Hepatitis A

I. Synonym and Added Informations

a. Also known as infectious hepatitis duly because it is transmitted person-to-person by ingestion of contaminated food or water or through direct contact with an infectious person

b. Epidemic Hepatitis, Epidemic Jaundice, Catarrhal Jaundice, Type A Hepatitis

c. Definition: Hepatitis A refers to liver inflammation caused by infection with the hepatitis A virus (HAV)

d. Unlike hepatitis B and hepatitis C, hepatitis A does not cause chronic (ongoing, long-term) disease. Although the liver does become inflamed and swollen, it heals completely in most people without any long-term damage. Once you have had hepatitis A, you develop lifelong immunity and cannot get the disease again.

II. Brief history

a. The disease was most detrimental to what early Mesopotamian civilizations deemed the seat of life--the liver.

b. The manifestations of liver diseases such as hepatitis B included jaundice, characterized by Hippocrates and found to be infectious as early as the 8th century.

c. By 1885, hepatitis was found to be transmittable through blood tranfusions and syringes when epidemics of jaundice broke out during the wars of the 17th-19th centuries. During World War II, between 1939-1945, a series of outbreaks occurred after vaccination for measles and yellow fever, implying further that the virus was blood-borne.

d. In 1947, MacCallum classified viral hepatitis into two types: Viral Hepatitis A, or infectious hepatitis, and Viral Hepatis B, or Seum hepatitis.

e. In 1973-1974, Stephen Feinstone, Maurice Hilleman and their colleagues discovered and described hepatitis A virus.

f. In 1974, it was first recognized that not all cases of viral hepatitis were hepatitis A or hepatitis B. It proved difficult to identify the infectious agent responsible for these cases of non-A, non-B hepatitis. However, it has recently become clear that many cases of post-transfusion non-A, non-B hepatitis are the result of infection with a new virus, hepatitis C.

III. Etymology

a. Hepatitis comes from ancient Greek hepar (ηπαρ) or hepato- (ηπατο-) meaning 'liver' and suffix -itis denoting “inflammation” and thus means “liver inflammation”.

b. Additional information

i. How Does Hepatitis Affect The Liver?

- The liver breaks down waste products in your blood. When the liver is inflamed, it doesn't do a good job of getting rid of waste products. One waste product in the blood, called bilirubin, begins to build up in the blood and tissues when you have hepatitis. The bilirubin can make the skin and/or whites of the eyes (or sclera) of a person with hepatitis turn a yellowish color called jaundice.

IV. Mode of transmission

a. It spreads by the fecal-oral route and infections often occur in conditions of poor sanitation and overcrowding. Hepatitis A is spread through feces. You can get infected through close contact with an infected person (for example, changing a diaper or having sexual contact), even if that person does not have any symptoms. In fact, hepatitis A is most contagious before symptoms appear. You can also get infected by eating contaminated food or drinking contaminated water. The virus can live on hands, in water and in soil. Hepatitis A is common in developing countries.

b. It can also be transmitted by the parenteral route but very rarely by blood and blood products.

V. Signs and symptoms

a. Abdominal pain, at area of liver—right side of abdomen just under the rib cage

b. Appetite loss

c. Clay-colored (grey or pale white) feces

d. Diarrhea especially in children

e. Fatigue

f. Low-grade fever

g. Jaundice, a yellow discoloration of the skin and the sclera, which is the white part of the eyes

h. Nausea

i. Urine is dark brownish in color, like cola or strong tea

j. Vomiting - If the vomiting is severe, dehydration may occur. The symptoms of dehydration include the following:

i. Feeling weak, tired

ii. Feeling confused or unable to concentrate

iii. Rapid heartbeat

iv. Headache

v. Urinating less frequently than usual

vi. Irritability

Note:

i. Symptoms usually last less than two months, although they may last as long as nine months. About 15% of people infected with hepatitis A have symptoms that come and go for 6-9 months.

ii. Hepatitis does not occur simply from being near someone who has the disease at work or at school.

VI. Treatment

a. There is no specific treatment for hepatitis A. Rest is recommended when the symptoms are most severe. People with acute hepatitis should avoid alcohol and any substances that are toxic to the liver, including acetaminophen (Tylenol).

b. Fatty foods may cause vomiting, because substances from the liver are needed to digest fats. Fatty foods are best avoided during the acute phase.

VII. Prevention

a. The virus may spread more rapidly through day care centers and other places where people are in close contact. Thorough hand washing before and after each diaper change, before serving food, and after using the restroom may help prevent such outbreaks.

b. Vaccines that protect against hepatitis A infection are available. The vaccine begins to protect 4 weeks after receiving the first dose. The 6- to 12-month booster is required for long-term protection.

i. The hepatitis A vaccine is called Havrix or VAQTA. It is a killed, or inactivated vaccine. This means it is made from smaller pieces of the whole hepatitis A virus. After you get the vaccine, your body learns to attack hepatitis A if you are exposed to it. This means you are very unlikely to get sick with hepatitis A. Because no vaccine is 100% effective, however, it is still possible to get hepatitis A after you have been completely vaccinated.

ii. The vaccine is given as a shot in your arm. You need two (2) vaccinations to make sure you are completely protected against the disease. After receiving the first vaccination, children and adults should have a booster vaccination in 6 to 12 months.

iii. You should be protected against disease within 2-4 weeks after getting the first dose.

iv. A vaccine for adults called Twinrix provides protection against both hepatitis A and B. It is given in three (3) doses.

VIII. Epidemiology/Statistics

a. Hepatitis A virus (HAV) infection over last 20 years shows shifting patterns in the prevalence of antibodies to HAV (anti-HAV) throughout South-East Asia and China.

b. A number of countries have shifted from high to moderate and from moderate to low endemicity, with a corresponding increase in the age of exposure from childhood to early adulthood. The changes have resulted from improvements in hygiene, sanitation and the quality of drinking water, reflecting improvements in living standards and socioeconomic progress. In general in the late 1970s and early 1980s, 85-95% of the population of developing countries like the Philippines, Korea, China and Thailand were anti-HAV-positive by age 10-15 years, compared with only about 50% in the more affluent countries like Malaysia and Singapore. In the early 1990s, 85-95% of the population were immune by age 30-40 years in the Philippines, Korea, China and Thailand, and by 50 years of age and above in Malaysia and Singapore. Similar trends were noted in Hong Kong, Taiwan and Japan. Exposure to HAV at a later age may be associated with an increase in hepatitis A morbidity and a greater propensity for outbreaks.

IX. Government Programs

- The Food and Waterborne Disease Prevention and Control Program (FWBDPCP) established in 1997 but became fully operational in year 2000 with the provision of a budget amounting Php551,000.00. The programs focus on cholera, typhoid fever, hepatitis A and other food-borne emerging diseases. Other diseases acquired through contaminated food and water not addressed by other services fall under the program.

References:

Braverman, P., et al (2006). Adolescent Medicine A Handbook for Primary Care. 530 Walnut Street Philadelphia, PA 19106: Lippincott Williams & Wilkins.

Gerin, J., et al. (1997). Viral Hepatitis and Liver Disease. Rome, Italy: Edizioni Minerva Medica.

Maddrey, W., Schiff, E., Sorrell, M. (2007). Schiff’s Disease of the Liver (10th edition, volume 1). 530 Walnut Street Philadelphia, PA 19106: Lippincott Williams & Wilkins.

Hepatitis A Retrieved June 25, 2011 from http://www.dhpe.org/infect/hepa.html

What I need to know about Hepatitis A. Retrieved June 25, 2011 from http://digestive.niddk.nih.gov/ddiseases/pubs/hepa_ez/

History of Hepatitis. Retrieved June 25, 2011 from http://www.stanford.edu/group/virus/1999/tchang/history.htm

The Origin of HCV and HBV. Retrieved June 25, 2011 from http://hepatitiscnewdrugs.blogspot.com/2010/10/when-was-hepatitis-first-discovered-hep.html

Hepatitis A shifting epidemiology in South East Asia and China Retrieved June 25, 2011 from http://www.traveldoctoronline.net/hepatitis-a-shifting-epidemiology-in-south-east-asia-and-china-MTA2ODM1NTE=.htm