Hepatitis A

Hepatitis A (formerly known as infectious hepatitis) is an acute infectious disease of the liver caused by the hepatovirus hepatitis A virus.^[1] Most commonly transmitted by the fecal-oral route, such as contaminated food, hepatitis A does not typically have a chronic stage and does not cause permanent liver damage. The patient's immune system makes antibodies against the hepatitis A virus that confer immunity against future infection. Some vaccines remain effective for a lifetime, while others have to be updated after a few months or years.[2]

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Virus

Hepatitis virus (HAV) is a non-enveloped ssRNA virus with a single serovar.^[1]

Symptoms

Symptoms of hepatitis A may be mistaken for flu. Some sufferers, especially children, may exhibit no symptoms at all. Symptoms typically appear 2 to 6 weeks after start of infection.^[2]

Symptoms may return over the following 6-9 months and may include:^[3]

• Fatigue
• Fever
• Abdominal pain
• Nausea
• Diarrhea
• Appetite loss
• Depression
• Jaundice, a yellowing of the skin or whites of the eyes
• Sharp pains in the right-upper quadrant of the abdomen

Treatment

There is no specific treatment for hepatitis A. Sufferers are advised to rest, avoid fatty foods and alcohol (these may be poorly tolerated for some additional months during the recovery phase and cause minor relapses), eat a well-balanced diet, and stay hydrated. Approximately 15% of people diagnosed with hepatitis A may experience one or more symptomatic relapse(s) for up to 24 months after contracting this disease.

Prognosis

The United States Centers for Disease Control and Prevention (CDC) in 1991 reported a low mortality rate of 4 deaths per 1000 cases for the general population but a higher rate of 17.5 per 1000 in those aged 50 and over. Death usually occurs when the patient contracts Hepatitis A while already suffering from another form of Hepatitis, such as Hepatitis B or Hepatitis C. In these cases, a liver transplant may be necessary.

Young children who are infected with hepatitis A typically have a milder form of the disease, usually lasting from 1-3 weeks, whereas adults tend to experience a much more severe form of the disease. They are often confined to bed and minimal activity for about 4 weeks and have to stop their work for one to three months or longer. Many adults take up to 36 months and occasionally longer to recover entirely. Symptoms that may be experienced after the first month or two are low immunity: It is much easier to catch minor infections and for these infections to linger longer than they normally would. Many people experience a slow but sure improvement, over this later period. They are generally able to function fairly normally, still needing more sleep and reduced athletic activity. It is common for recovering patients to experience occasional "off" days, during which they need to rest more. Hepatitis A can be sexually transmitted, especially during oral-anal contact, but not after the patient has recovered.

Prevention

Hepatitis A can be prevented by good hygiene and sanitation. Vaccination is also available, and is recommended in areas where the prevalence of hepatitis A is high. To prevent it, use your own towels and toothbrushes, eating utensils, and other personal products. Always wash your hands after and before eating and more importantly after using the toilet.

Vaccine

Main article: Hepatitis A vaccine

  This Hepatitis A vaccine, Avaxim, protects against the virus in more than 95% of cases and provides protection from the virus for ten years. The vaccine contains inactivated Hepatitis A virus providing active immunity against a future infection.^[4]

Epidemiology

  HAV is found in the feces of infected persons and those who are at higher risk include travelers to developing countries with high prevalence rates,^[5] and those having sexual contact or drug use with infected persons.^[6] The CDC estimated that in the U.S. there were 30,000 cases in 1997, but catalytic models estimate there were 127,000 cases each year from 1980 through 1999.^[7] HAV outbreaks still occur in developed countries and are usually traced to poor hand hygiene among infected, sometimes symptomatic restaurant employees failing to wash their hands after toilet breaks.^{[citation needed]}

High profile cases

The most widespread hepatitis A outbreak in American history afflicted at least 640 people (killing four) in north-eastern Ohio and south-western Pennsylvania in late 2003.^{[citation needed]} In November of that year, the outbreak was blamed on tainted green onions at a restaurant in Monaca, Pennsylvania.

In January of 2007, a possible outbreak was reported. Houlihan’s Restaurant in Geneva, Illinois had an employee that was diagnosed with hepatitis A.^[8] Any customers that ate and/or drank cold drinks from January 8 2007 - January 12 2007 were at risk of exposure to the virus. A free clinic was set up to give immunoglobulin injections, which were very expensive. The viral symptoms can take 15-50 days to show-up. Any treatment or prevention injection should be given within 14 days of possible exposure, if taken after that time the treatment is ineffective.

In February 2007, a high profile celebrity party by Sports Illustrated for its annual swimsuit issue turned into a health scare for stars in Hollywood after a caterer working for celebrity chef Wolfgang Puck was reported to have likely exposed them to acute hepatitis A. The Los Angeles County Health Department recommended to get treatment immediately, while Carl Shuster, President of Wolfgang Puck Catering, said the infected caterer was placed on medical leave and the company has "applied exceptional procedures" to disinfect the kitchens and food processing areas from hepatitis contamination.[3]

On May 4, 2007, there was a confirmed case of Hepatitis A in Slayton, Minnesota, where two employees of the Pizza Ranch were confirmed to have the disease, and one patron confirmed, though more confirmed cases are expected as the gestation period before there are any symptoms can be up to 50 days. [4]

In March 2007, English actor and statesman, John Inman died from complications due to hepatitis A

In May 2007 the Wildwood Grill and Brewing Co. at 2417, 4th Street S.W. in Calgary, Alberta was the focus of media attention after it was confirmed that a food handler in the restaurant's kitchen was infected with the hepatitis A virus. Reports indicated that none of the hundreds of patrons who ate at the establishment between April 30 to May 13 were infected with the virus. [5]

In June 2007 an O'Charley's restaurant in Lexington, KY reported that a staff member was infected with the virus and may have spread the disease to patrons. Three infections were confirmed, although the infections were due to contact with the employee outside of work. [6]

See also

• Hepatitis
• Hepatitis B
• Hepatitis C
• Hepatitis E
• Maurice Hilleman

References