What are the symptoms of hepatitis A. How is hepatitis A transmitted. How is hepatitis A diagnosed. What is the treatment for hepatitis A. Can hepatitis A be prevented. Who is at higher risk for hepatitis A. What are the long-term effects of hepatitis A.

Understanding Hepatitis A: An Overview

Hepatitis A is a viral infection that causes inflammation of the liver. Unlike other forms of hepatitis, it is typically not as severe as hepatitis B or C and rarely develops into chronic hepatitis or cirrhosis. However, it is highly contagious and can cause significant discomfort and health issues for those infected.

The hepatitis A virus (HAV) is usually present in the body for 2 to 6 weeks before symptoms appear. Some individuals may never experience symptoms, while others may suddenly develop a range of uncomfortable effects.

Key Characteristics of Hepatitis A:

• Caused by the hepatitis A virus
• Highly contagious
• Usually resolves on its own without long-term effects
• Can be prevented through vaccination
• Symptoms typically appear 2-6 weeks after infection

Recognizing the Symptoms of Hepatitis A

Identifying hepatitis A can be challenging, as symptoms may vary in severity and some individuals may remain asymptomatic. However, recognizing the signs can lead to earlier diagnosis and proper management of the condition.

Common Symptoms of Hepatitis A:

• Nausea and vomiting
• Jaundice (yellowing of skin and eyes)
• Low-grade fever (up to 102°F)
• Fatigue
• Abdominal pain, especially on the right side
• Dark-colored urine
• Loss of appetite
• Muscle pain

Are symptoms different in children and adults? Young children often experience milder cases of hepatitis A, while older children and adults are more likely to have severe symptoms. This age-related difference in symptom severity highlights the importance of vaccination and prevention strategies for all age groups.

The Transmission and Causes of Hepatitis A

Understanding how hepatitis A spreads is crucial for prevention and control of the virus. The primary mode of transmission is the fecal-oral route, which occurs when a person unknowingly ingests even a small amount of feces from an infected individual.

Common Transmission Routes:

1. Person-to-person contact
2. Consumption of contaminated food or water
3. Sexual contact with an infected person
4. Improper hand hygiene after using the bathroom or changing diapers

Is it possible to spread hepatitis A without showing symptoms? Yes, a person can have and spread hepatitis A even if they do not display any symptoms. This asymptomatic transmission makes proper hygiene and vaccination even more critical in preventing outbreaks.

Diagnosing Hepatitis A: What to Expect

If you suspect you may have hepatitis A, it’s essential to seek medical attention promptly. Diagnosis typically involves a simple blood test that can detect the presence of antibodies to the hepatitis A virus.

Diagnostic Process:

1. Medical history review
2. Physical examination
3. Blood tests to detect HAV antibodies
4. Liver function tests to assess liver damage

How long does it take to get hepatitis A test results? The turnaround time for hepatitis A blood test results can vary, but it typically ranges from a few hours to a few days, depending on the laboratory and testing method used.

Treatment Options for Hepatitis A

Unlike some other viral infections, there is no specific antiviral medication to treat hepatitis A. The virus usually clears on its own, and treatment focuses on managing symptoms and supporting the body’s natural healing process.

Key Treatment Approaches:

• Rest and adequate sleep
• Balanced nutrition
• Avoiding alcohol and acetaminophen
• Staying hydrated
• Monitoring liver function

In severe cases, hospitalization may be necessary to manage complications such as dehydration, severe pain, confusion, or bleeding problems.

How long does it typically take to recover from hepatitis A? Most people begin to feel better within a few months, though the recovery period can vary. It’s important to follow your doctor’s advice and allow your body the time it needs to heal completely.

Preventing Hepatitis A: Vaccination and Hygiene

Prevention is key when it comes to hepatitis A, and the most effective method is vaccination. The hepatitis A vaccine is safe, effective, and provides long-lasting protection against the virus.

Preventive Measures:

1. Vaccination (recommended for all children over 1 year old)
2. Proper hand hygiene
3. Safe food and water practices
4. Avoiding raw or undercooked meats and seafood
5. Practicing safe sex

How effective is the hepatitis A vaccine? The hepatitis A vaccine is highly effective, with studies showing that it provides protection against the virus in more than 95% of recipients after the recommended two-dose series.

High-Risk Groups and Special Considerations

While anyone can contract hepatitis A, certain groups are at higher risk of infection. Identifying these high-risk populations is crucial for targeted prevention efforts and early intervention.

Groups at Increased Risk for Hepatitis A:

• Travelers to countries with high hepatitis A rates
• Men who have sex with men
• People who use recreational drugs
• Individuals with chronic liver disease
• People working with primates or hepatitis A in research laboratories
• Homeless individuals

Should individuals in high-risk groups receive a booster vaccination? Yes, people in high-risk groups may benefit from booster doses of the hepatitis A vaccine. It’s important to consult with a healthcare provider to determine the appropriate vaccination schedule based on individual risk factors.

Long-Term Effects and Complications of Hepatitis A

While hepatitis A is generally a self-limiting disease, in rare cases, it can lead to complications or have long-term effects on health. Understanding these potential outcomes is important for comprehensive patient care and follow-up.

Possible Complications:

• Relapsing hepatitis
• Cholestatic hepatitis (prolonged jaundice and itching)
• Fulminant hepatitis (acute liver failure)
• Autoimmune hepatitis (in rare cases)

Can hepatitis A cause permanent liver damage? In most cases, hepatitis A does not cause permanent liver damage. However, in rare instances, particularly in older adults or those with pre-existing liver conditions, severe complications can occur. Regular follow-up with a healthcare provider is essential to monitor liver function and overall health during recovery.

Hepatitis A, while often less severe than other forms of viral hepatitis, remains a significant public health concern due to its high transmissibility. By understanding its symptoms, causes, and prevention strategies, individuals can take proactive steps to protect themselves and their communities from this viral infection. Vaccination, good hygiene practices, and awareness of risk factors play crucial roles in controlling the spread of hepatitis A and minimizing its impact on global health.

As research continues and public health initiatives evolve, our approach to managing and preventing hepatitis A will likely become even more effective. Stay informed about the latest recommendations from health authorities and consult with healthcare professionals for personalized advice on hepatitis A prevention and management.

Hepatitis A (Hep A) – Treatment

What is hepatitis?

Hepatitis is a general term for inflammation of the liver. Normally, the liver breaks down waste products in your blood. But when the liver is inflamed, it doesn’t do a good job of getting rid of waste products. This causes waste products to build up in your blood and tissues.

Many different things can cause hepatitis. The most common cause of hepatitis is infection with one of the 5 hepatitis viruses (A, B, C, D, or E). Lack of blood supply to the liver, poison, autoimmune disorders, excessive alcohol use, liver injury, and taking certain medicines can also cause hepatitis. Less commonly, viral infections such as mononucleosis or cytomegalovirus can cause hepatitis.

There are 2 main kinds of hepatitis: acute hepatitis and chronic hepatitis. Most people get over the acute hepatitis in a few days or weeks. Sometimes, however, the inflammation doesn’t go away. When the inflammation doesn’t go away in 6 months, the person has chronic hepatitis.

What is hepatitis A?

Hepatitis A (Hep A) is liver inflammation caused by the hepatitis A virus. Hepatitis A is different from other types of hepatitis. It isn’t typically as serious as hepatitis B or C, and it doesn’t usually develop into chronic hepatitis or cirrhosis (late-stage scarring of the liver).

Hepatitis A is very contagious. This means that you can easily catch the virus from someone or give it to someone else. You are most contagious soon after you are infected and before symptoms appear. Adults who are otherwise healthy are no longer contagious 2 weeks after the illness begins. Children and people who have a weak immune system may be contagious for up to 6 months.

Symptoms of hepatitis A

The hepatitis A virus is usually in your system for 2 to 6 weeks before symptoms appear. Some people never have symptoms. If symptoms do appear, they can appear suddenly and may include:

• Nausea
• Vomiting
• Jaundice (the yellowing of the skin and the whites of the eyes)
• Low-grade fever (fever up to 102°F)
• Fatigue
• Pain in your abdomen, especially on your right side
• Dark-colored urine
• Loss of appetite
• Muscle pain

Young children are likely to have mild cases of hepatitis A, while symptoms in older children and adults are more likely to be severe.

What causes hepatitis A?

Hepatitis A is caused by infection with the hepatitis A virus. You get the virus when you unknowingly eat a small amount of infected feces. This can happen through person-to-person contact, or through eating or drinking contaminated food or water.

A person can have and spread hepatitis A, even if that person does not have any symptoms. You are most likely to get hepatitis A from another person when:

• A person who has the virus does not wash their hands properly after going to the bathroom
• A parent does not wash their hands properly after changing the diaper of an infected child
• A caregiver does not wash their hands properly after cleaning up the stool of an infected person
• A person has sex with a person who has the virus

You can also get infected with hepatitis A by eating contaminated food or drinking contaminated water. Contaminated food and water are more common in developing countries. When traveling in areas where hepatitis A is common, avoid eating raw fruits and vegetables, shellfish, ice, and untreated water.

How is hepatitis A diagnosed?

See your doctor if you have any of the symptoms of hepatitis A. They can do a blood test to see if you have the disease.

Hepatitis A treatment

There is no specific medicine to treat or cure hepatitis A. If you have the virus, your body will eventually get rid of the infection on its own. You probably will feel sick for a few months before you begin to feel better.

To help your liver heal, you should get plenty of rest, eat a balanced diet and avoid alcohol and acetaminophen (one brand name: Tylenol). Talk with your doctor before you take any prescription medicines, over-the-counter medicines, vitamins, or supplements. Alcohol, acetaminophen, and certain other medicines, vitamins, and supplements can cause more damage to your liver.

You may need to stay in the hospital for a short time if you get dehydrated, have severe pain, suddenly become confused, or develop bleeding problems.

Can hepatitis A be prevented or avoided?

The best way to protect yourself against hepatitis A is to get the vaccine. The hepatitis A vaccination is recommended for all children older than age 1. It begins to protect you only 4 weeks after you are vaccinated. A 6- to 12-month booster is required for long-term protection. Ask your doctor if the vaccination is right for you.

You should also wash your hands with soap and warm water before and after cooking, after using the bathroom, and after changing diapers.

Wash fruits and vegetables thoroughly before eating and avoid raw or undercooked meat and fish.

You are at higher risk for hepatitis A if you:

• Live with or have sex with someone who has hepatitis A
• Travel to countries where hepatitis A is common
• Are a man who has sex with other men
• Use illegal drugs
• Have a clotting-factor disorder (such as hemophilia)

Living with hepatitis A

Once you recover from hepatitis A, you develop antibodies that protect you from the virus for life, according to the Centers for Disease Control and Prevention.

Questions to Ask Your Doctor

• Do I need treatment?
• What treatment is best for me?
• Will I need be hospitalized?
• Are there any medicines I should avoid taking?
• Are there foods I should avoid eating?
• Can I drink alcohol?
• How can I protect my family from getting hepatitis A?
• If I’ve had hepatitis A, am I at higher risk of getting other types of hepatitis?
• Will I have permanent liver damage?
• How soon before I travel should I be vaccinated?

Resources

American Liver Foundation: Hepatitis A

Hepatitis A and E Treatment

Hepatitis A and E Treatment | Johns Hopkins Medicine

Hepatitis A and E usually resolve after a period of four to eight weeks. They do not cause chronic hepatitis, and in most cases, no special treatment is necessary unless your immune system is suppressed and/or you have had a solid organ transplantation. You are not confined to bed while you recuperate. Once the jaundice disappears, you can safely return to work. We will discuss with you whether you need special treatment or medication.

Hepatitis A and E Prevention

Hepatitis A: Hepatitis A vaccination is recommended for all adults who are considered at risk, which include those traveling to areas where hepatitis A is common, those who use injections for medications, people who use illegal drugs, men who have sex with men, patients who already have chronic liver disease, health care workers and food handlers.

If you believe you were exposed to hepatitis A and have not been vaccinated, we can treat you with immune globulin, which is used to prevent the disease shortly after exposure. Immune globulin can be also given to those who are allergic to the hepatitis A vaccine or prefer not to get vaccinated. One dose of immune globulin can provide temporary protection up to three months.

Hepatitis E: Currently there are no vaccines against the hepatitis E virus, although much research is underway for development. If you are traveling to a country where hepatitis E is widespread, avoid contaminated food and water sources. A vaccination against hepatitis A may not protect you against hepatitis E.

Hepatitis A and E Complications

Rarely, the disease does not resolve, and you may experience complications from hepatitis. Fulminant hepatitis or acute liver failure is rarely associated with hepatitis A and E. A patient with fulminant hepatitis begins to deteriorate rapidly and may present with confusion (hepatic encephalopathy). This is seen in patients with chronic liver disease or people during pregnancy. There is even a risk of coma and liver and kidney failure.

This condition is rare. Careful management and thorough care provide the best hope for recovery. Liver transplantation may be lifesaving.

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Which hepatitis can be cured and which cannot be cured?

What are hepatitis A and E viruses?

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Hepatitis A and E viruses belong to the group of viruses with an enteral mechanism of infection. It implies infection “through the mouth.” They are the least dangerous from the point of view of the patient. These viruses always cause an acute illness, never turning into a chronic one.

Hepatitis A is Botkin’s disease, or “dirty hands disease”, it occurs when eating dirty food or water.

A patient with hepatitis A or E almost always recovers and develops lifelong immunity to infection. However, fulminant hepatitis, which is acute liver necrosis, can become a complication. In this case, liver failure appears, often leading to the death of the patient.

There is no specific treatment for hepatitis A and E. However, there are effective and safe preventive vaccines. The hepatitis A vaccine was invented a long time ago, however, it is not on the vaccination calendar in our country. It is known that during outbreaks of hepatitis A there is practically no infection of those who are vaccinated against this infection. And I, for one, am vaccinated.

Hepatitis E is a rarer hepatitis in developed countries with a similar route of infection. A vaccine was created against this virus in China several years ago, but so far it has been approved only in this country.

Hepatitis B and C

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There are also hepatitis B and C viruses that belong to the group of parenteral infections. They become infected through the blood: with intravenous drug use, medical procedures with the use of poorly sterilized instruments, infected blood during transfusions, and so on. Hepatitis B and C viruses cause chronic liver disease in most cases.

According to current estimates, there are about 240 million people in the world with chronic hepatitis B.

The risk of chronic infection with hepatitis B virus infection varies depending on the age of the patient: in infants under one year old it is more than 90%, while in adults it does not exceed 5%. The danger of chronic hepatitis B is that almost a third of patients develop cirrhosis and / or liver cancer.

Against the hepatitis B virus, scientists have developed a preventive vaccine that is safe and provides very good protection against infection. It is based on protein rather than infectious material and is well tolerated by humans. Interestingly, there is now a combination vaccine for hepatitis A and B.

The hepatitis C virus was discovered the latest – in 1989, when I was in the second grade. This virus is extremely difficult for laboratory research. In the case of other viruses, scientists usually take a cell line and try to infect it. And the hepatitis C virus, as it turned out, is not able to develop in almost any standard cell line. In general, research on the hepatitis C virus has been greatly hampered.

An incomplete cellular model was obtained only in 1999.

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A complete infectious model appeared only in 2005 – very recently. But by now, scientists know all the key mechanisms for the development of infection in a cell: from infection to the assembly of new viral particles.

We know that this is a very common virus. Why? Most likely, because in most cases the disease begins asymptomatically. Now, according to various sources, 130–150 million people have chronic hepatitis C. In Russia, according to some data, up to 3% of the population suffer from it. In 4/5 cases, hepatitis C becomes chronic. And even in the chronic stage, this virus can be asymptomatic – and it can only be diagnosed by special tests.

Like hepatitis B, hepatitis C is extremely dangerous: it often leads to fibrosis and cirrhosis of the liver. And in a number of patients, eventually – to cancer. As far as I know, the treatment of liver cancer is not very effective and can only be saved from it by transplantation. It is believed that up to 80% of all patients with cirrhosis and liver cancer are patients with chronic hepatitis B and C. There is evidence that even patients who have recovered from hepatitis C have an increased risk of getting cirrhosis or liver cancer.

How to treat hepatitis B and C?

Hepatitis B is treated quite poorly. That is, it is easy to suppress, but almost impossible to cure, because it has the so-called ccDNA – double-stranded circular DNA. And it is not yet known how to remove it from already infected cells. Several types of substances are used to suppress infection: nucleoside analogues and interferon alfa and its pegylated forms. However, they do not always work.

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Recently, a drug has been developed against hepatitis B based on inhibition of the cell receptor with which the virus interacts. In the early 2000s, scientists first found a cell line that reproduces the full cycle of the hepatitis B virus and identified the NTCP receptor, the bile acid receptor. And it turned out that when interacting with this receptor, the hepatitis B virus enters the body. Then the researchers took peptides that mimic a fragment of the viral protein that is responsible for binding to it, and developed a drug that is now undergoing clinical trials.

However, all these drugs cannot cure patients with chronic hepatitis B.

Unlike hepatitis B, hepatitis C can be cured. He is now responding very well to treatment. Patients are considered cured if, 24 weeks after the end of therapy, viral RNA is not detected by sensitive test systems. In the 2000s, therapy was based on interferon alfa – the treatment lasted up to 48 weeks, was very difficult for the patient and ineffective. Six months later, the patient was checked, if he did not have the virus, the patient was considered completely healthy. Then scientists developed direct-acting antiviral drugs, that is, not aimed at the proteins of the virus.

Thanks to them, the number of recoveries (percentage of cure / effectiveness of therapy) has increased.

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And, importantly, the treatment time has been reduced. Currently, there are combinations of direct-acting drugs that can cure up to 99% of patients with a virus of any genotype, and without the use of interferon. It became possible to treat, among other things, HIV-infected patients, who previously represented a separate cohort of patients. Doctors now treat them simply by considering the interactions of hepatitis drugs with antiretroviral drugs. It became possible to treat patients with cirrhosis of the liver, as well as patients before liver transplantation. And this is a huge breakthrough in science.

By the way, I personally work in a laboratory that investigates the metabolic processes during infection with the hepatitis C virus. Although patients can be cured, it is impossible to completely eliminate the risk of cirrhosis, fibrosis and liver cancer. These risks remain. We are exploring metabolic pathways and finding out how the virus affects them and whether it is possible to make a substance that can suppress the pathogenicity of the virus.

Hepatitis D virus, or Parasite on parasite

Hepatitis D virus (or delta virus) is a satellite virus. It was discovered a long time ago by an Italian group of scientists who were trying to find out why patients with chronic hepatitis B had different course and severity of the disease in northern and southern Italy. And the Italians found that patients with a severe course of the disease have some additional delta antigen. Then scientists realized that it was a satellite virus, that is, an incomplete virus. If an ordinary virus is a parasite to a cell, then it is a parasite to a parasite. It carries a short circular RNA and encodes only one antigen (protein). This antigen can be in two different forms – but still it is encoded by a single gene.

This protein can form a virus capsid – the inner shell of a viral particle, but it is not enough to form a full-fledged own virion. To form a viral particle, this virus uses the envelope proteins of the hepatitis B virus. The delta virus protein does not have enzymatic activity, and it uses the host cell apparatus to replicate its genome.

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The number of people infected with delta hepatitis in the world is estimated at 15 million people. There are two different types of infection – coinfection and superinfection.

Coinfection is the simultaneous infection with hepatitis B and delta viruses, and superinfection is the infection of hepatitis D in patients with already established chronic hepatitis B.

In each case, the course of the disease will be different. With coinfection, 95% of cases will develop acute hepatitis, but there will be no chronic disease. But at the same time, there is a fairly high probability of developing the already mentioned fulminant hepatitis. And that’s bad.

In the case of superinfection, as a rule, chronic hepatitis will occur, in which the development of liver fibrosis is sharply accelerated – the growth of connective tissue with the appearance of cicatricial changes, as well as an increase in the risk of cirrhosis and liver cancer.

In conclusion, it is important to note that hepatitis D can be prevented by vaccination against the hepatitis B virus. This is especially important for certain regions where the prevalence of this virus is quite high: in the Mediterranean, in parts of Africa, in the Middle East. In Russia, such a region is, for example, Tuva. About ten years ago, the number of infected people in a number of age groups reached 20%. However, younger people who are vaccinated against hepatitis B according to the vaccination schedule have not been found to be infected.

Hepatitis A

Hepatitis A

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• Hepatitis A

Key Facts

• Hepatitis A is an inflammatory disease of the liver that can be mild or severe.
• Hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and water or through direct contact with an infected person.
• Almost all patients with hepatitis A are completely cured and develop lifelong immunity. However, in very rare cases, infection with the hepatitis A virus can lead to fulminant hepatitis with a fatal outcome.
• The risk of contracting hepatitis A occurs when there is no safe water supply, poor sanitation and poor hygiene practices (eg hand infection and contamination).
• A safe and effective vaccine is available to prevent hepatitis A.

Overview

Hepatitis A is an inflammatory disease of the liver caused by the hepatitis A virus (HAV). The virus is spread primarily by an uninfected (and unvaccinated) person ingesting food or water contaminated with the faeces of an infected person. This disease is closely associated with poor water supply or contaminated food, poor sanitation, poor personal hygiene, and oral-anal sex.

Unlike hepatitis B and C, hepatitis A does not cause chronic liver disease, but can be accompanied by severe symptoms and sometimes proceed in a fulminant form (with acute liver failure), often resulting in death. In 2016, WHO estimated that hepatitis A killed 7134 people worldwide (representing 0.5% of all deaths from viral hepatitis).

Hepatitis A is present throughout the world and occurs both as isolated cases and as epidemics that tend to be cyclical. Epidemics caused by contamination of food or drinking water can be explosive, such as the epidemic in Shanghai in 1988, which affected approximately 300,000 people (1) . Epidemics can also be protracted and affect entire communities for several months as a result of person-to-person transmission. The hepatitis A virus persists in the environment for a long time and can remain viable even after food processing processes commonly used to control or inactivate bacterial pathogens.

Geographic distribution

Hepatitis A virus prevalence areas can be subdivided into areas with high, moderate or low infection rates. At the same time, the rate of infection is not always identical to the incidence, since in young children the infection occurs with mild symptoms.

In low- and middle-income countries with poor sanitation and hygiene standards, infection is widespread and most children (90%) is infected with hepatitis A virus before the age of 10 years, most often with asymptomatic infection (2) . High-income countries with good sanitation have low infection rates. The disease can occur among adolescents and adults from high-risk groups, such as people who inject drugs, men who have sex with men, and people who visit areas with high hepatitis A endemicity, as well as isolated populations, such as closed religious groups. In the United States of America, major outbreaks of hepatitis A are occurring among homeless people. In middle-income countries and areas with heterogeneous sanitation conditions, a large proportion of the population is immune to infection in early childhood and reaches adulthood without developed immunity.

Transmission of infection

The main mechanism of transmission of hepatitis A virus is fecal-oral transmission, in which the virus is transmitted by an uninfected person ingesting food or water contaminated with the faeces of an infected person. At the household level, infection can occur when an infected person fails to practice good hand hygiene when preparing food for other family members. Outbreaks of waterborne diseases, although rare, are usually associated with the consumption of contaminated sewage or inadequately treated water.

The virus can also be transmitted through close physical contact (eg, oral-anal sex) with an infected person, but normal household contact does not transmit the virus.

Symptoms

The incubation period for hepatitis A is usually 14-28 days.

Symptoms of hepatitis A can range from mild to severe and may include fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the eyes and skin). The full spectrum of symptoms does not occur in all infected people.

Clinical symptoms are more common in adults than in children. The prevalence of severe forms of the disease and mortality are higher among the older age groups. In children under 6 years of age, the infection is usually mildly symptomatic, and jaundice develops in only 10% of cases. In some patients, hepatitis A recurs, and a newly recovered person becomes ill again in an acute form. After that, the disease usually ends in complete recovery.

Who is at risk?

Anyone who has not been vaccinated or has not had the disease in the past can become infected with the hepatitis A virus. In areas with high virus circulation (high endemicity), most hepatitis A infections occur in early childhood. Risk factors include:

• unsatisfactory sanitary conditions;
• no safe water supply;
• the presence of an infected person among family members;
• sexual contact with a person with acute hepatitis A;
• recreational use of psychoactive substances;
• same-sex sex in men; and
• travel to areas of high endemicity without prior immunization.

Diagnosis

Hepatitis A does not differ clinically from other types of acute viral hepatitis. An accurate diagnosis is confirmed by a blood test for the presence of HAV-specific immunoglobulin M (IgM). In addition, reverse transcription polymerase chain reaction (RT-PCR) testing can be performed to detect hepatitis A virus RNA, which may require a referral to a specialized laboratory.

Treatment

There is no specific treatment for hepatitis A. The recovery process can be slow and take weeks or months. It is important to refrain from unjustified prescribing of drugs. Acetaminophen, paracetamol and antiemetics should not be prescribed.

In the absence of acute liver failure, hospitalization of patients is not required. Treatment is aimed at maintaining comfort and a balanced diet, including replenishing fluid losses caused by vomiting and diarrhea.

Prevention

The most effective means of controlling hepatitis A are improved sanitation, food safety, and increased vaccination coverage.

The prevalence of hepatitis A can be reduced by:

• ensuring an adequate supply of safe drinking water;
• organization in settlements of proper wastewater disposal; and
• good personal hygiene, such as regular handwashing before meals and after going to the toilet.

Several injectable, inactivated hepatitis A vaccines are available on the world market. All provide comparable levels of protection against the virus and have similar side effects. None of the vaccines are licensed for children under one year of age. China also uses an attenuated live vaccine.


WHO activities

In May 2016, the World Health Assembly adopted the first Global Health Sector Strategy on Viral Hepatitis 2016–2021. It highlights the critical role of universal health coverage and sets targets aligned with the Sustainable Development Goals. The strategy was to achieve the goal of eliminating viral hepatitis as a public health problem by 2030 (defined as a reduction of 90% new cases of chronic infections and a 65% reduction in mortality compared to the 2015 baseline) and included an action plan to achieve elimination through the implementation of key prevention, diagnosis, treatment and community outreach strategies. In May 2022, the Seventy-fifth World Health Assembly took note of a set of new comprehensive global health sector strategies for HIV, viral hepatitis and sexually transmitted infections for the period 2022–2030. Based on these previous and newly adopted strategies, many Member States have developed comprehensive national hepatitis programs and strategies to achieve elimination, guided by the global health sector strategy.

To support countries in achieving the global hepatitis targets of the 2030 Agenda for Sustainable Development, WHO works in the following areas:

• raising awareness, promoting partnerships and mobilizing resources;
• developing evidence-based policies and collecting evidence for action;
• ensuring health equity in the fight against hepatitis;
• prevention of the spread of infection; and
• expanded coverage of screening, care and treatment services.

WHO organizes an annual World Hepatitis Day event (one of nine major annual public health campaigns) to raise awareness and understanding of the problem of viral hepatitis.