Preventing Hepatitis A

Outbreaks of hepatitis A continue to be reported throughout the country. Since 2016, there have been more than 28,000 cases associated with single site exposures in 30 states, resulting in more than 17,000 hospitalizations and 288 deaths. Sources of the outbreaks have been traced to contaminated blueberries, strawberries, blackberries, lettuce, raw fish and even a flight attendant.

Hepatitis A is the most common cause of acute viral hepatitis in the United States. 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. The older you are, the sicker you can become.

Hepatitis A is transmitted through the fecal-oral route. The virus enters the body 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 and 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 darken and then yellowing of the eyes or jaundice may appear. The symptoms usually present themselves 15 to 50 days after exposure. Most often, the symptoms appear within four weeks. 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.

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 which is concerning. By the time jaundice occurs, most people are probably no longer contagious.

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 for the illness. The good news is that once an individual has recovered from hepatitis A, they cannot get it again and poses no health risk to others.

Hepatitis A can be prevented with careful hand washing after using the toilet and before eating or preparing food. People should avoid eating raw shellfish taken from potentially contaminated waters. Infected people should not handle foods during the contagious period.

There is a vaccine against hepatitis A that is effective in preventing HAV infection. Earlier this year, the Advisory Committee on Immunization Practices voted to update recommendations on the use of vaccines to protect against hepatitis A. The committee voted unanimously to recommend that all children and adolescents between the ages of 2 and 18 who have not previously received the hepatitis A vaccine should receive a catch-up vaccination. Vaccination is also recommended for travelers to countries with high rates of illness, for anyone with chronic liver disease, for men who have sex with men and for anyone using illegal drugs. I would recommend universal vaccination for anyone not previously exposed.

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David Bernstein
David Bernstein, MD, is a columnist for Long Island Weekly and chief of gastroenterology, hepatology and nutrition at North Shore University Hospital and Long Island Jewish Medical Center.

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