Hepatitis A is caused by a virus that is rejected with stool by the patient. The hepatitis A virus is transmitted by water, contaminated food or even dirty hands, but also by oral sex practices.
All age groups are at risk and, according to the American Liver Foundation; up to 22% of adults who contract the disease are hospitalized. Hepatitis A is the most common form of viral hepatitis, but it is also the mildest form of viral hepatitis. There is never a progression towards chronicity and fulminant or subfulminating hepatitis is rare (0.15 to 0.35% of cases). After exposure to the virus, the incubation period varies from 15 to 45 days. Most patients recover completely in 2 to 6 months.
Risk of relapse: The blood now contains specific antibodies that normally provide total protection for life. Between 10 and 15% of those infected may have a relapse within 6 months after the acute phase of the infection, but there is no progression towards chronicity?
Risk of contagion: Since hepatitis A is often asymptomatic, it is easy to spread the virus without knowing it. The person is contagious two weeks before the onset of symptoms and seven to ten days after their disappearance.
Symptoms of hepatitis A
The disease appears from the beginning in acute mode with flu-like symptoms: fever, headache, body aches, weakness, and nausea, lack of appetite, abdominal discomfort, jaundice, and touch sensitive liver.
Note: Jaundice is present in 50 to 80% of adults, but it rarely appears in children. Hepatitis A can often go unnoticed. We can believe that it is a cold snap, a big cold or flu.
Risk Factors for Hepatitis A
- Work in sewers or prisons, for the police or the fire department, garbage collection.
- Travel to any country where hygiene rules are poor – especially in underdeveloped countries. The following regions are particularly at risk: Mexico, Central America, and South America, several parts of the Caribbean, Asia (except Japan), Eastern Europe, Middle East, Mediterranean Basin, and Africa. See the more precise geographical map of WHO.
- Staying in risky places: school or business canteens, feeding centers, nurseries, summer camps, retirement homes, hospitals, dental centers.
- Injection drug use. Although it is infrequent that hepatitis A is transmitted through the blood, there has been a beginning of an epidemic among those who inject illegal drugs.
- Sexual practices at risk.
Prevention of hepatitis A
Prevention mainly concerns groups at risk and is exercised at three levels: vaccine, immunoglobulin, very strict rules of general hygiene.
Health Canada recommends pre-exposure vaccination for the following individuals
- Travelers or immigrants from endemic areas
- Family contacts or relatives of adopted children from countries where HA is endemic.
- Populations or communities at risk of HA outbreaks or where HA is highly endemic (eg, some Aboriginal communities).
- People whose lifestyle exposes them to a risk of infection, including users of illegal drugs (injection or not) and men who have sex with men (MSM).
- Subjects with chronic liver disease, including those with hepatitis C. These individuals may not be at increased risk for hepatitis A, but the disease may be more severe in their case.
- People with hemophilia A or B who receive plasma-derived clotting factors.
- Military personnel and humanitarian workers who may be posted abroad in areas of high HA prevalence.
- Zoo keepers, veterinarians and researchers in contact with non-human primates.
- Workers involved in HAV research, or production of the HA vaccine, may be exposed to HAV.
- Anyone who wants to reduce their risk of HA.
There are several vaccines against HAV:
- Avaxim and pediatric Avaxim
- Havrix 1440 and Havrix 720 junior
And combinations of vaccines:
- Twinrix and Twinrix junior (combined vaccine for HAV and HBV)
- ViVaxim (combined vaccine against HAV and typhoid fever)
- The vaccine has not been studied in pregnant women, but it is a vaccine with inactivated virus, the risk to the fetus is only theoretical. The decision is made on a case by case basis according to the evaluation of the possible benefits and risks.
- There are possible side effects, but infrequent: redness and local pain, general effects lasting one or two days (including headache or fever).
- The vaccine does not act immediately, hence the interest of an injection of immunoglobulin for urgent cases. See below.
this method is used for people who may be exposed to the virus less than four weeks after vaccination. In this case, an injection of immunoglobulin is made at the same time as vaccinating – but at another place on the body. This method is sometimes recommended for people who have had close contact with infected individuals. There is no risk in case of pregnancy.
Travel hygiene precautions
Pay attention to what you drink. Which means: never drink tap water. Choose bottled drinks that will be unpacked in front of you. Otherwise, sterilize the tap water by boiling it for three to five minutes. To brush your teeth, also use uncontaminated water. Never add ice cubes to drinks unless they have been prepared with mineral water from an encapsulated bottle. It is also important to avoid soft drinks and locally produced beers in endemic areas.
In case of accidental injury, never clean the wound with tap water. It must be done only with a disinfectant.
Eliminate all raw foods even when washed, since the wash water may be contaminated. And all the more so, in regions at risk, these foods can also be infected by other pathogens. We must therefore avoid the consumption of uncooked fruits or vegetables (except those with a peel), and green salads; raw meat and fish; and seafood and other crustaceans that are usually eaten raw.
The foregoing food recommendations also apply to those who frequent the best hotels or established tourist tours.
Always use condoms during sex if you travel to risky areas. And it is better to bring condoms with you because of the poor quality of those found in many areas at risk.
Hygiene measures to be observed at all times or in case of infected person in the household:
If you live with an infected person or if you are infected yourself, it is important to wash your hands well after defecation or before eating to avoid possible contagion in the household, in addition to being vaccinated.
Medical treatments for hepatitis A
There are no specific drugs to treat declared hepatitis A. However, doctors recommend that certain measures be taken to promote healing:
- First, rest, but that does not necessarily mean a long and total rest in bed. It has been observed that people who stay physically active in moderation heal about as fast as others.
- To drink a lot of water.
- Have a diet that does not overwork the liver. In other words: eat low-fat foods, cut coffee and alcohol.
NB: While the search for the virus in the blood is required in the case of other forms of hepatitis, it has no therapeutic interest for hepatitis A. Generally, it is also negative since at the moment tests are done, the virus has left the blood and is no longer detectable only in the stool.
In cases of fulminant hepatitis, which is very rare, a liver transplant may be required to prevent a fatal outcome.
Unconventional Treatments for Hepatitis A
The holistic approach joins the strictly medical approach regarding rest, water consumption and diet. It also suggests fighting the hepatotoxic effect of certain substances (drugs, industrial pollutants) and negative emotions. In addition, some additional measures may be helpful in relieving a painful liver, helping it get through this difficult time, and accelerating healing, especially when it comes to people who already have liver disease or who are not in very good health, or if there are complications or the disease is prolonged.
See Hepatites (overview) for details of each of the solutions proposed below.
Several western and Chinese plants may be useful in acute viral hepatitis. For hepatitis A, one could try the two following plants.
Yin Chen or sagebrush (Artemisia capillaris). It would be effective for acute hepatitis and jaundice.
Dandelion (Taraxacum officinale). This very common plant has already been investigated in the case of hepatitis and jaundice.