Hepatitis A
Overview
Hepatitis A is a liver disease caused by the hepatitis A virus (HAV). The virus is usually found in stool (bowel movement). It is spread by:
- putting something in your mouth that has been contaminated with the hepatitis A virus
- drinking water contaminated by raw sewage
- eating food contaminated by the hepatitis A virus, especially if it has not been properly cooked
- eating raw or partially cooked shellfish contaminated by raw sewage
- sexual contact (particularly anal sex) with a partner infected with the hepatitis A virus
While the virus can affect anyone in the United States, there are certain risk factors that increase your chances of getting hepatitis A, including:
- close contact with an infected person (Note: The virus is generally not spread by casual contact, such as you would encounter in school, the office, or at public event.)
- using household items that were used by an infected person, but were not properly cleaned
- sexual contact with multiple partners
- traveling to or spending long periods of time in a country where hepatitis A is common or where sanitation is poor
- injecting drugs, especially if you use shared needles
- childcare workers who change diapers or toilet train children
- children in daycare centers
- institutionalized patients
- hemophiliacs receiving plasma products
- swallowing contaminated water or ice made with contaminated water
- eating raw shellfish harvested from sewage-contaminated water
- eating fruits, vegetables, or other food that may have become contaminated during handling
Symptoms
Three out of every four adults who get hepatitis A have symptoms that usually develop over a period of several days. Hepatitis A does not always cause symptoms, but adults are more likely to have symptoms than children. Symptoms include:
- tiredness
- loss of appetite
- fever
- nausea
- abdominal pain or discomfort
- jaundice (yellowing of the eyes and skin)
- darker colored urine
- rash
A person can spread hepatitis A virus about one week before symptoms appear and during the first week of symptoms. Persons with no symptoms can still spread the virus. This often happens with young children who unknowingly spread hepatitis A virus to older children and adults. Unlike hepatitis B and C, hepatitis A causes no long-term liver damage and usually does not cause death. There is no chronic carrier state with hepatitis A. Having had the disease produces lifelong immunity from future hepatitis A virus infection.
Diagnosis
To diagnosis hepatitis A, the doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
- blood test -- to look for hepatitis A antibodies (These are proteins that your body has made to fight the hepatitis A virus.)
- liver function studies
- liver biopsy -- removal of a sample of liver tissue to be examined (only in severe cases)
Treatment Options
There are no specific treatments for hepatitis A. The goals of hepatitis A treatment are to:
- keep the patient as comfortable as possible
- prevent the infection from being passed to others
- prevent more liver damage by helping the patient avoid substances (medications, alcohol) that might stress the liver while it's healing
The disease generally will go away without treatment within two to five weeks. However, about 15 percent of people who are infected by hepatitis A will have relapsing symptoms for up to nine months. In almost all cases, once you recover, there are no aftereffects, and you are immune to the virus.
In rare cases, hepatitis A infection will be so severe that a liver transplant may be needed.
How to Protect Yourself Against Infection
Observe proper sanitary habits:
- Wash your hands with soap and water after using the bathroom or changing a diaper.
- Wash your hands with soap and water before eating or preparing food.
- Carefully clean all household utensils after use by a person infected with hepatitis A virus.
- Avoid using household utensils that a person infected with hepatitis A may have touched.
- Avoid sexual contact with a person infected with hepatitis A.
- Avoid injected drug use, especially with shared needles.
Immune (gamma) Globulin
This is a preparation containing antibodies that provides temporary protection from hepatitis A (about one to three months). It must be given before exposure to the virus or within two weeks after exposure to the virus.
Hepatitis A vaccine
This vaccine is made from inactive hepatitis A virus, and is highly effective in preventing infection. It provides protection from infection for four weeks following the first injection, and a second injection provides protection lasting up to 20 years. Licensed for those over two years of age, the vaccine is recommended for:
- people who have a chronic liver disease or a clotting factor disorder
- people who have close physical contact with people who live in areas with poor sanitary conditions
- people traveling to countries where sanitary conditions are poor
- children who live in areas that have repeated hepatitis A epidemics
- people who inject illicit drugs
- men who have sex with men
Note: It is unclear how safe the vaccine is when given during pregnancy. The vaccine should not be given to children under two years old. Check with your doctor to see if you should receive the vaccine, and if so, how many injections you should have.
Can hepatitis A virus be killed?
The virus is killed by heating to 85 degrees C (185 degrees F) for one minute. However, the disease can still be spread by cooked foods if they are contaminated after cooking. Adequate chlorination of water, as recommended in the United States, kills hepatitis A virus.