A Comprehensive Guide to Hepatitis A (HAV) 

Hepatitis A (HAV) is a vaccine-preventable virus that affects the liver. The virus causes the liver to swell and prevents it from optimal functioning. Fortunately, compared to hepatitis B or C, HAV does not cause chronic liver disease. The symptoms usually caused by HAV are mild, and most people recover with lifelong immunity. 

Is hepatitis A common?

While large scale outbreaks of HAV are rare, it has happened in the past. For example, in 1988, Shanghai had an epidemic that infected 300,000 people due to contaminated raw clams. The virus then continued to spread through person-to-person contact^[3].

According to the Center for Disease Control (CDC), reports of hepatitis A decreased more than 95% in the United States from 1995 to 2011. However, cases then started to rise again dramatically since 2016^[2].

How is hepatitis A transmitted?

The primary transmission source of HAV is poor sanitary conditions or ingesting an infected person’s faecal matter or blood^[1]. When the virus enters the body, it spreads to the liver to incubate and keep reproducing. Large numbers of viruses can be found in the stool of an infected person due to the extensive viral load in the liver^[2]. It commonly spreads through faeces when a family member prepares food with hands that haven’t been washed thoroughly.

There are cases where hepatitis A has been spread by contaminated food. As mentioned previously, the outbreak caused in Shanghai was due to the contamination of clams. The most common food and drinks to get the virus from are unpeeled and uncooked fruits and vegetables, shellfish, ice and water^[4].

Since hepatitis A spreads primarily from stool to mouth, there aren’t many cases of people getting the virus by close contact with someone who has it as long as proper sanitation is maintained. The most significant risk of contracting hepatitis A is travelling to a country with hepatitis outbreaks or poor sanitary conditions.

What are the symptoms of hepatitis A?

Hepatitis A has an incubation period between 2 - 4 weeks before symptoms start to appear. Typical symptoms of hepatitis A include:

• Fever
• Fatigue
• Nausea
• Loss of appetite
• Vomiting
• Abdominal Pain
• Dark urine
• Diarrhoea
• Clay-coloured stool
• Joint pain
• Jaundice

Most children under the age of 6 do not experience any symptoms when contracting hepatitis A^[5].

Hepatitis A Treatment

Rest

If you are in a country with a high spread of hepatitis and have acquired similar symptoms, it is important to stay home and rest. Resting helps reduce the stress on your body and remove potential chances of spreading it to someone else. 

Take care of your liver

Since hepatitis A mostly affects the liver, it is essential to avoid harming it in any way. This means abstaining from alcohol, taking over-the-counter medications and even some vitamins and minerals.

Get enough nutrition

One of the symptoms of hepatitis A is a loss of appetite. Combined with nausea and diarrhoea, it can be very tough to get the required calories and nutrients. Therefore, eating nutrient-dense high-calorie foods in small portions is recommended to avoid feeling sick and vomiting.

Keep a high standard of hygiene

Finally, as hepatitis A spreads through faecal matter, it is essential to keep a high standard of hygiene when you are ill so that the spread of the virus to other people is limited^[6].

Hepatitis A Prevention

• When going to countries or places that don’t have a high level of sanitation, avoid eating uncooked fruits and vegetables that you haven’t washed or peeled yourself. 
• Other foods to avoid are raw, undercooked meat and seafood. 
• Always drink water in a bottle and use it when brushing your teeth.
• Avoid beverages you don’t know how they were made^[7]. 

The best course of action to avoid contracting HAV is to get vaccinated.

Should I get the vaccine?

The Centre for Health Protection in Hong Kong advises that the vaccine should be taken by people travelling to areas with high rates of hepatitis A and persons with chronic liver disease as the liver is affected the most by HAV^[8].

How does the hepatitis A vaccine work?

The hepatitis A vaccine works contains inactivated hepatitis A virus. It then activates the body to produce antibodies that will remove the virus. The hepatitis A vaccine is given by two separate shots, 6 to 12 months apart. You should take the vaccine two weeks before you expect to be exposed to hepatitis A to get complete immunity. It is not recommended to give the vaccine to children under 12 months. 

As with most vaccines, there are some mild side effects which include soreness, headaches, loss of appetite and tiredness^[9]. 

References

1. 1. World Health Organization. (2021). ‘Hepatitis A’. WHO. 27 July 2021. Available at: <https://www.who.int/news-room/fact-sheets/detail/hepatitis-a>. [Accessed 29 September 2021]
   2. Zuckerman, A. J. (1996). ‘Hepatitis Viruses’. Medical Microbiology 4th edition. 1 January 1996. Available at: <https://www.ncbi.nlm.nih.gov/books/NBK7864/>. [Accessed 29 September 2021]
   3. Halliday, M. L. et al. (1991). ‘An epidemic of hepatitis A attributable to the ingestion of raw clams in Shanghai, China.’. The Journal of infectious diseases, 164(5), 852–859. November 1991. Available at: <https://pubmed.ncbi.nlm.nih.gov/1658157> [Accessed 29 September 2021]
   4. Medline Plus. (2020). ‘Hepatitis A’. U.S. National Library of Medicine. 12 January 2020. Available at: <https://medlineplus.gov/ency/article/000278.htm>.  [Accessed 29 September 2021]
   5. Centers for Disease Control and Prevention. (2020). ‘Hepatitis A Questions and Answers for Health Professionals’. CDC. 28 July 2020. Available at: <https://www.cdc.gov/hepatitis/hav/havfaq.htm>. [Accessed 29 September 2021]
   6. WebMD. (2020). ‘Hepatitis A Treatments, Complications, and Prognosis’. WebMD. Available at: <https://www.webmd.com/hepatitis/treatments-for-hepatitis-a>. [Accessed 29 September 2021]
   7. Mayo Clinic. (2020). ‘Hepatitis A’. Mayo Clinic. 28 August 2020. Available at: <https://www.mayoclinic.org/diseases-conditions/hepatitis-a/symptoms-causes/syc-20367007>. [Accessed 29 September 2021]
   8. Centre for Health Protection. (2019). ‘Hepatitis A’. Department of Health. 19 August 2019. Available at: <https://www.chp.gov.hk/en/healthtopics/content/24/24.html>. [Accessed 29 September 2021]
   9. Omudhome O. (2019). ‘Hepatitis A Vaccine’. MedicineNet. 11 December 2019. Available at: <https://www.medicinenet.com/hepatitis_a_vaccine-injection/article.htm>.