What is Hepatitis A?

Hepatitis A is a serious liver infection caused by hepatitis A virus. It is found in the stools of people in  Hepatitis A. Hepatitis A is spread via fecal-oral route of ingestion of food or drinks contaminated with the fecal content containing with hepatitis A. Eating raw shellfish which is contaminated because of poor sewage system is also a way of transmission. It usually happen in places with poor sanitation and from people with poor personal hygiene.  

The incubation period from ingestion of contaminated food to the onset of symptoms is 28 days. 

The symptoms of hepatitis A include 

• fever and lethargy
• jaundice (yellow skin/eyes and tea colored urine)
• abdomen discomfort
• loss of appetite and vomiting 
• severe abdomen pain in children 

Most people need to be hospitalized during acute hepatitis A. Most people recover within 2 months however some may have persistent illness for 6 months. It is a self limiting disease. However in elderly, there is a risk of developing into fulminant hepatitis (acute liver failure). There is no long term complications like association with liver cancer unlike hepatitis B and C.  

Treatment of Hepatitis A

As hepatitis A is a self-limiting disease hence there is no specific treatment. Treatment is only for symptomatic relief of symptoms and bed rest. The person with hepatitis A carries the virus and they can spread the virus to others hence they need to exercise proper personal hygiene. 

Patients who are dehydrated, with persistent vomiting and signs of impending liver failure need to be hospitalized for monitoring. 

Prevention of Hepatitis A 

One should observe good personal hygiene and avoid consuming raw seafood and water which could be contaminated with sewage. A better way or prevention is via immunization with hepatitis A vaccine. This is especially important for those who travel to hepatitis A endemic regions like southeast Asia, Caribbean, mexico, Africa, eastern Europe and south and central america.  

Who should get Hepatitis A vaccine? 

• Anyone age 1 year or older travelling to endemic areas like Southeast Asia, Mexico, Caribbean, Africa, Eastern Europe and South & central America. 
• Children between 1-2 years old
• Drug abusers
• Men who have sex with men
• Patients with chronic liver disease like hepatitis B carrier
• People who work with people with hepatitis A or with hepatitis A in laboratory. 
• It will also be helpful to get vaccinated for people who are health care workers, food handlers, those who work in sewerage. 

Hepatitis A vaccination

Hepatitis A vaccine consists of the inactivated form of hepatitis A virus a form of active immunisation. Two doses of vaccine should be given 6-12 months apart. The immunity against hepatitis A usually last 10-20 years. Protection against hepatitis A begin about 4 weeks later hence they should be given at least one month prior to travel.  

In children the first dose can be given between 12 to 23 months old. Those not vaccinated prior to 2 years old can get vaccinated at a later date. A second dose follows at 6-12 months later. 

For travelers who cannot get vaccinated with the above doses on time can get immediate and temporary protection by injecting passive immunization of hepatitis A immune globulin G (IG). 

Hepatitis A vaccine can be given at the same time with other vaccines. 


Contraindications to hepatitis A vaccination

• Those who have severe allergic (anaphylactic) reaction to the vaccine
• Those who are moderately or severely ill should only take the vaccination when they are better
• Pregnant women should deter vaccination as their is no evidence based controlled studies on its safety on the unborn child. 

Side effects of Hepatitis A vaccine

Some minor reaction to the vaccination include aching at injection site, fatigue, headache and loss of appetite. Usually these minor reactions will resolve on its own within 1-2 days. 

Severe anaphylactic reaction is very rare and usually will occur within minutes to hours after the vaccination. Patients with severe anaphylactic reaction will have hives, palpitations, weakness, dizziness, swollen face and lips and shortness of breath. These group of people should be hospitalized and resuscitated.