Hepatitis A: Symptoms, Causes, Risks, Complications, Diagnosis, Treatment, Prevention and Prognosis

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Hepatitis A

1Overview

Hepatitis A is a very contagious liver infection caused by hepatitis A virus (HAV), which is a member of the Hepatovirus, in the family Picornaviridae. This virus is found in the stool and blood of an infected person and is one of the enterically-transmitted viruses that causes inflammation of the liver.  This infection can be prevented through vaccination so that it won’t lead to chronic hepatitis.

The only reservoir of this infection is humans. This type of virus can infect children and adults. The mode of transmission of this infection is primarily through person-to-person contact or ingesting infected food and water with feces (fecal-oral route). Once infected, HAV usually resolves on its own over several weeks, and a full recovery is expected, but occasionally relapses happen.

According to the World Health Organization (WHO), most children, about 90 percent have been infected with hepatitis A before they reach ten years of age. This is due to poor sanitary conditions. However, since children do not show any symptoms of the infection, the parents may not know that they have been previously infected.

In developing countries, those with transitional economies and those with good sanitary conditions, children may not become infected and may grow into adults without immunity to the disease. Consequently, in developed countries with good sanitary conditions, the rates of infection are low. However, this may lead to a great number of adults being infected with the disease because they do not have immunity to the disease.

As a result, when these people visit countries with high levels of infection, there is a great chance that they will acquire the disease.

2Symptoms

The HAV is present for about 15 to 45 days before the symptoms would appear. The HAV infects the liver cells causing inflammation which then impairs liver function. The following signs and symptoms do not appear until the individual had the virus for a few weeks. However, not everyone with hepatitis A develops signs and symptoms. Children exhibit no symptoms at all.

  • Abdominal discomfort, especially in the area of the liver on the right side beneath the lower ribs
  • Jaundice (yellowish discoloration of the skin and eyes)
  • Exhaustion/ fatigue/ lack of energy
  • Nausea and vomiting
  • Decreased appetite
  • Clay- colored stools/ chalky- grey stool
  • Low- grade fever
  • Headache
  • Joint pain or muscle pain
  • Itchy skin or pruritus
  • Dark amber color of urine (bile is removed in the blood stream and excreted in urine)

3Causes

Hepatitis A infection is caused by hepatitis A virus excreted in the feces of an infected person. The virus is resistant to detergents, solvents like chloroform, temperature up to 60°C and drying. It can survive in fresh water and salt water for months.

It can easily be transmitted if the infected person does not practice proper hygiene, such as handwashing or when he does improper waste disposal. People contract this infection easily by fecal-oral route but very rare by blood or blood products.

The causes include:

  • Ingesting food and water contaminated with hepatitis A virus (e.g. vegetables; fruits; shellfish, which is a common source; water and ice); flies carry diseases like hepatitis An infection by contaminating these things
  • Putting something, such as object in the mouth that had been contaminated with infected feces
  • Changing diapers (fecal residue of the infected person may remain in the hands of people changing soiled diapers)
  • Improper handling of foods (infected food handlers who don’t wash their hands with soap and water after bowel movement);
  • Taking part in sexual practices like oral-anal contact

4Risk Factors

The following are at risk for hepatitis A infection:

  • People living in household with someone infected with hepatitis A virus
  • People who traveled internationally Especially to places with poor sanitation
  • Employees and children in the day care (changing diapers of babies)
  • Individuals who practice oral-anal sex (men having sexual contact with another man); or having sexual activity with an HAV infected person
  • People who use illegal drugs (via injection)
  • Restaurant workers and food handlers
  • Laboratory workers who directly handle live hepatitis A virus
  • Those living or working in a nursing home center

5Complications

Hepatitis A, unlike the other viral hepatitis, does not cause a long-term liver damage.  But in rare cases, a fulminant hepatitis A or acute liver failure happens suddenly. Though rare, it could be very devastating and lethal as it may require an urgent liver transplant and sometimes might lead to death. This happens mostly to elderly patients or with those having chronic liver disease.

6Diagnosis

To accurately diagnose hepatitis A, the doctor does a physical examination to the client like observing signs of jaundice and assess if the liver for enlargement and tenderness. He may also order the following blood tests or test for antibodies that the body produces to fight infection.

  • HAV Immunoglobulin M (IgM) antibody test detects the first antibody produced by the body when exposed to hepatitis A. This also detects the early or recent infections and to diagnose those with symptoms of acute hepatitis.
  • HAV Immunoglobulin G (IgG) antibody test detects if the person developed immunity from past infection. Ig antibodies are present for life thus protecting against persistent infection by the same virus.
  • Bilirubin Test
    The bilirubin test detects the underlying cause of jaundice. High bilirubin level in the blood causes the yellowish discoloration of the skin known as jaundice.
  • Liver Enzymes (Aminotransferases)
    When the liver is damaged, the aminotransferase enzymes are released.
  • Alkaline Phosphatase (ALP)
    High ALP levels can indicate blockage inside the bile duct
  • Serum Albumin Concentration
    This measures the protein in the blood. Low levels indicate poor liver function.

7Treatment

There are no specific treatment or cure for hepatitis A. The infection will resolve on its own in weeks or months without complications. Once the individual recovers, he or she has already a lifetime immunity. The physician will just order a test to check liver function and be sure the body is recuperating.

Managing signs and symptoms of hepatitis A infection helps the client recover fast. While recuperating, the client should get as much rest she/he needed. Those clients with hepatitis A feel tired and have less energy.

Eat small and frequent meals especially high-calorie foods, such as fruit juice or milk instead of water for the management of nausea. Avoid fatty foods too to avoid vomiting. Let the doctor know the medications you are taking like acetaminophen (Tylenol), which is toxic to the liver. Do not drink alcohol while infected with hepatitis because the liver has difficulty processing medications and alcohol.

While still contracted with hepatitis A infection, avoid the following:

  • Preparing food for others
  • Sexual contact/ activity
  • Not washing hands after using the bathroom.

8Prevention

The best tools in preventing hepatitis A virus are vaccination and maintaining and observing proper hygiene practices.

Vaccination is highly effective in preventing hepatitis An infection. According to a recent review, the duration of immunity from vaccination reported that protective levels of antibody to HAV could be present for at least 14–20 years in children and at least 25 years in adults.

9Prevention

The best tools in preventing hepatitis A virus are vaccination and maintaining and observing proper hygiene practices.

  • Vaccination is highly effective in preventing hepatitis An infection. According to a recent review, the duration of immunity from vaccination reported that protective levels of antibody to HAV could be present for at least 14–20 years in children and at least 25 years in adults.

  Vaccination is recommended to the following:

  • Children one to two years of age and adults who are at risk of developing the infection must be vaccinated according to the Center for Disease Control and Prevention. The booster dose is given one year after following the initial dose.
  • Those who are traveling especially to countries with poor sanitary conditions should be vaccinated too at least a month before their departure. An individual can get immunoglobulin as a temporary immunity to the virus. It gives two to three months immunity before exposure and two weeks immunity if she/he comes in contact with someone with hepatitis
  • Men are having sexual contact with men. There have been reported cases of the recent outbreak of HAV due to men having sex with men.
  • Persons with chronic liver disease as they have higher rate of contracting HAV
  • People who work with HAV clients directly
  • People using illegal drugs (via injection)
  • Their outbreaks of HAV reported; there is a higher frequency among users of injection and non-injection drugs.
  • Travelers should follow precautions when traveling. Do not eat raw and uncooked meat and fish. Before eating and cooking, wash the fruits and vegetables by yourself to make sure it is clean. Do not use tap water for drinking or brushing teeth. If there is no bottled water, boil the tap water for at least 1 minute for safe drinking.
  • Always practice proper hygiene. Properly wash your hands with antibacterial soap and water after using the bathroom, after changing a diaper and when preparing food. Do not buy foods from street vendors.
  • Treat water for drinking. There should be adequate chlorination of water to kill hepatitis A virus (HAV) in water supplies.

10Prognosis

There are rare reported cases of deaths in hepatitis A infection.  These cases happen in the elderly and persons with a chronic liver disease.  Hepatitis A infection can resolve on its own, and nearly all patients recover within six months.