• Hepatitis A

    (Hep A)

    Definition

    Hepatitis A is an infection of the liver. It can be passed easily from contaminated food, water, or close contact with an infected person..
    Hepatitis
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    Causes

    Hepatitis A is caused by a specific virus. It may be spread by:
    • 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 with a partner infected with the hepatitis A virus, especially as oral-anal contact
    Hepatitis A is present in stool of people with the infection. They can spread the infection if they do not wash their hands after using the bathroom and touch other objects or food.

    Risk Factors

    Factors that increase your chance of a hepatitis A infection include:
    • Having close contact with an infected person—although the virus is generally not spread by casual contact
    • Using household items that were used by an infected person and not properly cleaned
    • Having oral-anal sexual contact with an infected person
    • Traveling to or spending long periods of time in a country where hepatitis A is common or where sanitation is poor
    • Working as a childcare worker, changing diapers or toilet training children
    • Being in daycare centers
    • Being institutionalized
    • Injecting drugs—especially if you share needles
    • Receiving plasma products, common in conditions like hemophilia

    Symptoms

    Hepatitis A does not always cause symptoms. Adults are more likely to have them than children.
    Symptoms include:
    • Tiredness
    • Loss of appetite
    • Fever
    • Nausea and vomiting
    • Abdominal pain or discomfort
    • Yellowing of the eyes and skin
    • Darker colored urine
    • Light or chalky colored stools
    • Rash

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done.
    Tests may include:
    • Blood test—to look for signs of hepatitis A
    • Liver function studies

    Treatment

    Hepatitis A usually goes away on its own within two months. There are no lasting effects in most once the infection passes.
    The goals of hepatitis A treatments are to:
    • Help you stay as comfortable as possible
    • Prevent the infection from being passed to others
    • Prevent stress on the liver while it's healing. Mainly done by avoiding certain substances like specific medications or alcohol
    You will be immune to the virus once you are well.
    In rare cases, the infection is very severe. A liver transplant may be needed in these cases if the liver is severely damaged.

    Prevention

    To decrease your chance of hepatitis A:
    • Wash your hands often with soap and water.
    • Wash your hands before eating or preparing food.
    • Avoid using household utensils that a person with hepatitis A may touch. Make sure all household utensils are carefully cleaned.
    • Avoid sexual contact with a person with hepatitis A.
    • Avoid injected drug use. If you do, do not share needles.
    • If you travel to a high risk region, take the following precautions:
      • Drink bottled water
      • Avoid ice chips
      • Wash fruits well
      • Eat well-cooked food
    Medical treatments that may help prevent infection include:
    • Immune (Gamma) Globulin—temporary protection from hepatitis A. It can last about 3-6 months. It must be given before exposure to the virus or within two weeks after exposure.
    • Hepatitis A Vaccine—highly effective in preventing infection. It provides full protection four weeks after the first injection. A second injection provides long-term protection. The vaccine should be considered for:
      • All children aged 12-23 months
      • Children aged 24 months or older who are at high risk and have not been previously vaccinated
      • People traveling to areas where hepatitis A is prevalent (The Centers for Disease Control and Prevention's Traveler's Health website shows which areas have a high prevalence of hepatitis A.)
      • Men who have sex with men
      • Injection drug users
      • People who are at risk because of their job, such as lab workers
      • People with chronic liver disease
      • People with blood-clotting disorders, such as hemophilia
      • People who will have close contact with an adopted child from a medium- or high-risk area
      • People who desire immunity to hepatitis A
    Check with your doctor to see if you should receive the vaccine.

    RESOURCES

    American Liver Foundation http://www.liverfoundation.org

    Hepatitis Foundation International http://www.hepfi.org

    CANADIAN RESOURCES

    Canadian Institute for Health Information http://www.cihi.ca

    Canadian Liver Foundation http://www.liver.ca

    References

    Baker CJ, Pickerling LK, Chilton L, et al; Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2011. Ann Intern Med. 2011;154(3):168-173.

    Hepatitis A. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated December 19, 2012. Accessed February 20, 2013.

    Hepatitis A FAQs for the Public. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/hepatitis/A/aFAQ.htm#overview. Updated September 17, 2009. Accessed February 20, 2013.

    Hepatitis A vaccine. What you need to know. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-hep-a.pdf. Accessed February 20, 2012.

    .

    What I need to know about hepatitis A. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/hepa%5Fez/index.aspx. Updated December 19, 2012. Accessed February 20, 2013.

    Workowski KA, Berman S, Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR 2010;59(No. RR-12):1-110.

    9/25/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for use of hepatitis A vaccine in close contacts of newly arriving international adoptees. MMWR Morb Mortal Wkly Rep . 2009;58:1006.

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