Hepatitis A

Introduction

Hepatitis A is a disease caused by the Hepatitis A Virus (HAV) and affects the liver. Hepatitis A is preventable. The virus is transmitted from human to human by the ingestion of food/water that has been contaminated by the fecal material of an infected person. Other routes of transmission include close contact or sexual contact with an infected person, the ingestion of water contaminated by sewage and shared needles. Unlike Hepatitis B, Hepatitis A does not become a chronic infection. A person can not contract Hepatitis A more than once. Conversely, as with Hepatitis B, some patients will show no symtoms of the disease. HAV is most prevalent in developing nations and areas where sanitation practices are of poor quality.^[1][2][3]

Prevention

• Hepatitis A vaccinations*
• If you drink water, buy it bottled or bring it to a rolling boil for 1 minute before you drink it. Bottled carbonated water is safer than uncarbonated water.
• Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid popsicles and flavored ices that may have been made with contaminated water.
• Eat foods that have been thoroughly cooked and that are still hot and steaming.
• Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well.
• When you eat raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands with soap first.) Do not eat the peelings.
• Avoid foods and beverages from street vendors. It is difficult for food to be kept clean on the street, and many travelers get sick from food bought from street vendors.
• Do not share personal items such as toothbrushes.
• Practice good hygiene by washing your hands as often as possible, especially after toilet visits.
• Use latex or polyurethane condoms during all types of sexual encounters including oral. Do not use lambskin or other "natural" condoms as they do not protect against STDs.
• Avoid recreational intravenous drug use or use only sterile needles and syringes.*

*This precautionary statement is made only for the purpose of preventing HAV transmission and is not one condoning the use of recreational drugs.

Pre-Exposure Vaccinations

The Hepatitis A vaccine is a series of two injections given at days 0 and 180 (6 months). The immunizations have been shown to be effective up to 20 years duration. The vaccine becomes fully effective over a four week period. People planning to travel before fully immunized should consider receiving an immune globulin injection before embarking on their travels. Immune globulin boosts the immune system and lowers the infection rate if exposed. Those traveling to endemic areas regularly or are at greater risk should receive a booster at 1-2 years following the initial injections.

Currently, a combination vaccine (Twinrex®) can be given to persons 18 years of age and over. Twinex® has been shown to provide protection against both Hepatitis A & B, and is considered as effective as both vaccines when each is administered separately.^[1][4]

Symptoms and Treatment

Symptoms

Hepatitis A has an incubation period of 15-50 days post-exposure. During that time, the virus can be spread to others. Some patients will not develop any symptoms of the disease. Those who do will usually experience a sudden onset and mistake these signs for severe intestinal influenza. Children are less likely to develop symptoms than are adults.

Symptoms of HAV include weakness/fatigue, loss of appetite, nausea, vomiting, low-grade fever, abdominal pain (with possible localization around the liver), "orange/brown" urine, jaundice, joint pain and itching. Not all patients will display all symptoms. Most patients improve over a short period of time and undergo no permenant damage to the liver. Approximately 10% of patients will experience a prolonged recovery or possible relapsing symptoms over a 6-9 month timeframe.^[1][5]

Treatment

At this time, there is no treatment for Hepatitis A infection. Those requiring medical attention will be treated symptomatically.^[1][6]