal or oral sex with someone who has HAV.
 * Not washing hands after changing a diaper (young children often are asymptomatic).
 * 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.
 * 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.).

Who is at highest risk?
All of the following groups are recommended to get the Hepatitis A 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.
 * 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.

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.

Where to find medical care for Hepatitis A?
Directions to Hospitals Treating Hepatitis A

Diseases with similar symptoms

 * Hepatitis B
 * Hepatitis C
 * Hepatitis D
 * Hepatitis E