Hepatitis A

What is hepatitis A?

The liver is a large, hard-working organ that protects the body from toxins. It can handle all sorts of insults, but it also has its weaknesses. It doesn't like too much alcohol, and it definitely doesn't like viruses that cause hepatitis or inflammation of the liver.

There are five types of hepatitis viruses: hepatitis A, B, C, D, E, and F. Of these, A, B, and C are by far the most common. Fortunately, cases of hepatitis A in the United States and the rest of the industrialized world have plummeted thanks to widespread vaccinations and improved sanitation practices. In 2008, there were fewer than 25,000 new cases of hepatitis A in this country, although many of them were never reported, according to the Centers for Disease Control and Prevention (CDC). The number of children in the United States who get hepatitis A has declined, but it is a major threat in the developing world, where most people who catch the virus do so during childhood.

Unlike some other types of viral infections of the liver, hepatitis A is a short-lived illness that almost always goes away on its own without causing lasting damage. Although hepatitis A is not dangerous in most cases, you definitely want to avoid catching it. In rare instances, hepatitis A can cause liver failure and death, usually in people older than 50 or who have other liver diseases, such as hepatitis B or C.

How do people catch hepatitis A?

The hepatitis A virus is just one of many disease-causing germs found in human feces. People usually catch hepatitis A by getting the virus in their mouths, often because they eat food or drink water that has been contaminated by human waste. Children who don't wash their hands after using the bathroom can easily spread the germ to caregivers and other children. If the germ gets on your hands -- perhaps while you are changing a diaper -- your hands will need a good wash before you touch food or put one of your fingers in your mouth.

A person can also develop the disease if they have sex that involves oral-anal contact with someone who has hepatitis A.

People with hepatitis A are usually contagious for a couple of weeks after they start feeling sick. Once you've had the disease, you can't catch it again.

What are the symptoms of hepatitis A?

When someone is infected with hepatitis A, the illness can range from mild, lasting a few weeks, to severe, disabling the patient for several months. Some people, especially children, never have symptoms at all. When it strikes, most of us can expect a sudden fever along with headache, nausea, stomach pain, vomiting, joint pain, dark urine, pale or clay-colored bowel movements, and a lack of energy or appetite. Some people may also have chills, diarrhea, constipation, and itchy skin. The skin and the whites of the eyes may start to turn yellow. This is called jaundice, and it's a classic sign of liver trouble. In some rare cases the brain can be affected, causing confusion, unusual eye and body movements, and even coma. While the symptoms may fade relative quickly for children, adults are usually sick for about two months. Some people continue to feel ill off and on for up to six to nine months.

How is hepatitis A diagnosed?

Since all sorts of liver problems tend to cause similar symptoms, your doctor won't be able to diagnose hepatitis A just by looking at you. He or she will run a blood test that can confirm the source of the illness.

What is the treatment for hepatitis A?

There is no treatment for hepatitis A -- antibiotics won't help because it's caused by a virus, not a bacterium -- but you can take steps to make yourself feel better while you recover. You may need to rest for several weeks, and you'll have to avoid alcohol and acetaminophen (Tylenol) until you feel better and your liver is up to snuff again. Nearly one-third of people who get hepatitis A need to be hospitalized for dehydration and other complications while they recover.

How can hepatitis A be prevented?

The surest way to avoid hepatitis A is to get vaccinated. Two doses of the hepatitis A vaccine given at least six months apart will provide protection for a lifetime. The CDC now recommends that the vaccine, first introduced in 1995 be given to children routinely starting at 12 to 23 months of age.

Adults who have never been vaccinated should definitely roll up their sleeves before visiting a developing country or trekking in backcountry areas. Ideally, travelers should get the shot at least one month before they leave. If there isn't time for that, a doctor can combine the vaccination with a shot of immune globulin (IG), a medication that provides a temporary boost of disease-fighting antibodies. Vaccinations might also be recommended if there's an outbreak of hepatitis A in your community or if you already have a chronic liver disease. People who use street drugs, those who receive regular clotting factor medicine, and anyone who has anal sex are at extra risk for infection, so a vaccination makes sense for them, too.

Whether or not you've been immunized against hepatitis A, good hygiene is an important step toward good health. Always wash your hands thoroughly before eating and after using the bathroom or changing a diaper. When traveling to countries without modern sanitation, don't drink water unless it has been boiled for at least one minute or comes in a bottle or can. Avoid ice, too, unless you know it was made with clean water. Make sure all your food is thoroughly cooked, and don't eat raw fruits and vegetables unless you can peel them yourself with clean hands.

References

Centers for Disease Control and Prevention. Hepatitis A fact sheet. June 2009.

American Academy of Family Physicians. Hepatitis A: What you should know. 2006.

Brundage, S. and A. Fitzpatrick. Hepatitis A. American Family Physician. 2006. 73: 2162-2168.

World Health Organization. Hepatitis A.

National Institute of Diabetes and Digestive and Kidney Diseases. What I need to know about hepatitis A. April 2009.

Centers for Disease Control and Infection. FAQs for the Public.

Mayo Clinic. Hepatitis A. Treatment and Drugs. September 5, 2009.

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