Hepatitis A

What is hepatitis?

Hepatitis is an inflammation of the liver caused by certain viruses and other factors, such as alcohol abuse, some medications and trauma. Its various forms affect millions of Americans. Although many cases of hepatitis are not a serious threat to health, infection with certain hepatitis viruses can become chronic (long-lasting) and can sometimes lead to liver failure and death.

How many kinds of viral hepatitis are there?

There are four major types of hepatitis, all caused by different viruses: hepatitis A, hepatitis B, hepatitis C and delta hepatitis. This “HealthBeat” focuses on hepatitis A.

What is hepatitis A and how is it transmitted?

Hepatitis A, formerly known as infectious hepatitis, is caused by the hepatitis A virus. The virus enters through the mouth, multiplies in the body and is passed in the stool. It can be carried on the hands of an infected person who does not wash his or her hands thoroughly after using the toilet. The infection can be spread by direct contact with the hepatitis A virus or when another person consumes food or drink handled by an infected person who does not practice good hygiene, such as handwashing. In some cases, it can be spread to persons who ingest sewage-contaminated water.

What are the symptoms of hepatitis A?

The symptoms of hepatitis A include fatigue, poor appetite, fever and vomiting. Urine may become darker. Jaundice may then appear. Symptoms can appear from 15 to 50 days after exposure, but usually within 28 to 30 days of being exposed to the virus.

The disease is rarely fatal, and most people recover in a few weeks without any complications. Infants and young children tend to have very mild or no symptoms and are less likely to develop jaundice than are older children and adults. Not everyone infected with the virus will have all of the symptoms. There are no long-term effects. Once an individual recovers from hepatitis A, he or she is immune for life and does not continue to carry the virus.

During the recovery period, it is important to avoid drinking alcohol and taking certain prescription and over-the-counter medications (e.g., acetaminophen/Tylenol®), which can injure the liver.

How contagious is hepatitis A?

Casual contacts — fellow classmates or work associates, for example — are generally not at risk. Because close personal contact in classrooms or offices is unlikely and because older children and adults typically practice good hygiene, the likelihood that hepatitis A will be transmitted in these settings is reduced. However, hepatitis A can be transmitted in child day-care settings, especially if good hygiene is not practiced after changing diapers. It also is due to the close personal contact among children, who are still learning to practice proper hygiene.

The contagious period begins about two weeks before symptoms appear and continues up to one week after the onset of jaundice (a yellowing of the skin and whites of the eyes). Because of the delay in symptoms, a person can transmit the virus without realizing it.

In Illinois, the incidence of hepatitis A has declined since 1990, when 1,726 cases were recorded, to 112 cases in 2008.

How can hepatitis A be prevented?

The single most effective way to prevent the spread of the hepatitis A virus is careful handwashing after using the toilet. Also, infected people should not handle foods during the contagious period (about two weeks before symptoms appear and up to one week after onset of jaundice).

Is there a vaccine to prevent hepatitis A?

In 1995, a hepatitis A vaccine was licensed for use in the United States. This vaccine is recommended for children older than one year of age and certain adolescents, persons who plan to travel to countries where hepatitis A occurs frequently, those who have blood clotting disorders or chronic liver disease, men who have sex with men and illegal drug users. Two doses of the vaccine are needed for lasting protection. These doses should be given at least 6 months apart.  Please check with your physician.

After receiving the full series of vaccinations, a person should develop long-term immunity. Research suggests immunity could last as long as 20 years.

What is the proper handwashing technique?

Wet hands with soap and warm water. Rub hands for 20 seconds, making sure you clean under fingernails. Rinse under warm water. Dry hands on a paper towel or your own clean towel. In washrooms where paper towels are available, use a paper towel to turn off the water faucet and throw the towel away.

How can illness be prevented after a possible exposure to the hepatitis A virus, such as eating food handled by someone with hepatitis A in a restaurant?

A vaccine is available that can help prevent hepatitis A infection if it is given early enough.  

Who should NOT get the vaccine after being exposed to hepatitis A in a setting such as a restaurant?

• Individuals who have had hepatitis A infection before or received 2 shots of the hepatitis A vaccine
  
  
• Individuals who have had a severe reaction to the hepatitis A vaccine or another vaccine in the past
  
  
• Individuals who are allergic to neomycin (an antibiotic)
  
  
• Infants less than 12 months of age
  
  
• Pregnant women

Anyone who is moderately or severely ill at the time the shot is scheduled should probably wait until they recover. People with a mild illness can usually get the vaccine.

How long will this vaccine protect me against hepatitis A?

One dose of hepatitis A vaccine provides protection for at least 1 year. A second dose in 6 to 12 months provides protection for at least 20 years.  A vaccination series started with one brand of vaccine may be completed with the same or other brand of hepatitis A vaccine.

Can I get hepatitis A more than once?

No. Once you have had hepatitis A infection you cannot get it again.

Who should receive immune globulin to prevent hepatitis A?

For individuals who should not get the vaccine, or if vaccine is not available, a "shot" called an immune globulin can be given. Immune globulin is a sterile preparation of antibodies that can lower the risk of infection for about 3 to 5 months. Also, people with a weakened immune system or chronic liver disease should be given one dose of immune globulin.

Household members, day-care contacts or others in close personal contact with an infected person should call a doctor or their local health department to obtain information about receiving preventive treatment to reduce the risk of becoming ill. In normal working and classroom situations (except day-care centers), contacts do not need to receive immune globulin or vaccine.

How is hepatitis A treated?

No special medicines or antibiotics are used to treat a person once symptoms appear. Generally, bed rest is all that is needed.