Handwashing and Vaccines Reduce Incidence of Hepatitis A

Although there are five different strains of hepatitis virus - A, B, C, and the rarer D and E - they all cause acute, or short-term, infectious diseases that result in liver inflammation. The hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong.

Hepatitis A Virus Causes Acute Illness
Hepatitis A is transmitted through the fecal/oral route, meaning it is spread primarily through food or water contaminated by feces from an infected person. It often occurs when people who have hepatitis A do not wash their hands after using the toilet and then prepare or serve food to others.

There have been high-profile cases in recent years where groups of people contract the virus in restaurants due to unsanitary practices or contaminated food or water. However, large hepatitis A outbreaks are uncommon in the United States.

"Acute hepatitis can cause short-term jaundice, fatigue which is severe in some people and itching, which is very common," said Kia Saeian, MD, Medical College of Wisconsin Associate Professor of Medicine. "That usually subsides in six months. Most people with hepatitis A get a complete resolution of their symptoms. Rarely does it lead to liver failure."

Dr. Saeian is the Program Director of the Gastroenterology and Hepatology Fellowship and Director of the Hepatitis Treatment Program at the Medical College. He practices at the Froedtert & Medical College of Wisconsin Gastroenterology and Hepatology Clinic.

Besides jaundice, fatigue and itching, people with hepatitis A might experience abdominal pain, loss of appetite, nausea, diarrhea, and fever. Their urine can become darker than normal. Adults will have signs and symptoms more often than children who contract the disease. People with less severe cases of hepatitis might have mild symptoms or none that are noticeable.

Some Groups More Vulnerable
Anyone can get hepatitis A, but some groups are at increased risk, including children who go to day care, people who work in day care centers, people who live with someone who already has hepatitis A, men who have sex with men, and people who travel to countries where hepatitis A is common.

According to the US Centers for Disease Control (CDC), one-third of Americans have evidence of past infection with hepatitis A and about 15 percent of those infected report prolonged symptoms for six to nine months. However, the number of acute and estimated cases of hepatitis A has dropped dramatically in the last 30 years. Before the availability of a hepatitis A vaccine, the CDC reported about 35,000 cases yearly. In 2006, only 3,579 cases were reported.

Hepatitis A Vaccine
Hepatitis A is preventable. People can protect themselves and others by washing their hands every time they use the toilet and before they prepare or eat food; by wearing gloves if they have to touch other people's stool and washing their hands thoroughly afterwards; and, if they are traveling to or through a country where hepatitis A outbreaks occur frequently, by using bottled water for drinking and for washing food.

In addition to good personal hygiene and proper sanitation, vaccines are available to provide long-term protection against hepatitis A.

Although the hepatitis A vaccine is not part of the normal course of recommended vaccines for US children or adults, there are certain groups who should be immunized:

• people spending time in countries where hepatitis A is common
• people with chronic liver disease or compromised immune systems
• people who work with populations that are at increased risk of exposure to the hepatitis A virus
• men who have sex with men
• people who use illegal drugs

Immune globulin can be used for short-term prevention of hepatitis A virus infection. It provides almost immediate protection in cases where someone has been exposed to the hepatitis A virus but has not been vaccinated or their vaccination has not yet taken effect.

Most people who have hepatitis A get well on their own after a few weeks, but should get plenty of rest and avoid alcohol until their symptoms have resolved.

In very rare cases, hepatitis A may relapse in the first six months, however in most cases, Dr. Saeian said, once someone contracts hepatitis A, they are protected for life from a recurrence.

This article includes information from the National Digestive Diseases Information Clearinghouse.

Melissa Rigney Baxter
HealthLink Contributing Writer

For more information about hepatitis, see the HealthLink articles Hepatitis B Can Have Serious Long-Term Consequences and Hepatitis C Virus Is a Leading Cause of Chronic Liver Disease.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.