Hepatitis A

Hepatitis A is a liver disease caused by the hepatitis A virus. The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the faeces of an infected person.

The disease is closely associated with unsafe water, inadequate sanitation and poor personal hygiene.

• Transmission within households
• Sexual transmission
• Residential institution transmission
• Daycare center transmission
• Transmission among military personnel

• Consumption of raw or undercooked shellfish, vegetables, or other foods
• Consumption of foods contaminated by infected food handlers
• Blood transfusion
• Illicit drug use

• Poor sanitation
• Lack of reliable clean water resource
• Overcrowding
• Personal contacts
• Institutionalization

• Occupation (e.g. daycare)
• Foreign travel
• Male homosexuality
• Illicit parenteral drug use

• Mild flu-like symptoms
• Anorexia,
• Nausea and vomiting,
• Fatigue,
• Malaise,
• Low-grade fever (usually < 39.5°C),

• Myalgia,
• Mild headache
• Pale stools
• Pruritis
• Jaundice
• Hepatomegaly

A person is diagnosed with hepatitis A virus based upon their signs or symptoms, a physical examination, and blood testing. The blood test becomes positive about five days before symptoms appear and remains positive for about six months after infection.

As no specific treatment exists for hepatitis A, prevention is the most effective approach against the disease.

Vaccination is highly effective in preventing HAV disease. The efficacy of the hepatitis A vaccine ranges from 80% to 100% after 1-2 doses compared to placebo.

For acute cases of HAV infection, therapy is generally supportive, with no specific treatment of acute uncomplicated illness. Locating the primary source and preventing further outbreaks are paramount. Initial therapy often consists of bed rest. The patient should probably not work during the acute phase of the illness.

Nausea and vomiting are treated with antiemetics.

Hand washing is an essential and effective way to prevent the spread of infection. Hands should ideally be wet with water and plain or antimicrobial soap and rubbed together for 15 to 30 seconds. Special attention should be paid to the fingernails, between the fingers, and the wrists. Hands should be rinsed thoroughly and dried with a single-use towel.

It is not clear if alcohol-based hand rubs are effective against hepatitis A virus. For this reason, food handlers, daycare providers, travelers, and anyone else who is at risk of transmitting or becoming infected with HAV is advised to wash their hands with soap and water when possible. Alcohol-based hand rubs are a reasonable alternative if a sink is not available.

Hands should be cleaned after changing a diaper or touching any soiled item. They should also be washed before and after preparing food and eating, after going to the bathroom, and after handling garbage or dirty laundry.

Dehydration may be managed with hospital admission and intravenous (IV) fluids. The majority of children have minimal symptoms; adults are more likely to require more intensive care, including hospitalization.

The advent of new antiviral agents, such as direct-acting antivirals (DAAs) and host-targeting agents (HTAs) has expanded the potential therapeutic options available against HAV.

Pain control is essential to quality patient care. Acetaminophen is useful for pain and/or fever.

Patients with fulminant hepatic failure (FHF) are considered for liver transplantation. Recurrent disease after liver transplantation has not been reported.

Hepatitis A virus infection is preventable with several strategies, discussed below. Hand washing is one of the most effective strategies for reducing transmission since the virus can live on the fingers for up to four hours.

Hand washing is an essential and effective way to prevent the spread of infection. Hands should ideally be wet with water and plain or antimicrobial soap and rubbed together for 15 to 30 seconds. Special attention should be paid to the fingernails, between the fingers, and the wrists. Hands should be rinsed thoroughly and dried with a single-use towel.

It is not clear if alcohol-based hand rubs are effective against hepatitis A virus. For this reason, food handlers, daycare providers, travelers, and anyone else who is at risk of transmitting or becoming infected with HAV is advised to wash their hands with soap and water when possible. Alcohol-based hand rubs are a reasonable alternative if a sink is not available.

Hands should be cleaned after changing a diaper or touching any soiled item. They should also be washed before and after preparing food and eating, after going to the bathroom, and after handling garbage or dirty laundry.

• Do not drink raw (unpasteurized) milk or foods that contain unpasteurized milk.
• Wash raw fruits and vegetables thoroughly before eating.
• Keep the refrigerator temperature at 40^oF (4.4^oC) or lower; the freezer at 0^oF (-17.8^oC) or lower.
• Use precooked, perishable, or ready-to-eat food as soon as possible.
• Keep raw meat, fish, and poultry separate from other food.
• Wash hands, knives, and cutting boards after handling uncooked food, including produce and raw meat, fish, or poultry.

People who are preparing to travel to areas where HAV infections commonly occur should take precautions when eating and drinking to avoid becoming ill.

Hepatitis A vaccination is available in Pakistan. Hepatitis A vaccine is recommended for all children between 12 and 23 months of age and those ages 2 to 18 who live in states or communities of high disease incidence.

The most common side effect of the hepatitis A virus vaccine is brief redness or discomfort at the injection site.

The hepatitis A virus vaccine is recommended for all at-risk adults, including:

• Travelers to countries where hepatitis A virus is common; the vaccine can be given at any time before traveling
• Injection and non-injection illegal drug users
• Men who have sex with men
• People with chronic liver disease
• Adults with blood clotting factor disorders
• Adults who are at risk for infection at work, including daycare center staff, personnel in healthcare facilities (e.g. nursing homes), and food handlers

Individuals who are at risk for hepatitis A but who are allergic to components of the hepatitis A vaccine or who prefer not to receive the vaccine should consider taking a dose of immune globulin.

Immune globulin is an injection that provides temporary protection against hepatitis A and reduces the risk of infection by more than 90 percent. However, the hepatitis A vaccine is preferred to immune globulin in most cases because it provides long-lasting protection and because immune globulin is not always available.