Hepatitis A

Hepatitis A is an infectious liver disease caused by the hepatitis A virus (HAV). The disease varies in severity from a mild illness lasting 1-2 weeks to a severely disabling disease lasting several months. 

There are other kinds of viral hepatitis such as hepatitis B, hepatitis C, hepatitis D, and hepatitis E. These diseases and the viruses that cause them are not related to hepatitis A although they also affect the liver. This difference means that there are different ways of spreading the disease and different means for preventing and controlling these diseases.

Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and it is rarely fatal. However, it can cause fulminant hepatitis (acute liver failure) which is often fatal.

The incubation period (the time between initial contact with the virus and the onset of the disease) for hepatitis A ranges from 15 to 50 days, but most commonly about 28 days. The length of the incubation period depends on the amount of virus to which a person is exposed. Exposure to a large dose of virus results in a short incubation period.

Not all individuals infected with the hepatitis A virus will have symptoms.  When symptoms develop, they include a low-grade fever, tiredness, weakness, loss of appetite, nausea, vomiting, diarrhea, abdominal pain (especially on the upper right side, over the liver), dark urine, joint pain, intense itching, and yellowing of the skin and eyes  (jaundice). Adults show the signs and symptoms more often than children.

Infected individuals can spread the virus from 2 weeks before the symptoms begin to 2 weeks after symptoms end. However, an infected person who has no symptoms can still spread the virus. Unlike some other forms of viral hepatitis, hepatitis A does not cause long-term (chronic) damage and is usually not fatal.  Symptoms may last 2 to 3 months. Those individuals with pre-existing liver disease have a higher risk of complications. The severity of the illness tends to increase with age. After infection, most people are immune to HAV for life.

The common test for hepatitis A is the antibody test. When a person becomes infected, the body creates antibodies to protect itself from the virus. There is a blood test available to measure these antibodies -HAV-specific Immunoglobulin G (IgG). Reverse transcriptase-polymerase chain reaction (RT-PCR) is another test used to detect the hepatitis A virus. A doctor should also do a complete medical examination and get information about your activities in order to make a clinical diagnosis of hepatitis A.

There is no specific treatment for hepatitis A. Recovery is slow and takes several weeks or months. It is important to replace fluids lost by vomiting or diarrhea. It may also be necessary to avoid some common medications, prescriptions, and supplements.   Avoid alcohol. 

The hepatitis A virus is found in the feces of infected persons. The virus is usually spread from person to person by putting something in the mouth that has been contaminated with the feces of a person with hepatitis A. The virus is more easily spread under poor sanitary conditions and when good personal hygiene is not practiced (e.g., when hands are not thoroughly washed after using the toilet). The virus can be transmitted through close personal contact when there is poor personal hygiene such as in day cares, households, and schools. The virus can also sometimes be transmitted through oral and anal sexual activity.

People can get hepatitis A by drinking contaminated water or ice, or eating raw and undercooked shellfish harvested from contaminated water. Raw or frozen fruits and vegetables or other foods can become contaminated during handling.

Occupations at risk may include sewage workers. As well, people who work with HAV-infected animals (e.g., zoo keepers, veterinarians, researchers) or in a hepatitis A research laboratory may be at risk.

Healthcare workers are not considered to be at increased risk when they follow routine practices and infection control procedures. 

Workers in the food handling sector may be at risk if exposed to contaminated food or water. Workers who have active hepatitis A should not prepare or handle food for others. 

People who visit, live or work in countries where hepatitis A is common may be at increased risk.

The prevention of hepatitis A in the workplace is based on good hygiene and sanitation. The spread of hepatitis A can be reduced by:

• adequate supplies of safe drinking water
• proper treatment or disposal of sewage
• personal hygiene practices, such as regular hand-washing
• avoiding sharing items such as towels, and washing soiled laundry separately in hot water
• if you are infected, do not prepare meals for others

Education programs for workers about personal hygiene practices should emphasize that careful hand washing is extremely important in the prevention of disease. Workers should be informed about using appropriate protective clothing and about removing it at the end of the shift. They should also be informed about the necessity of washing hands frequently, and before eating, drinking, or smoking; they should also avoid nail biting.

If travelling to an area where hepatitis A occurs, follow the precautions above.  In addition, take precautions regarding food and water, such as: 

• avoiding ice cubes
• peeling your own raw fruit and vegetables 
• drinking water from a safe supply (such as bottled or boiled water)
• eating only foods that are well-cooked, unless you have prepared them yourself. 

A hepatitis A vaccine is available and it is highly effective in preventing infection. Consult your health professional.