Hepatitis A is a liver condition caused by the virus of the same name. It spreads through contaminated water and food, ingested by a person who is not immunized.
This is not chronic, and is very rarely fatal.
This occurs sporadic epidemics worldwide. With a tendency for cyclic recurrences.
This is one of the most frequent causes of food borne disease.
The disease has social and economic consequences in the community. It take months for people to recover from illness and return to everyday life.
Geographically, developing countries with poor sanitary condition and hygiene condition have high levels of infection, so much 90% of the children are already infected by the virus before the age of 10, but the infection being very mild it may go undetected. This creates immunity so symptomatic disease rates are low and outbreaks of the epidemic is low. In countries with transitional economies and variable sanitary conditions, though childhood infection is low, the irony is it leads to a more susceptible older age group, so infections can occur in adolescents and young adults, and there is a potential for large out breaks. In developed countries with good sanitary and hygienic conditions, the infection rates are no doubt low, but adolescents and young adults tend to be a high risk group. Here the transmission is through infected needles, unprotected sex, or travelling to high endemicity area without vaccination, and in isolated population of closed religious groups.
Transmission is through faecal-oral route. This is when the person ingests food or water that has been contaminated with faeces of an infected person. Waterborne infections are however less common. When they do occur they are associated with sewage-contamination or inadequately treated water.
The symptoms show after an incubation period of 14-28 days ranging from mild to sever, there fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark coloured urine and jaundice.—jaundice manifests as yellowing of skin and white of the eyes. All the symptoms may not show up on every patient. The severity and mortality are usually more in adults.
The High risk groups are those who are not vaccinated. Other risks are
- Poor sanitation
- Lack of safe water
- Injecting drugs
- Living in a household with an infected person.
- Being an unprotected sexual partner with a person with acute hepatitis
- Travelling to areas of high endemicity without immunization.
The diagnosis of Hepatitis A is not different from other acute viral hepatitis. HAV- specific IgM and IgG antibodies in the blood help to diagnose the specific virus. Additional tests include reverse transcriptase like polymerase chain reaction but this requires specialized laboratory facilities.
Hepatitis A does not have specific treatment. The recovery from symptoms is the recovery and it is very slow, may take several weeks or months. The aim of the therapy is to maintain comfort and adequate nutritional balance including replacement of fluids that are lost due to vomiting and diarrhoea.
Hepatitis A can be prevented by improving sanitation, food safety and immunization. The spread can reduced by
- Providing adequate safe drinking water,
- Proper hygiene practises, like washing the hands before eating.
- Proper waste and sewage management within communities.
- Vaccines, though vaccines are not licensed for children below a year.
Comprehensive immunization plan should be adopted for prevention for viral hepatitis. Immunization in children should be a local call. However healthcare education to improve sanitation and hygiene should be continued. Immunization of travellers to endemic area and people in homosexual relationship is also important. Periodic screening and maybe vaccination of people with debilitating diseases might be considered.
WHO’s work plan for prevention and control of viral hepatitis.
- Raising awareness and promoting partnership and mobilizing resources.
- Formulating evidence based policy and data for action
- executing screening care and treatment.
Hepatitis A is a viral disease suffered by at 1.4 misslion people every year. It could range from mild to very sever in intensitiy. It could transmitted either by contaminated food and water or direct contact. It is usually associated with poor sanitation. Vaccines are available to prevent this disease.