Hepatitis A: Unknown, Common And Preventable

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Although not discussed much as it does not cause chronic disease and rarely leads to a fatal outcome, hepatitis A is the most common cause of acute viral hepatitis in the United States and it is preventable. Anyone, regardless of age, who has not been previously infected or who has not been vaccinated against hepatitis A can become infected and ill from the hepatitis A. 

Hepatitis A is transmitted through a fecal-oral route. The hepatitis A virus enters through the mouth, multiplies in the body, and is passed in the feces. The virus can then be carried on an infected person’s hands and can be spread by direct contact, or by consuming food or drink that has been handled by the individual. This is the reason restaurant food handlers are frequent vectors of disease transmission. In some cases, it can be spread by sexual contact or by consuming contaminated water or food (e.g., raw shellfish, fruits, vegetables).

The symptoms of hepatitis A may include fatigue, poor appetite, fever and nausea. Some people might also have vomiting and abdominal cramping. Urine may become darker in color, and then jaundice may appear. The symptoms may appear from 15 to 50 days after exposure; most often, the symptoms appear within four weeks. The disease is rarely fatal and most people recover in a few weeks without any complications. Infants and young children tend to have very mild symptoms and are less likely to develop jaundice than are older children and adults. Not everyone who has Hepatitis A is diagnosed by a specific blood test.

Hepatitis A can be easily transmitted from one person to another in homes, schools and work places. The contagious period begins about two weeks before the symptoms appear. Most people are probably no longer contagious after the first week of jaundice.

There are no special medicines or antibiotics that treat hepatitis A. Generally, providers will recommend rest, good nutrition, fluids, and treatment of symptoms. A small number of people might need to be hospitalized but this is rare. The good news is that once someone has recovered from hepatitis A, he/she cannot get it again and poses no health risk to others.

Hepatitis A can be prevented with careful hand washing after using the toilet, changing diapers, or before eating or preparing food. People should avoid eating raw shellfish taken from potentially contaminated waters. Also, infected people should not handle foods during the contagious period. Disinfection of ‘clean’ surfaces with a 1:100 dilution of household bleach in water or cleaning solutions containing quaternary ammonium and/or hydrogen chloride are effective in inactivating hepatitis A.

Hepatitis A can be prevented with vaccination which is recommended for all children, for travelers to countries with high rates of illness, and for people at high risk of infection with the virus. Any person who wants immunity against hepatitis A may also be vaccinated and we recommend that everyone be vaccinated. The vaccine is given as two shots, six months apart or in combination with the hepatitis B vaccine which is three shots over a six-month period.

Close contacts of an infected person or those exposed to a common source (such as an infected food handler or a food known to be contaminated) should call a doctor or the health department to determine if they should be vaccinated or obtain immune globulin to reduce their chance of becoming ill.

David Bernstein, MD, FAASLD,FACG, AGAF, FACP, is the chief of hepatology and Sandra Atlas Bass Center for Liver Diseases and a professor of medicine at Hofstra-Northwell School of Medicine.

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