Hepatitis A

Introduction

Hepatitis A is one of the most contagious types of hepatitis that affects millions of people worldwide each year. Like other types of hepatitis, hepatitis A also affects the normal functioning of your liver. It is caused by the hepatitis A virus (HAV). This virus is highly contagious, and it transmits primarily through contaminated food or water. Hepatitis A is not as severe as other types of hepatitis, such as Hepatitis B or C. It usually gets well on its own within 2 to 3 weeks with no risk of long-term complications.

 

Causes

Hepatitis A is caused by the hepatitis A virus (HAV), which is usually transmitted by the fecal-oral route. If you eat or drink something that has been contaminated with the fecal matter of an infected person, you can develop hepatitis A. This type of contamination can happen if you eat prepared food from someone who does not follow a proper hand wash routine or maintain hygiene safety. Hepatitis A can also spread by having close contact with an infected person, even if the person has not developed any signs or symptoms. There are a few other ways of transmission of this virus. One of them is drinking polluted or contaminated water. You may also contract this virus if you eat raw shellfish that have been captured from contaminated water. This virus can also be spread from person to person via sexual intercourse. Although the risk of spreading this virus through blood is negligible, it is still very contagious because of its various modes of transmission.

 

Risk Factors and Epidemiology

The risk of hepatitis A is higher in developing countries where hygiene measures are not followed as strictly as in developed countries. Traveling to rural areas where there are active cases of hepatitis A can lead to the spread of this virus to other regions. Working in a child care center can also increase the risk of this infection, as this infection is common among children. If you have an infected family member, you may contract this infection from them through close contact. Any type of sexual contact with an infected person also increases the risk of hepatitis A. Other risk factors include using illegal drugs, being positive for HIV, living on the streets, having a disease that impairs clotting mechanisms such as hemophilia, or working with non-human primates.

In Pakistan, the risk of hepatitis is higher in rural areas where sanitary measures are not practiced. This virus predominantly infects children below the age of 14 years. It has been estimated that the hepatitis A virus causes almost 50% of cases of acute viral hepatitis among children.

 

Signs and Symptoms

Young children below the age of 6 usually do not present with any symptoms. Older children, teens, and adults can also carry this virus without having any symptoms, but it is uncommon. If you get contaminated by this virus, it may take 14 to 28 days for the signs and symptoms to become apparent. The symptoms of this infection include jaundice, abdominal pain or discomfort, fever, fatigue, clay-colored stools, dark urine, nausea or vomiting, itching, loss of appetite, unexplained weight loss, and joint pain. Abdominal pain is predominant in the right upper quadrant, where your liver is located. Majority of these symptoms are mild in nature.

 

Diagnosis

It is difficult to diagnose hepatitis A on the basis of symptoms alone. Some people may develop symptoms while others don’t. Your doctor may require a brief history to identify the possible cause and its route of contamination. Physical examination can be done, including looking for signs of jaundice and abdominal pain. The conformational diagnosis of hepatitis A can be made by running a blood test for the presence of this virus. A specific diagnosis can be made if HAV-specific immunoglobulin (IgM) antibodies are present in the blood. The test is highly accurate and sensitive. It remains positive for 3 to 6 months (up to 12 months).   HAV IgG antibody appears soon after IgM and lasts for a long time. When IgM is absent, it signals a previous infection or immunization rather than an acute infection. IgG is a type of antibody that can be detected for the remainder of one's life. In some cases, further tests like reverse transcriptase-polymerase chain reaction (RT-PCR) to detect hepatitis A viral RNA may be required.

 

Differential Diagnosis

Hepatitis A should be differentiated from other forms of hepatitis such as hepatitis B, C, D, E, alcoholic hepatitis, and autoimmune hepatitis. It should also be distinguished from other diseases that cause fever, jaundice, abdominal pain, or gastrointestinal issues. Differentiation can be done based on blood tests for this virus.

 

Treatment

There are no specific methods to treat hepatitis A. In majority of the cases, this infection goes away on its own without any complications. The treatment options are mainly focused on improving symptoms. Bed rest is suggested for a few days or weeks, depending on the severity of your symptoms. Drink plenty of water and maintain a balanced diet to speed up the recovery process. Nausea or loss of appetite can make it difficult to eat, so you can try eating small portions of meals frequently throughout the day. Alcohol should be avoided at all costs during the recovery period of this infection. You should also avoid preparing food for others during this period. Direct contact and sexual contact should also be limited to prevent the spread of this virus.

 

Medication

Medications are not required for the treatment of hepatitis. If you develop any symptoms, talk to your doctor before taking any over-the-counter medicines. Drugs metabolized by the liver, such as acetaminophen, should be avoided as they may cause more harm than benefit.

 

Prognosis

It can take four weeks to a few months to recover completely from this infection. Adults take longer than children and teenagers. Rest is recommended during this period until you start to feel better. The risk of complications and fatality is very rare, but it may occur among older adults.

 

Prevention

The primary mode of prevention of this infection is getting the hepatitis A vaccine. Two shots of vaccine are given. The second shot is given 6 to 12 months after the first shot. The vaccine is highly recommended if you’re traveling to areas with active cases. Hepatitis A can also be prevented by washing your hands thoroughly before eating, drinking, or preparing food. Avoid eating from street vendors and other places where sanitary measures are not practiced.