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 Treatments, Complications, and Prognosis

Written by WebMD Editorial Contributors

• How Is Hepatitis A Treated?
• How to Treat Hepatitis A Symptoms at Home
• Possible Complications of Hepatitis A
• Prognosis for Hepatitis A

Unlike other types, the hepatitis A virus is rarely dangerous. Almost everyone who gets it makes a full recovery. But since it can take anywhere from a few weeks to several months to clear up, it’s a good idea to know how to take care of yourself in the meantime.

If you think you’ve been exposed to hepatitis A, you should see your doctor right away. Getting a vaccine or a drug called hepatitis A immune globulin could keep you from getting sick. But for this to work, you’ll need to get the vaccine very soon after coming into contact with the virus.

There’s no treatment once you’ve been infected. You’ll have to wait until your body gets rid of the virus. Most people find that their liver is healed within 6 months.

Try these tips to care for yourself while you’re waiting for the virus to go away:

• Stay in. Until any fever and jaundice have cleared up, your doctor will want you to skip work or school and stay at home.
• Rest up. It’s normal to feel very tired during the first few weeks that you’re sick.
• Take care of your skin. Some people with hepatitis A get very itchy. Keep your house cool, wear loose clothes, and skip very hot baths and showers.
• Eat small meals. This is easier on your stomach than big, heavy meals. It’ll also lessen your chances of feeling queasy or throwing up.
• Get enough calories. A loss of appetite is common. To make sure you’re getting enough nutrients, you may need to choose foods that are high in calories. You could even try drinking fruit juice instead of water.
• Avoid alcohol. Drinking alcohol will strain your liver. You’ll want to avoid it until your doctor gives you the go-ahead.
• Go easy on your liver. While you’re sick, your liver will have a tough time breaking down any drugs, including over-the-counter ones. Ask your doctor what medicines — including vitamins and supplements — are safe for you to take.
• Keep your illness to yourself. The hepatitis A virus is easily spread to others. Until you’re well, avoid all sexual activity, even sex with a condom. Don’t prepare food for others. Wash your hands each time you use the toilet or change a diaper.
• Check in with your doctor. They’ll want to make sure you’re coping with your symptoms. They can let you know when you’re well enough to return to your normal routine.

Hepatitis A can cause more serious health problems. Keep in mind all that these are rare and more likely to happen in people who are over 50.

• Cholestatic hepatitis. Occuring in about 5% of patients, this means the bile in your liver is obstructed on its way to the gallbladder. It can cause changes in your blood and result in jaundice fever and weightloss
• Relapsing hepatitus. More common in the elderly, The symptoms of liver inflamation such as jaundice, reoccur periodlically but are not chronic.
• Autoimmune hepatitis.  this triggers your own body to attack the liver.  If left untreated, it could result in chronic liver disease, cirrhosis and ultimately liver failure.
• Liver failure.  Happens in less than 1% and this usually affects people who are:
  • Older
  • Already have another type of liver disease
  • Have a weakened immune system

If your doctor feels your liver isn’t working well, they may admit you to the hospital to keep an eye on how well your liver is working. In severe cases, you might need to have a liver transplant.

Most people get better within 2 months. There are usually no long-term effects. After you recover, you’ll be immune for the rest of your life.

It’s rare, but for some people, the disease comes and goes for about 6 months before it goes away completely.

You are very unlikely to develop liver failure, though the chances are higher if you already had a liver condition or you’re elderly. If you have liver failure, you’ll need a transplant.

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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) transmission occurs 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 (such as infection and contamination of the hands).
• 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 fulminant (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 in the form of isolated cases and in the form of 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, medium 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 visiting 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 infection with the virus occurs as a result of the consumption of food or water contaminated by the feces of an infected person by an uninfected 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 of the disease occur more often 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 with 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
• maintaining good personal hygiene, such as washing hands regularly 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 its nine major annual public health campaigns) to raise awareness and understanding of the problem of viral hepatitis. In 2022, WHO is celebrating World Hepatitis Day with the slogan “ Providing Hepatitis Care Nearby” ” and calls for streamlining the delivery of viral hepatitis services, making them more accessible to the public.

Hepatitis A: symptoms, diagnosis, treatment

Hepatitis A is an infectious liver disease caused by a virus.

The hepatitis A virus has an acid-resistant envelope. This helps viruses that have entered contaminated food and water to pass the acidic protective barrier of the stomach. The hepatitis A virus is stable in the aquatic environment, so epidemics of hepatitis A are often transmitted by water. The hepatitis A virus is highly immunogenic, after the illness, a stable lifelong immunity is formed.
Hepatitis A is one of the most common human infections. In countries with warm climates and poor sanitation, hepatitis A is very common. It is known that in Central Asia almost all children are ill with hepatitis A. In Eastern Europe, the incidence of hepatitis A is 250 per 100,000 population per year.
The source of infection for is a person with hepatitis A who sheds billions of viruses into the environment through faeces. When drinking water or food contaminated with the hepatitis A virus (especially poorly thermally processed seafood), the viruses enter the intestines, then, being absorbed, they enter the liver with the blood stream and invade its cells – hepatocytes. Virus particles-virions multiply in the cytoplasm of liver cells. After leaving the liver cells, they enter the bile ducts and are excreted with bile into the intestines. The inflammatory process in the liver, leading to damage to hepatocytes, has an immunological basis. Cells of the human immune system, T-lymphocytes, recognize virus-infected hepatocytes and attack them. This leads to the death of infected hepatocytes, the development of inflammation (hepatitis) and impaired liver function.
Hepatitis A virus is transmitted by faecal-oral-water and ingestion. Hepatitis A is most likely to be contracted in hot countries, including those where traditional places of tourism and recreation are located. First of all, these are the countries of Africa (including Egypt and Tunisia), Asia (Turkey, Central Asia, India and Southeast Asia, including the islands), some countries of South America and the Caribbean. Hepatitis A is primarily a childhood infection. Many children carry the infection in an anicteric form and hepatitis A is not recognized during this period.
In developed countries, hepatitis A, also called “dirty hands disease “, is difficult to get sick due to the high culture of the population and the excellent work of communal services. Therefore, there are very few people who have antibodies to this infection, and the risk of getting sick upon contact with the hepatitis A virus is quite high. More often this happens during business trips and tourist trips to hot countries, to African and Asian resorts, to the republics of Central Asia.

When buying fruits and vegetables in the market, do not forget to wash them properly , always cook seafood.
Healthy people can be in contact with the sick, observing the elementary rules of hygiene. However, it is better to isolate children from patients.

To determine the likelihood and risk of infection with , but rather to decide whether vaccination is necessary, a blood test for the presence of antibodies to the hepatitis A virus of the immunoglobulin G class ( anti – HAV IgG ) is performed. If these antibodies are found in the blood, then contact with the virus was: infection or vaccination. This means that you have immunity to the virus, which means that the risk of infection is zero and vaccination against hepatitis A is not needed. It is almost impossible to get hepatitis A again. If there are no antibodies, then there is a risk. You need a vaccination. There is a special drug – immunoglobulin, which can be administered immediately before a possible infection or within 2 weeks after infection. This will allow for a short time to protect either from infection or from the development of the disease in case of infection.

Risk of contracting hepatitis A and when vaccination is needed (vaccination against hepatitis A):

• Family members (household members) of a person infected with hepatitis A virus
• Persons who have sex with an infected person
• People (especially children) living in areas with a high prevalence of hepatitis A
• Travelers traveling to countries with a high incidence of hepatitis A

What to do if there is a patient with hepatitis A in the family?

It is recommended that all family members be screened for antibodies to hepatitis A (anti-HAV IgG). In the absence of these antibodies, vaccination is necessary. Remember to follow the simplest rules of hygiene: wash your hands with soap and water after using the toilet and using the bathroom, after caring for a small child, before eating and preparing food.

Hepatitis A clinic

Within a month (incubation period 15-50 days, average 30) after the alleged infection, you can expect the main symptoms: fever, dyspepsia (nausea, vomiting, heaviness in the stomach and right hypochondrium), weakness, darkening urine (the color of strong brewed tea, frothiness) and then jaundice – yellowing of the sclera, skin, discoloration of feces. After the onset of jaundice, the general condition often improves slightly. Jaundice lasts about 3-6 weeks, sometimes longer. The disease lasts on average about 40 days. This largely depends on age, the state of immunity, the presence of concomitant chronic diseases, and the strict implementation of the doctor’s recommendations. Some people (about 15%) have a long-term course of hepatitis A, within 6-9months. Recovery usually follows. Most cases of hepatitis A have typical symptoms, leading to recovery.

The infection is most severe in children under one year of age , adults and the elderly. In adults, the infection often proceeds with severe intoxication and jaundice, on average they get sick for about 3 months. The risk of death in hepatitis A is 0.1% in children, 0.3% in adolescents and adults. All acute hepatitis of any origin are manifested by the same signs, so you need to see a doctor and conduct a full examination.

Diagnosis of hepatitis A

In addition to collecting an epidemiological history (where the person was during the last month, what he ate, what kind of water he drank, whether he had contact with patients with jaundice, etc.) and examination, test results are required (general blood count, biochemical blood tests, analysis for markers of viral hepatitis, coagulogram, urinalysis).

The criterion for the diagnosis of acute hepatitis A is the presence in human blood of antibodies to hepatitis A, related to class M immunoglobulins (anti – HAV IgM). These antibodies are found only in the acute period, with recovery, their titer decreases.

Hepatitis A treatment

Modern treatment is more focused not on fighting hepatitis A viruses, but on reducing the concentration and removal from the body of harmful substances that appear when the liver is damaged and functions are impaired. Therefore, detoxification solutions, glucose, vitamins, hepatoprotectors (drugs that protect liver cells) are administered. The decision to prescribe special antiviral therapy is made by the doctor. Hepatitis A ends with recovery.
The prognosis is favorable, liver function is usually fully restored. In the acute period, it is necessary to adhere to a sparing diet, physical and mental rest is observed.

Hepatitis A prevention, vaccination

Quite effective vaccines have been developed to protect against hepatitis A. These vaccines are killed hepatitis A viruses and are highly immunogenic. The vaccine is administered twice with an interval of 6-12 months. After the first dose of the vaccine, antibodies to the hepatitis A virus appear in most vaccinated people after 2 weeks.