The Facts about Hepatitis A

Hepatitis A, once known as “infectious hepatitis,” is a liver disease caused by the hepatitis A virus (HAV). The disease is fairly common throughout the world, although it occurs more often in developing countries with poor sanitation. Several hundred cases are reported each year in Wisconsin.

Hepatitis A virus is passed in the stool (feces) of infected people. It spreads when a person puts something in his or her mouth that has been contaminated with the stool of someone who has hepatitis A. This type of transmission is called "fecal-oral," and is not as unusual as it sounds. Many infections result from contact with a household member or sex partner who has hepatitis A. Casual contact, as in the usual office, factory, or school setting, does not spread the virus. In some cases the virus spreads to people when they drink water that has been contaminated with improperly treated sewage.

Unless they wash their hands thoroughly with soap after using the toilet, people with hepatitis A can carry the virus on their hands and transmit it to others. The virus can pass directly from the hands of infected people to others, or it can be spread through food or drinks that infected people have handled. This is why local outbreaks of hepatitis A have often originated at restaurants, parties or other gatherings where food and drinks are served.

Symptoms
The symptoms of hepatitis A can include profound fatigue, poor appetite, fever and vomiting. Urine may become darker in color, and some people also show jaundice – the skin and the whites of their eyes turn yellow. Hepatitis A is rarely fatal and most people recover in a few weeks without complications.

Hepatitis A symptoms may appear two to seven weeks after exposure to the infected source, but usually occur about four weeks after exposure. However, people who have been infected are contagious from about two weeks before the symptoms appear and continue to be contagious for about one week after the onset of jaundice. After they recover from hepatitis A they are immune to it for life and do not continue to carry the virus.

Anyone can contract hepatitis A, but it occurs more frequently in children. Infants and young children tend to have very mild or no symptoms and are much less likely to develop jaundice than are older children or adults. Because the virus is passed in feces, children with hepatitis A who are not toilet-trained can be an important source of the infection.

Prevention
Good personal hygiene and proper sanitation can help prevent hepatitis A. Vaccines are also available for long-term prevention of hepatitis A virus infection in persons 2 years of age and older. Immune globulin is available for short-term prevention of hepatitis A virus infection in individuals of all ages.

The single most effective way to prevent the spread of the hepatitis A virus is careful hand washing after using the toilet or after diapering children. In addition, infected people should not handle foods during the contagious period. Because people with hepatitis A can be infectious to others for about two weeks before they even know they are sick, routine use of good hygiene is important.

For people who have already been exposed to hepatitis A, an injection of immune globulin – given within 14 days of exposure – will reduce their chances of becoming ill. Household members, day care contacts, or others in close contact with an infected person should promptly call a doctor or the health department about the advisability of obtaining a shot of immune globulin. In typical workplace and classroom situations, contacts do not need to receive immune globulin.

A vaccine to prevent hepatitis A is available, but should be given at least four weeks before potential exposure takes place. Therefore, its use is currently limited to persons whose activities are likely to put them at risk of exposure to the hepatitis A virus in the future, such as travelers to countries where the infection is prevalent. Other groups for whom the vaccine is recommended or may be beneficial include:

• People with chronic liver disease. People who already have liver problems, especially those with have hepatitis C, can become extremely ill if they contract hepatitis A.

• People who have blood clotting-factor disorders.

• Sexually active men who have sex with other men.

• People who work or live in institutions for the developmentally challenged.

• People who use illegal drugs.

• People living in communities that have very high levels of hepatitis A and that periodically have community-wide epidemics of the disease.

Vaccination consists of two shots, given six to twelve months apart. The initial dose will provide immunity to hepatitis A beginning in about four weeks and lasting about one year. The second dose provides long-term immunity, which lasts for years and may even be life-long.

Treatment
There are no special medicines or antibiotics that are used to treat people once the symptoms of hepatitis A have appeared. Although symptoms might take months to disappear completely, bed rest and plenty of fluids are all that are generally needed for recovery.

This article includes information from the Wisconsin Department of Health and Family Services and the US Centers for Disease Control and Prevention (CDC).

For more information see Preventing Hepatitis A Infection While Traveling.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.