Hepatitis A is a highly contagious liver
infection caused by the hepatitis A virus. Although not usually
as serious as other types of viral hepatitis, hepatitis A causes
inflammation that affects your liver's ability to function.
You're most likely to contract hepatitis A
from contaminated food or water or from close contact with
someone who's already infected — even if that person doesn't
appear sick. Some people who are infected never develop signs
and symptoms, but others may feel as if they have a severe case
of the flu.
Mild cases of hepatitis A don't require
treatment, and most people who are infected recover completely
with no permanent liver damage. Unlike hepatitis B and C,
hepatitis A doesn't develop into chronic hepatitis or cirrhosis
— both potentially fatal conditions.
Practicing good hygiene — including
washing your hands often — is one of the best ways to protect
against hepatitis A. Effective vaccines are available for people
Hepatitis A Causes
The hepatitis A virus is found in the
stools (feces) of people with hepatitis A. It is transmitted
when a person puts something in his or her mouth that has been
contaminated with the feces of an affected person. This is
referred to as fecal-oral transmission.
If food or drinking water becomes
contaminated with stool from an infected person (usually
because of inadequate hand washing or poor sanitary
conditions), the virus can quickly spread to anyone who
drinks or swallows the contaminated food or water.
The virus can also be spread by eating
raw or undercooked shellfish collected from water that has
been contaminated by sewage.
The hepatitis A
virus can be transmitted through blood transfusions,
although this is extremely rare.
People who are infected can start spreading
the infection about 1 week after their own exposure. People
who do not have symptoms can still spread the virus. Infection
with HAV is known to occur throughout the world.
The risk of infection is greatest in
developing countries with poor sanitation or poor personal
Infection rates are
also higher in areas where direct fecal-oral transmission is
likely to occur, such as daycare centers, prisons, and
People at increased risk for hepatitis A
Household contacts of people infected
Sexual partners of people infected with
International travelers, especially to
Military personnel stationed abroad,
especially in developing countries
Men who have sex with other men
Users of illegal drugs (injected or
People who may come
into contact with HAV at work
professions such as health care, food preparation, and sewage
and waste water management are not at greater risk of
infection than the general public.
People who live or work in close quarters, such as dormitories,
prisons, and residential facilities, or work in or attend
daycare facilities are at increased risk only if strict personal
hygiene measures are not observed.
Signs And Symptoms
Some people may have
hepatitis A and never develop signs or symptoms. Young
children, especially, tend to have mild cases, but signs and
symptoms in older children and adults are likely to be more
severe. In general, you'll have the virus for up to one month
— its average incubation period — before developing any
problems. When signs and symptoms appear, they often come on
suddenly, and you may mistake them for intestinal flu
(gastroenteritis). They include:
Nausea and vomiting
Abdominal pain or
discomfort, especially in the area of your liver on your right
side beneath your lower ribs
Loss of appetite
You also may experience
yellowing of your skin and the whites of your eyes (jaundice).
Not all people with hepatitis A develop jaundice.
You'll likely regain
more energy after signs and symptoms disappear, and your liver
may heal completely within one or two months. Some people with
hepatitis A have relapses over a six- to nine-month period.
Of Hepatitis A
To prevent hepatitis A,
Wash hands well after
using any washroom.
Eat only freshly
commercially bottled water or boiled water in places where
sanitation and the water supply are questionable.
Do not drink drinks
with ice in them.
Do not eat non-peelable
raw fruits or vegetables unless cleaned thoroughly.
Maintain a reasonably
high index of suspicion while traveling anywhere and be
appropriately cautious about ingesting food or water where one
might suspect hepatitis A is more common.
Get a hepatitis A vaccination before traveling to areas such as
Mexico, eastern Europe and developing countries. Short term
protection for hepatitis A can also be provided by immune
globulin, including its administration up to two weeks following
Of Hepatitis A
The doctor will take a
thorough medical history and may palpate the area over the liver
to check for tenderness or enlargement.
If the skin becomes
jaundiced and the person is exhibiting other symptoms of
hepatitis, the doctor will do various lab tests, such as blood
tests and liver panel tests. Additional lab tests include the
hepatitis A antibody tests ELISA II and RIBA II.
Rarely, the doctor may
also perform a liver biopsy where a small portion of the liver
would be taken for further examination under a microscope.
Hepatitis A virus tests
detect substances in the blood that indicate a hepatitis
infection is active or has occurred in the past. The test
detects proteins (antibodies) made by the body in response to
the virus that causes hepatitis. It is important to identify the
type of hepatitis virus causing infection so that its spread can
be prevented and the proper treatment can be started
Detection of the virus or antigen ;- The virus can be detected
in the faeces up to 2 weeks before the appearance of the
jaundice and up to 2 weeks afterwards. However by the time that
jaundice appears, viral titres in the faeces are already at a
low titre and so in practice EM if the stools is rarely of
diagnostic value. Hepatitis A virus can also be detected in the
serum, saliva, urine and semen although transmission is unlikely
to take place via these routes. There had been anecdotal reports
of hepatitis A transmitted through blood transfusions.
2. Serology ;- This is the method of choice for the diagnosis of
acute hepatitis A. A variety of ELISAs and RIAs are available.
The detection of specific IgM is diagnostic of recent infection.
(IgM may be found 45 - 60 days after the onset of symptoms).
Serum IgG is used in determining the immune status of the
individual before the prescription of immunoglobulin for foreign
Hepatitis A virus (HAV) Testing
HAV infection is spread
through food or water that has been contaminated by the feces
(stool) of an infected person.
IgM anti-HAV antibodies
indicate a recent infection with hepatitis A virus. IgM anti-HAV
antibodies generally can be detected in the blood as early as 2
weeks after the initial HAV infection. These antibodies
disappear from the blood 3 to 12 months after the infection.
IgG anti-HAV antibodies mean that you have had a hepatitis A
viral infection. About 8 to 12 weeks after the initial infection
with hepatitis A virus, IgG anti-HAV antibodies appear and
remain in the blood for lifelong protection against HAV.
Hepatitis A test
No hepatitis A virus (HAV) antibodies are
Hepatitis A virus (HAV)
antibodies are found. You may need more tests to find out if
you have a present, active infection or a past, resolved
IgM anti-HAV antibodies are
found if you have an active infection. IgM antibodies
usually show up in the blood as early as 2 weeks after you
become infected with HAV, when symptoms of hepatitis A are
present, and for a few months after symptoms have gone
Only IgM anti-HAV antibodies are found if
you have had an infection in the past or when you have had
the hepatitis A vaccine. This means that you are protected
against the infection for life.
Who Is At Risk For Hepatitis A?
Anyone who has not already been
infected with hepatitis A virus can become infected, but some
people are at increased risk:
Persons who share a household or
have sexual contact with someone who is infected with
hepatitis A virus
Children and staff in child-care
centers (especially centers where children are in diapers)
where someone has hepatitis A virus infection
Travelers to countries where
hepatitis A is common and where proper sewage disposal and
clean water, food, and sanitation are not available
Residents and staff of
institutions for developmentally disabled persons where
someone has hepatitis A
Men who have sex with men
Persons who use street drugs
Workers who handle animals
infected with hepatitis A virus or who work with hepatitis A
virus in a research laboratory
Persons with clotting factor
disorders who receive injections of factor concentrates.
Hepatitis A occurs endemically in
all parts of the world, the exact incidence is hard to estimate
because of the high proportion of sub clinical infections. At
least 1.5 million new cases are reported each year. While the
actual incidence in developed countries is decreasing, the
infection is almost universal in developing countries. Hepatitis
A virus (HAV) is a faecal-oral pathogen and transmission is
particularly associated with faecally contaminated food and
water. Shellfish is particularly notorious as a vehicle for the
spread of HAV. In a recent epidemic in Shanghai following a clam
festival, there were over 500,000 cases. Infection is
particularly common in conditions of poor sanitation and
overcrowding, institutions for the mentally handicapped are
particularly vulnerable. Many food borne outbreaks can be traced
to poor hygiene in infected food handlers who were shedding
large amounts of virus during the incubation period. The source
of the outbreak can often be traced to uncooked food or food
that has been handled after cooking. Until recently, about 50%
of young adults in the UK had evidence of past infection, but as
in the case of other industrialized countries, the incidence is
rapidly decreasing so that hepatitis A is rapidly becoming a
disease of young adults rather than children in these countries.
HAV is frequently acquired from travelers from areas where HAV
infection is of a low prevalence to an area where it is
The incubation period is 3 - 5 weeks (15 - 40 days), with a mean
of 28 days. Spread is faecal-oral although blood borne infection
is possible in theory (this was achieved experimentally in
volunteers). All age groups are susceptible to HAV. In areas
where HAV is hyper endemic, hepatitis A is an childhood infection
where the infection is usually sub clinical or mild. In developed
countries where the overall incidence is decreasing rapidly, the
infection is now more commonly seen in adults where the disease
is usually more serious.
The pathological changes are
common to all types of viral hepatitis, with parenchymal cell
necrosis and histiocytic periportal inflammation. Rarely in
cases of fulminant hepatitis there is massive necrosis. Liver
enzymes such as AST and ALT are elevated as a result of release
by damaged liver cells. Elevation of these enzymes may often be
the only abnormality found in individuals with asymptomatic and
anicteric infections who are tested because of known exposure.
Serum bilirubin may be elevated, especially in most cases of
symptomatic infections and bilirubin may be found in the urine.
The leucocyte count is usually normal but sometimes atypical
lymphocytes are seen.
Following an incubation period of
around 4 weeks, at the end of which virus particles are excreted
in the faeces, there is an acute onset of non-specific symptoms
such as fever, chills, headache, fatigue, malaise, and aches and
pains. A few days later, anorexia, N+V and right upper abdominal
pain appear, followed by the onset of jaundice with pale stools
and dark urine. With the appearance of the jaundice, there is
usually a subjective improvement of symptoms. The jaundice
deepens for the first few days and then persists for 1 - 2
weeks. Convalescence may be prolonged and complete recovery in
adults usually takes place within a few months. In children the
infection is commonly asymptomatic or the prodromal phase mild
or absent. The mortality rate is very low for hepatitis A and no
carrier state exists.
Complications of hepatitis A
include prolonged cholestatic jaundice which responds to
corticosteroid therapy, and relapsing disease which occurs in 6
to 10% of patients and lasts 16 to 40 weeks. Relapsing disease
appears to be immunologically mediated and must not be treated
by corticosteriods. Extrahepatic complications include a rash
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