The highly contagious liver infection caused by the hepatitis A virus (HAV) is called Hepatitis A. HAV is spread through ingestion of contaminated food and water, and direct contact with an infected person. The infection rates are low in high-income countries with good sanitary & hygienic conditions. Whereas in low- and middle-income countries with poor sanitary conditions and hygienic practices this infection is common. It is observed that most children (below the age of 10 years) have been infected with the hepatitis A virus and most often without symptoms.
Large outbreaks have been reported among persons experiencing homelessness or among people who use injection drugs in the United States of America. According to CDC, nearly 12,474 hepatitis A cases were reported in the US in 2018 but the actual number of cases is likely around 24,900. Once a person recovers from the infection, they develop antibodies so, it is not possible to become infected again.
Hepatitis A is a type of viral hepatitis that causes an acute (short-term) infection and does not become chronic. Most people get better without treatment after a few weeks. People do not have a long-lasting illness. HAV can cause liver failure only in rare cases.
In the US, this infection has become relatively rare. Hepatitis A vaccine became available in 1995, henceforth the rate of infections has declined by 95% in the US. One of the best ways to prevent HAV is to get vaccinated. According to WHO, 1.4 million cases of hepatitis A occur around the world every year.
The virus is found in human feces and passed on when a person eats or drinks contaminated food and water. Hepatitis A is also a sexually transmitted infection (STI) passed on through unprotected sexual activities, especially anal sex. Sharing contaminated needles and syringes will also transmit the infection.
HAV can spread by:
- Eating food prepared by someone with HAV
- Eating food that was rinsed with contaminated water
- Consuming contaminated water
- Swallowing contaminated ice
- Eating raw shellfish harvested from the water where the virus lives
- Having close contact/sex with an infected person
- Men who have sex with men
- Touching mouth after touching a contaminated object
- Contact with hepatitis A infected fecal matter
This virus can survive for a month or more in freshwater, wastewater, seawater, and soil. Most of the time the infection is passed on through close personal contact with an infected household member or sex partner, and not through casual contact.
HAV can survive outside the body for months. However, heating food & liquids to temperatures of 185°F (85°C) for at least 1 minute can kill the virus. Whereas, exposure to freezing temperatures does not kill the virus. An outbreak was traced to a batch of frozen strawberries in 2016.
Symptoms of Hepatitis A
Mostly, people do not experience any kind of symptoms. When they have, symptoms may occur 2 to 4 weeks after they are exposed to the virus.
Symptoms may include:
- Sudden nausea and vomiting
- Abdominal pain or discomfort
- Clay-colored bowel movements
- Loss of appetite
- Weight loss
- Dark urine
- Joint pain
- Intense itching
Infected children under the age of 6 show no symptoms but older children, teens, and adults usually develop mild symptoms. These symptoms may go away after about 2 months but they might keep coming back for up to 6 months. Sometimes, hepatitis A infection results in a severe illness that may last several months.
Hepatitis A Testing
After consulting with the doctor, they may recommend a blood test to check for the presence of a viral infection. The blood test will reveal the presence or absence of the HAV.
Blood tests are taken to look for:
- IgM (immunoglobulin M) antibodies– the body produces these when a person is exposed to hepatitis A. And it stays in the blood for about 3 to 6 months.
- IgG (immunoglobulin G) antibodies– show up after the virus has been in the body for a while. An infected person may have them all their life and it protects them against hepatitis A.
If a person tests positive for IgG antibodies, but not for IgM antibodies, it means, they had a hepatitis A infection in the past or had vaccinations to protect against it. Apart from these tests, additional it may include reverse transcriptase-polymerase chain reaction (RT-PCR) to detect the HAV RNA and it may require specialized laboratory facilities.
In some cases, people have only a few symptoms and no signs of jaundice. It’s hard to diagnose any form of hepatitis through a physical examination without any visible signs of jaundice. This can be undiagnosed when symptoms are minimal. However, complications due to a lack of diagnosis are rare.
Is hepatitis A curable?
Currently, no medication can get rid of the hepatitis A virus once a person has it. As it is a short-term viral infection that goes away on its own in one or two months. Rarely hepatitis A can cause liver failure and can be life-threatening.
The treatment is focused on reducing symptoms. To ease symptoms, it is better to avoid alcohol, drink plenty of water, and maintain a healthy diet. Doctors may also suggest medicines to help relieve symptoms. Consult the doctor when symptoms are for longer than 6 months. Only a few people with severe symptoms will need medical care in a hospital. On rare occasions, hepatitis A can last longer and can be life-threatening if it causes liver failure.
Few tips to treat symptoms at Home:
- Rest up – It’s common for an infected person to feel very tired during the first few weeks.
- Take good care of your skin – Few people with hepatitis A get very itchy. It’s better to keep the house cool, wear loose clothes, and avoid very hot baths and showers.
- Should avoid all sexual activity, even sex with a condom.
- Loss of appetite is common, so one must make sure to get enough nutrients.
- Avoid drinking alcohol (will strain your liver).
Doctors will ask the infected person to skip work or school and stay at home until fever and jaundice have cleared up.
HAV does not cause long-term liver damage and doesn’t become chronic. Only in few cases, this viral infection can cause a sudden loss of liver function particularly in older adults or people with chronic liver diseases. In case of acute liver failure, he/she should stay in the hospital for monitoring and treatment. Few people with acute liver failure may require a liver transplant.
Hepatitis A Vaccine
The best way to prevent HAV is by getting vaccinated for hepatitis A (Havrix, Vaqta). The vaccine has made the infection much less common in the US. But the outbreaks of hepatitis A among unvaccinated people are still happening.
Children require 2 doses of the hepatitis A vaccine. The first dose (12 through 23 months of age) and the second dose (at least 6 months after the first dose). And older children and adolescents 2 through 18 years of age should be vaccinated (if not vaccinated previously). For adults who were not vaccinated previously can also get the vaccine.
Mild side effects may include tiredness, headache, loss of appetite, and soreness where the shot was given. Other reported side effects include belly pain, nausea, dizziness, difficulty in sleeping.
Who should get vaccinated?
- All children aged 12–23 months
- Unvaccinated children and adolescents aged 2–18 years
- Family and even caregivers of adoptees from countries (where hepatitis A is common)
- Men who have sex with men
- People who use injection or non-injection drugs
- A person who has an occupational risk for infection
- International travelers
- People experiencing homelessness
- People with clotting factor disorders
- A person with HIV
- People with chronic liver disease
- Any person wishing to obtain immunity
Who should not get vaccinated?
- People who have a severe allergic reaction to a hepatitis A vaccine or any vaccine component
- Pregnant women (unless they are at greater risk for contracting HAV)
- People who are ill (unless it is a mild illness)
Hepatitis A and Hepatitis B
Both hepatitis A and hepatitis B are liver infections caused by two different viruses. Hepatitis A is a type of viral hepatitis that causes an acute (short-term) infection and does not become chronic. Hepatitis B is short-term in the beginning. And in some people, the virus remains in the body, resulting in chronic disease. Most people with hepatitis A recover with no lasting liver damage. Whereas, in hepatitis B almost 15%-25% of chronically infected people develop chronic liver disease, including cirrhosis, liver failure, or liver cancer. Both infections can be prevented by vaccines.
Hepatitis A and HIV
People with HIV and liver disease are at risk of hepatitis A infection. When an HIV-infected person gets hepatitis A, the viral load is likely to increase as the immune system is weaker. This will make a person more likely to pass on HIV if they have sex without a condom. Doctors may adjust the treatment for people with prolonged or severe hepatitis A.
Hepatitis A during pregnancy
Contracting hepatitis A during pregnancy is rare. But it can be associated with a higher risk of preterm labor, particularly when the infection occurs during the second or third trimester of pregnancy. Other increased risks may include:
- Premature uterine contractions
- Premature rupture of membranes
- Placental abruption
The spread can be reduced by:
- Improving sanitation and food safety
- Personal hygiene practices like regular handwashing before meals and after going to the bathroom
- Avoid drinking tap water or eating raw food, especially when you travel to a place with poor sanitation
- Dine at established and reputable restaurants, rather than from street vendors
Safety precautions while traveling:
- You should peel and wash all fresh fruits and vegetables
- Should avoid eating raw or undercooked meat and fish
- Avoid beverages of unknown purity (with or without ice)
- Use bottled water to drink and use it when brushing your teeth
- It’s better to boil tap water before drinking it (when bottled water isn’t available)
A person needs to wash hands often, especially after using the toilet or changing a diaper and before preparing food or eating.
Facts about Hepatitis A
- Since the vaccine became available in 1995. The incidence rates decreased more than 95% from 1995 to 2011.
- According to CDC, nearly 3,366 cases of HAV were reported in the US with an estimated number more than double that in 2017.
- According to CDC, 12,474 hepatitis A cases were reported in the US in 2018, but the actual number of cases is likely around 24,900.
- Larger outbreaks occurred among persons who used drugs and persons who experienced homelessness in 2017.
- Nearly, 2.3 billion people in the world are infected with one or more of the hepatitis viruses.
- More than 90% of children get infected by HAV by the age of 10 in the high endemic regions.
- As per World Health Organization, 7134 persons died from hepatitis A worldwide in the year 2016.
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