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What is Hepatitis A

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(beeping) - [Instructor] Now let's take a closer look at hepatitis A. Hepatitis A is a highly contagious liver infection caused by hepatitis A virus, known as HAV. It's present in the feces of infected persons and is most often transmitted through consumption of contaminated water or food. Most people in areas of the world with poor sanitation have been infected with this virus. Hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis, which is acute liver failure, which is often fatal. So who's at risk for hepatitis A? Well, people who have direct contact with someone who has hepatitis A, travelers to countries where hepatitis A is common, men who have sexual contact with men, people who use drugs, both injection and non-injection, household members of caregivers of recent adoptee from countries where hepatitis A is common, people with clotting factor disorders, such as hemophilia, and people working with nonhuman primates. So how common is hepatitis A in the United States? Well, latest statistics in 2015 showed that there was an estimated 2,800 cases of hepatitis A in the U.S. alone, and hepatitis A rates have declined by more than 95% since the hepatitis A vaccine first became available in 1995. You might be asking yourself, well how is it transmitted? Hepatitis A virus is transmitted primarily by the fecal-oral route, when an uninfected person ingests food or water that's been contaminated with the feces of an infected person. Now food and water contamination can include even frozen and undercooked food. Hepatitis A virus can be transmitted at any point, growing, harvesting, processing, handling, and even after cooking foodstuff. Areas where there are poor sanitary conditions or poor personal hygiene are also risks. And lastly, close personal contact with an infected person such as through sex or caring for someone who is ill. Let's look at the incubation period of hepatitis A. The incubation period ranges between 15 and 50 days with an average of 28 days, but the signs and symptoms are as follows. They may show fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark colored urine, clay colored stools, joint pain and aches, along with jaundice, which is a yellowish pigment of the skin. Not everyone who is infected will have all of these symptoms. Adults have signs and symptoms of illness way more than children do and the severity of disease and fatal outcomes are also higher in the older age groups. Infected children under six years of age do not usually experience noticeable symptoms and only 10% develop jaundice. Among older children and adults, infection usually causes more severe symptoms with jaundice occurring in more than 70% of the cases. Hepatitis A diagnosis. Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis. Specific diagnosis is made by the detection of the HAV specific immunoglobulin G antibodies in the blood. Additional tests can include reverse transcriptase polymerase chain reaction to detect the hepatitis A virus RNA and may require specialized laboratory facilities to do so. Let's take a look at the treatment. There are no specific treatments for hepatitis A. Recovery from symptoms following infection may be slow and may take several weeks or months. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhea. Now let's look at hepatitis A prevention. The most effective ways to combat hepatitis A are through improved sanitation, food safety, and immunizations. The spread of hepatitis A can be reduced by adequate supplies of safe drinking water, proper disposal of sewage within communities, and personal hygiene practices, such as regular hand washing with safe water.

In this lesson, we'll be going in-depth into all things Hepatitis A, including what it is, who's at risk, how common it is in the U.S., how it's transmitted, the signs and symptoms, how it's diagnosed, treatment options, and saving the best for last – how to prevent it.

What is Hepatitis A?

Hepatitis A is a highly contagious liver infection that is caused by the Hepatitis A virus (HAV). The virus can be found in the feces of people who are infected with the virus and is most often transmitted through the consumption of food and water.

Most people in areas of the world that have poor sanitation have been infected with the Hepatitis A virus. The infection does not cause chronic liver disease and is rarely fatal. However, the Hepatitis A virus can cause debilitating symptoms of fulminant Hepatitis (acute liver failure), which IS often fatal.

Who is Most at Risk of Getting Hepatitis A?

The chances of contracting Hepatitis A really depend on your environment and your associations with others. Those most at risk include:

  • People with direct contact with someone who has Hepatitis A
  • Travelers to countries where Hepatitis A is common
  • Men who have sexual contact with other men
  • People who use drugs, whether they are injectable or non-injectable
  • Household member and caregivers of recent adopted children from countries where Hepatitis is prevalent
  • People with clotting factor disorders, such as hemophilia
  • People who are working with nonhuman primates

How Common is Hepatitis A in the U.S.?

In 2015, there were an estimated 2800 Hepatitis A cases in the U.S. alone, and since sanitation and hygiene are much better in the U.S. than in many other countries, you would expect those numbers to be significantly higher in developing areas around the world.

Pro Tip #1: Hepatitis A rates have declined by more than 95 percent since the Hepatitis A vaccine first became available in 1995. Those who do have a higher risk of becoming infected with Hepatitis A may want to consider getting vaccinated. It should be noted that children in the U.S. are routinely vaccinated between their first and second birthdays.

How is Hepatitis A Transmitted?

The Hepatitis A virus is transmitted primarily by the fecal-oral route. The fecal-oral route (also called the oral-fecal route or orofecal route) describes a particular route of transmission of a disease wherein pathogens in fecal particles pass from one person to the mouth of another person.

In other words, this usually occurs when an uninfected person ingests food and/or water that has been contaminated with the feces of an infected person. Which is why mothers everywhere always ask, did you wash your hands?

A Special Point About Food and Water Contamination

It's not just undercooked or raw foods that can become contaminated with the Hepatitis virus. In fact, food can become contaminated with the virus at any point on its journey from seed to food, and this includes:

  • During the growing process
  • During the harvesting process
  • During the processing process
  • While being handled
  • After cooking
  • Even while frozen

As Hepatitis A relies on dirty conditions to thrive, areas of the world where there are poor sanitary conditions or poor personal hygiene are prime environments for contracting Hepatitis A.

Also, Hepatitis A can be transmitted through close personal contact with someone who is infected with the virus, such as having sexual contact or caring for someone who is ill with the disease.

What are the Signs and Symptoms of Hepatitis A?

Before getting into the signs and symptoms of Hepatitis A, it's worth noting that the incubation period for the disease is between 15 and 50 days, with 28 days being the average incubation period.

The signs and symptoms of Hepatitis A can range from mild to severe and include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay colored stools
  • Joint pain
  • Jaundice (yellowing of the skin)

Pro Tip #2: Just because you don't have all the symptoms doesn't necessarily mean you haven't been infected with the virus. Not everyone, particularly adults, will have all of these symptoms. However, adults will generally have more than children.

Infected children under the age of six will not usually show any symptoms associated with Hepatitis A, and only 10 percent of them will develop jaundice. However, among older children and adults, the infection will usually cause jaundice, along with other more severe symptoms, in 70 percent of the cases.

Also noteworthy is that the severity of the disease plus fatal outcomes are both higher in older age groups.

How is Hepatitis A Diagnosed?

The problem is that cases of Hepatitis A are not clinically distinguishable from other types of acute viral Hepatitis. A specific diagnosis is made by the detection of HAV-specific Immunoglobulin (IgM) antibodies in the blood of those suspected of having the virus.

Another diagnostic test is the reverse transcriptase polymerase chain reaction. Reverse transcription polymerase chain reaction is a laboratory technique combining reverse transcription of RNA into DNA and amplification of specific DNA targets using polymerase chain reaction … just in case you were interested.

How is Hepatitis A Treated?

Sadly, there are no specific (as in good) treatments for Hepatitis A. recovery from symptoms following infection is often slow and may take several weeks or months, which makes vaccination all the more appealing of an option.

Instead, therapies are usually aimed at maintaining comfort and adequate nutritional balance, including the replacement of fluids that are lost from vomiting and diarrhea.

How is Hepatitis A Prevented?

The most effective ways to prevent Hepatitis A include:

  • Improved sanitation
    • Proper community sewage disposal
  • Following food safety recommendations
  • Immunization
  • Adequate supplies of safe water
  • Personal hygiene practices
    • Regular handwashing with safe water

And in case you're not entirely sure how to wash your hands, not to worry; we have a whole lesson devoted to just that coming up later.