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October 25, 2017
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Hepatitis A

Hepatitis A

The liver is in the upper right part of the tummy (abdomen). It performs various functions:

1.It makes proteins that are essential for blood to clot(clotting factors).

2.It helps to process fats and proteins from digested food.

3.It stores glycogen, a chemical made from sugars. When required, glycogen is broken down into glucose which is released into the bloodstream.

4It makes bile which passes from the liver to the gut and helps to digest fats.

5.It helps to remove or process alcohol, poisons and toxins from the body.

6.It processes many medicines which one may take.

Grasping hepatitis and hepatitis A

Hepatitis means inflammation of the liver. There are a number of things that can cause hepatitis. For example, drinking too much alcohol, various drugs and chemicals, and also several different viruses. One virus that causes hepatitis is called the hepatitis A virus. After first contact with the virus, hepatitis A virus is carried in the bloodstream to the liver. It can then affect one’s liver to cause hepatitis.

Communication of hepatitis A and its prevalence

Hepatitis A can affect anyone. The virus is passed out in the stools (faeces) of infected people. In areas of poor sanitation, or where disposal of sewage is poor, hepatitis A can become common due to dirty (contaminated) water and food. This means one may become infected with hepatitis A by eating uncooked food prepared or washed in contaminated water, or by drinking contaminated water. Shellfish caught in contaminated water can also carry the hepatitis A virus. Someone who has hepatitis A infection may pass on the infection to others. This can occur through preparing food, or through close contact with another person, if they have not washed their hands properly after going to the toilet.

The highest risk areas of the world for hepatitis A infection 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.

Apart from travellers, there are certain groups of people who may be at increased risk of getting hepatitis A. For example, people who share drug injecting equipment, men who have sex with men, and other people whose sexual practices involve oral-anal contact. Someone’s occupation may make them more likely to get hepatitis A infection – for example, sewage workers and laboratory workers may have an increased risk. Also, people who have blood clotting problems such as haemophilia and so need to receive blood clotting factors may have an increased risk. This is because the hepatitis A virus may not be completely destroyed during the preparation of these blood products.

People who are known to have liver problems are not more likely to get hepatitis A infection. However, if they do become infected, the infection is more likely to be severe.

Manifestations of hepatitis A

Symptoms may develop shortly after one becomes infected with the virus, usually within 2-7 weeks. This time period between first coming into contact with the virus and developing symptoms is known as the incubation period. One may not know one is infected with hepatitis A during the incubation period. However, one can pass on the virus to others during this time if one’s standard of hygiene is not good. For example, if hands are not washed after going to the toilet or before preparing food.

Following the incubation period, the first symptoms that may develop include:

Flu-like symptoms. For example, general aches and pains and headaches. (These are the most common symptoms.)

An ache over one’s liver (the upper part of the right side of the tummy (abdomen) below the ribs..

Tiredness, feeling sick, sometimes being sick (vomiting) and diarrhoea.

The above symptoms can last anywhere from a few days to up to two weeks. Jaundice may then develop. Jaundice is a yellow colouration of the skin and the whites of the eyes. One’s urine may also turn dark and one’s stools (faeces) may turn a pale colour. This is due to pigments in the blood not being properly cleared by the inflamed liver. Jaundice can also cause itching of the skin. After jaundice appears, tiredness, feeling sick (nauseated) and vomiting symptoms tend to improve in most people. Jaundice usually lasts somewhere between one and three weeks, but it may last longer in some people. One may also have aching over one’s liver during the period of jaundice.

Even after the jaundice has faded, hepatitis A infection can leave one feeling tired, losing appetite and generally weak for some weeks, and sometimes for longer. Most people have fully recovered within two months, although in others it may take up to six months.

In a very small number of people, the illness can be more severe. However, in general, complications are rare Hepatitis A infection does not become persistent (chronic). This is unlike some other forms of hepatitis such as hepatitis B and C which can cause a chronic infection.

It may be noted that in some people, hepatitis A infection only causes mild symptoms and no jaundice. In others, particularly in children aged under 5, no symptoms develop at all , the condition called subclinical infection.

Identification of hepatitis A

One’s doctor may suspect hepatitis A infection by one’s typical symptoms. A simple blood test can detect if one is infected with the hepatitis A virus. The test detects an antibody against the virus which one can make when one is first infected.

A different antibody persists long-term after the infection has cleared. This antibody keeps one immune from future infection. A blood test can detect this second antibody which shows if one had had hepatitis A in the past, and that one is now immune.

If hepatitis A is suspected, one’s doctor may also suggest other blood tests called liver function tests. These measure the activity of chemicals (enzymes) and other substances made in the liver. This gives a general guide as to whether one’s liver is inflamed and how well it is working.

Possible challenges involved

Serious illness is rare with hepatitis A infection. The illness can be unpleasant and make one feel quite ill, but most people make a full recovery. However, in a small number of cases, the infection can cause severe liver inflammation leading to liver failure. This is more common in older people who develop this infection. An extremely small number of people die from severe hepatitis A infection. A liver transplant can be life-saving if liver failure develops.

Somewhere between 1 to 2 in 10 people who get hepatitis A infection will seem to recover but will then have a return (relapse) of their symptoms between about 1 and 3 months after their original illness. This is because the infection hadn’t cleared completely. This relapse will have similar symptoms to the initial illness. Some people can have a relapse of their symptoms more than once.

Treatment of hepatitis A

There is no specific treatment needed for hepatitis A. It is usually a self-limiting illness which means it usually goes away on its own. One’s immune system will normally clear away the infection. Most people with hepatitis A infection don’t need to be admitted to hospital. However, admission to hospital may be suggested if one is severely ill or one is being sick (vomiting) and is lacking in body fluid (dehydrated).

Treatment is aimed at relieving one’s symptoms. It is common to feel more tired than usual when one has hepatitis A so one may need to have plenty of rest. The doctor may be able to suggest some painkillers and some anti sickness medication if needed. To help ease the symptom of itch, one needs to keep cool, wear loose clothing and avoiding hot baths or showers. Avoiding fatty foods may help to reduce the feeling of sickness. Also, one should not drink alcohol while one is ill.

During one’s illness, the doctor may also want to keep a check on how the patient’s liver is working by repeating blood tests from time to time to look at this.

It is important to have excellent personal hygiene to reduce the risk of passing the virus on to others. Hands should be thoroughly washed after going to the toilet. One should also avoid handling food and having unprotected sex when one is infected with the virus. One should consult the doctor to know when it is safe to return to work, or for one’s child to return to school or nursery.

Keeping hepatitis A at bay

Vaccination

Immunisation against hepatitis A is recommended before travelling to certain countries where hepatitis A is common. One should see one’s doctor ideally 4-6 weeks before the date of travel. Also, immunisation is sometimes advised for contacts of people who develop the illness. In certain other circumstances, there might be groups of people who may be at increased risk of infection.

Cautious consumption of food and drinks

Eating and drinking the following should be avoided when travelling to high-risk countries:

Untreated drinking water, including ice cubes made from untreated water.(Treated or bottled water should only be used for brushing teeth.)

Raw or inadequately cooked shellfish.

Other foods that may have been grown close to the ground such as strawberries.

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

Raw salads and vegetables that may have been washed in contaminated water. Washing fruits and vegetables in safe water and peel them oneself is recommended.

Also one should be careful when buying food from street traders. It should be made 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.

It needs to be noted that if one had hepatitis A infection, one will be immune to further infection. This means that one can’t catch the infection again.

​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).

Infection with hepatitis A virus can cause an unpleasant illness, but most people fully recover. Some people have no symptoms at all. Symptoms include flu-like symptoms and yellowing of the skin and the whites of the eyes (jaundice) which then gradually clear without treatment. Serious problems are very rare. Good personal hygiene (in particular, washing hands after going to the toilet) helps to prevent spreading the virus to others. Immunisation is advised before going to countries where hepatitis A is common and for those people at increased risk of developing hepatitis A.