What is hepatitis A?

Hepatitis is the Greek term for liver inflammation.

Hepatitis A is caused by hepatitis A virus (HAV).

Viral hepatitis can be caused by many other viruses – including hepatitis B, C, D and E.

How do you catch hepatitis A?

HAV is acquired by eating food or drinking water that has been contaminated by the faeces of infected individuals.

Outbreaks can occur in countries where the water supply is contaminated by sewage. Contamination of shellfish has led to major outbreaks. Close contact with infected individuals can also transmit infection – and this is a particular concern in schools where children may not be careful about handwashing after using the toilet facilities.

A person infected with HAV is infectious just before the onset of symptoms and can shed the virus for many weeks afterwards.

What are the symptoms of hepatitis A?

• HAV has an incubation period of 10 to 40 days. This is the time from the exposure to the virus until the onset of the disease.
• The first symptoms include loss of appetite, distaste for cigarettes, nausea, aching muscles and joints and a mild fever.
• Later symptoms include yellowing of the skin, mucous membranes, and whites of the eyes (jaundice, icterus); light-coloured stools; and dark urine.
• When the latter symptoms develop, the infected person usually begins to get better.
• The duration of the disease is typically two to three weeks, but individuals may remain symptomatic for some months.
• Young children are, in most cases, only mildly affected by the disease, and they may not develop jaundice. This is known as 'subclinical infection'. Patients with underlying liver disease are particularly prone to severe hepatitis.

How can type A hepatitis be prevented?

Consider a hepatitis A vaccination if you are visiting countries with limited hygiene.

Good hygiene reduces the risk of infection:

• wash or peel fruits and vegetables during trips to countries with poor sanitary conditions.
• bottled water is generally safer than water from the tap, but ice cubes may be made from contaminated water
• remember that shellfish can be contaminated by human sewage.

If a household member is infected with the type A virus, the following is recommended:

• always wash your hands with soap and water after using the toilet
• good hygiene in connection with food preparation is essential
• have a separate towel for each family member
• wear disposable gloves when helping the sick family member with personal hygiene
• clothes that have been contaminated by stools should be washed immediately or kept in a tightly closed bag until they can be washed
• household members who are not ill should be given gammaglobulin (see below).

Your doctor will advise on vaccinations for household and other close contacts.

Is there a vaccine for type A hepatitis?

A vaccine for type A hepatitis is available. People receive one injection and then a booster dose after 6 to 12 month.

The protection provided by the vaccine exceeds 95 per cent, and it lasts for at least 10 years.

The vaccine is recommended before travelling to countries where the general standard of hygiene is unreliable, eg Asian, South American, and African countries.

What can be done at home?

• Rest while blood tests show that the disease is active.
• Abstain from all alcohol intake while ill.
• Eat a healthy, well-balanced diet.

Seek advice if your job involves food handling.

How is type A hepatitis diagnosed?

The diagnosis is made on the basis of an antibody test, which will demonstrate the presence of antibodies against hepatitis A virus in the patient's blood.

IgM antibodies suggest recent infection ( or vaccine) and IgG antibodies suggest previous infection or successful vaccination.

Blood tests for liver function will reveal the severity of the liver damage and are monitored until recovery.

Those with severe hepatitis may require hospital admission and more detailed monitoring

Future prospects

• Most patients have fully recovered after four to eight weeks.
• Liver failure, a potential complication, is very rare.

In contrast to hepatits B and C, chronic (ongoing) infection does not occur. There is generally a total recovery and this leads to lifelong immunity.

How is type A hepatitis treated?

There is no specific antiviral therapy.

Inpatient care may be required for those with more severe disease.