Hepatitis A Immunisation

Understanding hepatitis A

Hepatitis A virus. Causes the illness called Hepatitis A. This virus mainly causes inflammation of the liver and its indications are :

Sometimes, being sick (vomiting)

Yellowing of your skin and the whites of your eyes (jaundice)

A raised temperature (fever).

Generally feeling unwell

Some people who are infected however do not develop any symptoms making it a subclinical illness. The illness is not usually serious and full recovery is normal but the symptoms can be quite unpleasant for a while. The hepatitis A virus is passed out in the stools (faeces) of infected people and infection is usually spread by eating dirty (contaminated) food or drink.

Hepatitis A infection is more common in countries where there is poor sanitation or where disposal of sewage is poor. If one catches hepatitis A, the illness is not usually serious, but it may ruin a holiday or business trip.

It is important that Hepatitis A should not be confused with hepatitis B or C. Hepatitis B and C are caused by different viruses and are more serious diseases.

Proneness to hepatitis A

Travellers from countries Western Europe, North America, and Australasia should consider being immunised. The highest risk areas include the Indian subcontinent (in particular India, Pakistan, Bangladesh, and Nepal), Africa, parts of the Far East (except Japan), South and Central America, and the Middle East. Immunisation is generally recommended for anyone over the age of 1 year.

Communication of hepatitis A . Close contacts of someone found to have hepatitis A infection for example, family members or other members of the institution, may be offered immunisation. The most important measure for anybody with hepatitis A is good personal hygiene. In particular, washing hands after going to the toilet or before eating.

Sufferers of chronic liver disease. In case one is suffering a persistent (chronic) liver disease (for example, cirrhosis)it is suggested that one takes the hepatitis A vaccine. Hepatitis A infection is not more common in those with chronic liver disease but, if infection does occur, it can cause a more serious illness.

Susceptiveness to hepatitis A at work. For example, laboratory workers who are exposed to hepatitis A during their work and sewage workers are advised to be immunised against hepatitis A.

Residents at large boarding institutions. Outbreaks of hepatitis A have been associated with large residential institutions for people with learning difficulties, where standards of personal hygiene among clients or patients may be poor. Therefore, immunisation of staff and residents of some institutions may be recommended.

Injecting drug users who share drug injecting equipment are also thought to have an increased risk of hepatitis A infection and so should consider immunisation.

People with certain blood clotting problems such as haemophilia, who need to receive blood clotting factors, may have an increased risk of hepatitis A infection. This is because the hepatitis A virus may not be completely destroyed during the preparation of these blood products. Immunisation is therefore suggested for these people.

Men who have sex with men and other people whose sexual practices involve oral-anal contact may also like to consider immunisation against hepatitis A.

It is important to note that if one has been infected with hepatitis A in the past, one should be immune to further infection and therefore not need immunisation. A blood test can detect antibodies to check if one is already immune. This may be worthwhile doing if one has had a history of yellowing of the skin and the whites of the eyes (jaundice) or comes from an area where hepatitis A is common.

Hepatitis A Antiserum (Vaccine)

There are a number of different hepatitis A vaccines available. There are also some combined vaccines for both hepatitis A and hepatitis B and also hepatitis A and typhoid fever. A combined vaccine may be useful if one requires protection against both diseases.

The hepatitis A single vaccine is given as two doses. The first dose of the vaccine protects against hepatitis A for about one year. The vaccine causes the body to make antibodies against the virus. These antibodies protect from illness should one become infected with this virus. Ideally, you should have an injection at least two weeks before travel to allow immunity to develop. However, the vaccine may still be advised even if there is less than two weeks before one’s travel.

A second dose of the vaccine 6-12 months after the first gives protection for about 20 years. If one is late with this second dose, one should have it as soon as possible but one doesn’t need to start with the first dose again. Another booster dose of hepatitis A vaccine after 20 years can be given to those people still at risk of infection.

The doses of the combined vaccines against both hepatitis A and hepatitis B or hepatitis A and typhoid may need to be given at slightly different time intervals.

Possible side-effects from the anti-serum

Some people develop a temporary soreness and redness at the injection site. Much less common are:

Headaches.

temporary loss of appetite.

A mild raised temperature (fever).

Tiredness.

Feeling sick (nauseated).

Severe reactions are extremely rare.

Non-requirement of hepatitis A vaccine

There are a very few situations where the hepatitis A vaccine is not recommended. They include:

One type of vaccine (Epaxal) should not be given to anyone who is known to be allergic to eggs.

If one has an illness causing a high temperature (fever). In this situation, it is best to postpone immunisation until after one has fully recovered from the illness.

Children under the age of 1 year. The risk of hepatitis A in children under the age of 1 is very low. The hepatitis A vaccine is not licensed for this age group.

In case one has had an allergic reaction to the vaccine or to any of its components in the past.

The vaccine may be given in case of pregnancy or breast-feeding and immunisation against hepatitis A is thought to be necessary.

Some more aspects

Immunisation for travellers is only one aspect of preventing illness. No immunisation is 100% effective. So when travelling to at-risk areas, one should have very good personal hygiene and also be careful about what one eats and drinks.

Eating and drinking the following should be avoided when one is travelling to areas where the risk of hepatitis A is higher:

Foods that may have been grown close to the ground, such as strawberries.

Untreated drinking water, including ice cubes made from untreated water. Also only treated or bottled water should be used when brushing the teeth.

Raw or inadequately cooked shellfish.

Unpasteurised milk, cheese, ice cream and other dairy products.

Raw salads and vegetables that may have been washed in unclean (contaminated) water. (Fruit and vegetables should be washed in safe water and peeled oneself.)

Moreover one needs to be careful when buying food from street traders. One needs to make sure that food has been recently prepared and that it is served hot and on clean serving plates. Food that has been left out at room temperature (for example, for a buffet) or food that may have been exposed to flies could also pose a risk.

Conclusion:

​Hepatitis A is self limiting viral infection which in most cases needs symptomatic treatment. It can become severe only in already unwell patients. People living in high risk areas should consider vaccinating themselves against Hepatitis A, as should people travelling from low risk areas (Developed counties).