Hepatitis A

 
The Hepatitis A virus, although present in antiquity, was first discovered in 1973. The virus grows in the liver and is carried into the gut by bile so that faeces (bowel motions) can contain a large amount of the virus.
 
The hepatitis A virus can be passed from person to person (e.g. among family members or sexual contacts) or among large groups of people (epidemics) by food or water that has been contaminated with faeces. 
 

How do I know if I have Hepatitis A?

 
The average time between exposure to the hepatitis A virus and the developing of symptoms is usually between 15 and 50 days.
 
Symptoms may begin suddenly or gradually. The most obvious sign of infection is jaundice where the eyes and skin turn yellow and the urine turns brown or tea-coloured. These symptoms are common in older children and adults, however relatively few children under 6 years of age will become jaundiced but may still be infectious for hepatitis A. 
 
Other common signs of infection include loss of appetite, nausea, vomiting, abdominal pain and fever. Less frequently there will be diarrhoea, itching and muscle pain and occasionally joint pains and skin rashes.
 

How can the doctor tell if I have Hepatitis A infection or liver damage?

 
Your doctor can do blood tests to measure the body’s response to the hepatitis A virus.
 
Test TubesEarly in the illness a specific antibody to the virus, called  HAV IgM is present indicating current infection. As the body's immune system fights off the virus, HAV IgM disappears and is replaced with another anti-body called HAV IgG. This antibody provides life-long immunity to further infection. In people who have recovered from hepatitis A virus, onlyHAV IgG is present in blood.
 
The doctor may also do blood tests to measure both liver function, including bilirubin (the pigment that causes jaundice), and the amount of inflammation in the liver.
 

What is the treatment for Hepatitis A?

 
Treatment is usually just bed rest and adequate intake of fluids. Medications should be limited to those that are absolutely necessary.
 
It is best not to take sedatives and strong painkillers if possible and alcohol should be avoided. Occasionally people who are very ill need to be admitted to hospital.
 

What is the outcome of Hepatitis A infection?

 
The majority of patients with hepatitis A will recover completely; most by two or three months and the rest by six months.
 
A small number (about 5% or 1 in 20) will take longer to recover. Death occurs in about 0.2 %( about 1 in 500) of people, more often in older patients (over age 50) or in those with pre-existing liver damage. In other words, if you are one of the 499 out of 500 who survive, the liver will completely recover.
 
Hepatitis A, by itself, does not cause chronic liver disease [eg. cirrhosis]
 
If you have Hepatitis B or C and then develop Hepatitis A, there can be very serious consequences, even death. All patients with these viruses should be vaccinated against Hepatitis A (see section on vaccination below).
 

Can Hepatitis A infection be prevented?

 
The risk of becoming infected with the hepatitis A virus varies around the world.
 
In countries with poor sanitation and crowding in households most people develop hepatitis A infection in childhood and are protected from repeat infection for the rest of their lives.
 
Parts of Africa, Asia, Central and South America pose a high risk of infection to travellers from more developed countries that have never been infected. 
 
In countries with a low rate of infection (North America, Western Europe, and Australia) certain people are at higher risk of infection because of sexual or occupational exposure. Hepatitis A occurs more frequently in male homosexuals and among injecting drug users. Workers in day care centres or residential institutions are at risk because of exposure to young children who may be infected but have no obvious signs that they are ill.
 
If you have Hepatitis B or C and then develop Hepatitis A, there can be very serious consequences, even death. All patients with these viruses should be vaccinated against Hepatitis A (see section on vaccination below).
 
General measures to prevent hepatitis A virus infection include good personal hygiene such as hand washing after using the toilet and before eating meals.
 

Is there a Vaccine to prevent Hepatitis A infection?

 
Yes. A vaccine has been developed which can provide long-lasting protection to hepatitis A. The vaccine is made from inactivated virus and is given as two separate injections; at day 0 and then a booster dose at 6-12 months.
 
The vaccine appears to be well tolerated and provides protection for at least 10 years and probably longer.
 

Who should receive Hepatitis A Vaccination?

 

• Travellers from areas of low occurrence to high occurrence, including military personnel.

• Men who have sex with men

• Injecting drug users

• Recipients of blood and blood products (such as those used for treatment of inherited clotting disorders).

• Persons with occupational exposure to the virus:

- Day care centre or residential institutional workers

- Laboratory workers exposed to biological specimens

- Food handlers

- Nursing staff and other healthcare workers in contact with patients in paediatric wards, infectious diseases wards, emergency rooms and intensive care units.

- Sewage treatment workers

- Health care workers and teachers in remote aboriginal and Torres Strait communities

- Patients with chronic liver disease (chronic hepatitis B or C, alcoholic cirrhosis etc).
 
ACKNOWLEDGEMENTS
The Australian Gastroenterology Institute.
 
www.health.qld.gov.au - access public health brochures on hepatitis A,B and C