News: Hepatitis A
Informer
2/17/05
Health Watch
By Ann Almodovor, APRN
Hepatitis A is a very contagious and potentially deadly liver disease caused by a virus. Approximately 1.4 million people worldwide and 143,000 people in the U.S. become infected each year with Hepatitis A. In certain parts of the world, Hepatitis A is more common and a person is more likely to get the disease if traveling or living there.
Hepatitis A is sometimes called a travel disease because it is the most frequently-occurring, vaccine-preventable infection in travelers. Each year 24 million people from the United States visit areas where Hepatitis A is endemic. However, you don't have to leave the country in order to be exposed to the disease.
Outbreaks in the United States have been associated with contaminated food, infected food handlers and with day-care centers. Not long ago, there was an outbreak linked to consumption of green onions in a chain-restaurant in Pennsylvania that resulted in several deaths. The disease is spread primarily by fecal-oral transmission. This means it can be contracted by ingesting contaminated food, shellfish or water.
The classic symptoms of acute viral hepatitis are malaise (discomfort, uneasiness), fatigue, loss of appetite and change in taste with aversion to alcohol and smoking, headache, nausea, vomiting and right upper quadrant pain. Jaundice (yellowing of skin and whites of eyes), dark urine, clay-colored stools and an enlarged tender liver also occur with infection. The illness is usually self-limited and does not result in chronic infection, however complete recovery can be slow. The incubation period (from time of exposure to the development of symptoms) is usually two to six weeks. Full recovery from Hepatitis A can take up to six months and relapses are possible during convalescence.
What happens if you get hepatitis A?
If symptoms of hepatitis are present, blood tests are necessary to confirm infection, to determine which virus is responsible and to monitor the severity of the infection. The treatment of all forms of acute hepatitis including Hepatitis A involves supportive care, rest and avoidance of potentially liver-toxic substances (such as alcohol and certain medications). Most patients can be cared for on an outpatient basis but hospitalization is necessary if the patient is unable to maintain adequate food or fluid intake by mouth or if the infection is severe.
Close contacts of patients with Hepatitis A (such as suitemates or household members) are at risk of getting it for as long as two weeks after the jaundice has appeared in the patient because he or she is shedding the virus during this time. Viral shedding (in blood and stools) also occurs one to two weeks before the jaundice appears, so Hepatitis A is contagious for as long as four weeks total. Close contact of Hepatitis A patients may need to be injected with immune serum globulin and careful handwashing and other preventive measures are necessary.
Are you at risk?
Persons at increased risk of infection by Hepatitis A include:
* Travelers - especially to Mexico, parts of the Caribbean, Africa, Asia (except Japan), the Mediterranean basin, Eastern Europe, the Middle East and Central and South America.
* Persons living in or relocating to any community in the U.S. or abroad with one or more recorded Hepatitis A outbreaks within the past five years.
* Military personnel.
* Persons who engage in high-risk sexual activity (such as homosexually active males).
* Users of illicit injectable drugs.
* Hemophiliacs and other recipients of blood products.
* Employees of day-care centers.
* Institutional care workers.
* Laboratory workers who handle Hepatitis A virus.
* Handlers of primate animals that may harbor Hepatitis A virus.
How can you protect yourself against hepatitis A?
There are things you can do to protect yourself and others from Hepatitis A. Before you travel to areas where Hepatitis A is endemic consider these means of reducing your risk:
* Avoid untreated tap water in drinks or ice cubes. When drinking or brushing your teeth, use only bottled or boiled water.
* Do not eat unpeeled fruits, salads, uncooked vegetables or raw shellfish (e.g., oysters, clams and mussels). These foods can be contaminated with Hepatitis A.
* Do not eat food or drink beverages bought from street vendors (except commercially bottled beverages).
* Hepatitis A may also be avoided through vaccination with immune globulin (IG) or Hepatitis A vaccine. IG contains antibodies to the virus and provides short-term protection against the disease. Hepatitis A vaccines provide longer-term protection against Hepatitis A.
* Health Services has Hepatitis A vaccine available.
Hepatitis A vaccine
The Hepatitis A vaccines contains a killed or inactivated virus that cannot cause hepatitis but does stimulate the body's immune system to make antibodies that help protect against the virus. The total duration of protection is not known at present but protection might last your lifetime. The vaccine is indicated for active pre-exposure prophylaxis against disease caused by Hepatitis A in persons two years of age and older. Primary immunization should be done at least two weeks prior to potential exposure to the virus.
The recommended vaccination regimen consists of one primary dose and one booster dose (six months after the primary dose in adults). The vaccines are generally well-tolerated with injection-site complaints (i.e. redness, tenderness, warmth, irritation) being the most frequently reported complaints. Other side effects and allergic reactions are rare but possible and the benefits and risks of vaccination should be discussed with your health care provider. A very high degree of protection is possible with the immunization but as with all vaccines it may not protect 100 percent of all those who are vaccinated. For more information on Hepatitis A and vaccination, a good source is the CDC website (www.cdc.gov).
The Hepatitis A vaccine is administered here on campus at the Health Services and can be given to anyone without prior allergy to the vaccine or current illness with fever. The cost is $20. Again, it needs to be given at least two weeks before travel so plan ahead and call for an appointment at x6601 if your Spring Break or summer travels may take you some place where Hepatitis A may be a threat to your health.
