Hepatitis A

What is Hepatitis A?
Hepatitis A is one of several known viruses that cause inflammation of the liver. The Centers for Disease Control and Prevention (CDC) estimate that 150,000 people in the United States are infected each year by hepatitis A, a low rate compared to the rate in the underdeveloped countries. The vast majority of people recover from the infection within one to two weeks without any serious health problems.

How is Hepatitis A transmitted?
Transmission usually occurs by drinking water or eating food contaminated with fecal material that contains the virus. Unlike hepatitis B and C viruses, the hepatitis A virus remains stable as it enters the digestive tract. Fecal matter from an infected person has a high concentration of the virus during a certain period of infection, whereas saliva and other bodily fluids have a low concentration. The virus can survive in this contaminated fecal matter on a persons hand or on a surface for three hours at normal room temperatures. Therefore, an eating utensil contaminated with the virus could be a way to transmit the infection to a person. Contaminated shellfish are also a frequent source of infection. Direct contact with an infected person is another confirmed transmission route. Kissing on the mouth, anal sex and contaminated

I.V. needles are also transmission routes. Two groups--gay men and injection drug users--are cited as having high risk for hepatitis A and also at high risk for HIV. In over 40% of reported cases, it is not known how these people were infected.

Who is at risk for Hepatitis A?
The risk of becoming infected with hepatitis A usually depends on the hygienic and sanitary conditions in an area. High risk areas are the Middle East, South America, Eastern Europe, Central America, Africa, and Southeast Asia. There are areas in the United States where poor sanitary conditions or hygiene have resulted in outbreaks. It is two to three weeks before or right after symptoms appear that people will shed high concentrations of the virus into the feces and transmit the infection to others. The CDC lists household or sexual contact, daycare attendance or employment, or recent international travel as the major known risk factors for transmission of hepatitis A. The CDC estimates that one third of the U.S. population has been infected.

What are the symptoms of Hepatitis A infection?
Persons with hepatitis A may not have any symptoms. In those that do have symptoms, they resemble the flu. These symptoms include fatigue, nausea, vomiting, pain in the liver area, dark urine or light colored stools and fever. Liver function tests are elevated and many adults develop jaundice. Children under age two rarely have symptoms. As mentioned earlier, most people recover in one to two weeks.

Can Hepatitis A result in serious complications?
A very small percentage of people infected with hepatitis A risk serious complications. These include people with alcoholic hepatitis, chronic hepatitis with cirrhosis or the elderly over 60 years of age. These people may suffer liver failure after becoming infected with hepatitis A. Persons with hepatitis A may show improvement in their symptoms and liver function tests only to suffer a relapse, usually after four weeks. A relapse may occur more than once and there is no way to predict who will suffer recurrence of acute symptoms. In rare cases, jaundice lasts for two or more months. It is rare for pregnant women who are infected with hepatitis A to suffer serious complications to themselves or their newborns.

How is Hepatitis A diagnosed and treated?
Hepatitis A is diagnosed by a blood test that is positive for the antibody to the virus, which appears about four weeks after the infection. There are very rare false positives or negatives with this test. Liver function tests are elevated above normal. Symptoms will normally appear during the first four weeks of infection.

There is no specific treatment for hepatitis A. Most people are told to rest for one to four weeks after a diagnosis is made, to avoid intimate contact and to consume foods high in protein. People who have come in contact with an infected person should be given temporary immunization with immune serum globulin within two weeks of exposure.

Can hepatitis A be prevented?
Avoiding areas and circumstances at risk can help to prevent hepatitis A as well as good hand washing. There is a vaccine currently on the market for hepatitis A. The vaccine is made form an inactive hepatitis A virus that has been suspended in a sterile solution. It is not made from infected blood. The body reacts with the inactive virus to produce an antibody that protects against infection of the liver by hepatitis A virus. Clinical trials have shown that the vaccine is effective in preventing infection in over 90% of people exposed. There are generally no side effects, except for soreness at the site of the injection. Children and adults should receive an initial dose of the vaccine and a booster dose 6 to 12 months later. It takes at least two weeks before protection is achieved. It is not certain how long protection lasts.

If you are traveling to a high risk area or living in a high risk area, it is a good idea to contact you physician about receiving the vaccine.

Please contact your physician or other health care professional if you have any questions.