20 2015 Feb
Dr Clem Bonney - Hepatitis A

Hepatitis A

Hepatitis A
Hepatitis A is a liver disease caused by the Hepatitis A virus. The disease is associated with unsafe water, inadequate sanitation and poor personal hygiene. The virus spreads when an uninfected (and unvaccinated) person ingests food or water contaminated with the faeces of an infected person.
While Hepatitis A infection does not cause chronic liver disease and isn’t fatal like Hepatitis B and C, the symptoms and acute liver failure are crippling, and can lead to loss of life.

How Hepatitis A Is Passed On
The Hepatitis A virus is transferred when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. While rare, these outbreaks are a result of sewage-contaminated or inadequately treated water.
The virus can also be transmitted through close physical contact with an infectious person, although casual contact among people does not spread the virus.

Symptoms
Hepatitis A incubates for 14–28 days.
Symptoms range from mild to severe, and can include fever, discomfort, appetite loss, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice - a yellowing of the skin and whites of the eyes. Not everyone who is infected will show all of the symptoms.
Adults will show signs and symptoms of illness more often than children with the disease while mortality increases with age. Infected children under six don’t experience noticeable symptoms, with few developing jaundice. With older children and adults, infection will cause severe symptoms, with jaundice occurring more frequently.

Testin
The time between exposure to the virus and the development of symptoms can vary between 15 and 50 days, the average being 30 days. Hepatitis A virus is excreted for up to two weeks before the onset of symptoms: people with hepatitis A should be considered infectious for a week after the onset of jaundice.

Hepatitis A is diagnosed by a blood test. The detection of IgM Hepatitis A Antibodies (anti-HAV IgM) will confirm a recent infection. These antibodies are present for three to six months after infection. The detection of IgG Hepatitis A Antibodies (anti-HAV IgG) indicates past infection and immunity against hepatitis A infection.

Liver function test (LFTs) abnormalities, specifically elevated serum bilirubin and serum aminotransferase (ALT and AST) values, can also show acute liver infection.

Treatment
There is no medical treatment available for Hepatitis A. The symptoms of Hepatitis A are best relieved through rest and adequate fluid intake. Medications should be limited only when considered essential, and alcohol should be avoided.

Prevention
To avoid catching Hepatitis A:
Always wash hands thoroughly after going to the toilet, before preparing and eating food, after handling soiled linen e.g. nappies.
Don’t share food, cutlery, crockery, cigarettes and drinks with other people.
When travelling in regions with poor sanitation, drink bottled water and avoid eating food that has been cleaned or prepared using contaminated water.
In a natural disaster, listen to warnings about contaminated drinking water and follow any instructions issued by the relevant authorities.

Vaccination
A vaccine is available to protect against Hepatitis A infection for people aged two and older. There are currently five Hepatitis A vaccines and two combined Hepatitis A/Hepatitis B vaccines registered for use in Australia. The vaccines are made from inactive Hepatitis A virus. The body reacts with the inactive virus to produce antibodies that protect against infection. Clinical trials have shown that the Hepatitis A Vaccine is highly effective in preventing infection.