THIS INFORMATION IS NOT MEDICAL ADVICE. THIS IS INFORMATION SOURCED FROM THE CDC, AND THE SF DEPARTMENT OF PUBLIC HEALTH.

With the recent declaration from Ohio’s health department regarding a statewide outbreak of hepatitis A, many people may have concerns. Below is a compilation of information about the virus.

What is Hepatitis A?

Hepatitis A is a contagious liver infection caused by the hepatitis A virus (HAV).  In the USA, hepatitis A infections have declined by 90% since 1995. Hepatitis A is still common in Latin America, Africa, the Middle East, and Asia.

How do People Get Hepatitis A?

 If you're traveling to higher risk places where hepatitis A outbreaks frequently occur, then take the necessary precautions. More specifically, peel and thoroughly wash all fresh fruits and veggies yourself before eating them.^[13] Avoid eating any raw or undercooked meat, poultry and fish. Drink only bottled water and also use it when brushing your teeth. Don't drink any beverages with ice added.

• Higher risk areas for hepatitis A include Mexico, China, Southeast Asia, Africa, Asia and most parts of South America.
• If bottled water isn't available to you, boil tap water for about 10 minutes before drinking it.

Hepatitis A virus is found in the stool (feces) of people with HAV infection. It enters the body through the mouth after someone handles something contaminated with HAV, or eats or drinks something contaminated with HAV.

People usually get hepatitis A by having close contact with a person who is infected, from food or drinks prepared by someone who is infected, or by eating shellfish harvested from sewage-contaminated water.  After the virus enters the body, there is an incubation period lasting 2 to 7 weeks until illness begins.

Who is at Risk for Infection?

Anyone who is not immune to hepatitis A can get hepatitis A infection. Food-borne outbreaks occur sporadically throughout the USA. Certain groups of people do have a higher risk of developing HAV infection:

• Persons living in the same household with an infected person
• Sex partner of an infected person
• Persons traveling to countries where hepatitis A is common
• Men who have sex with men
• People who use injection drugs
• Children in day care
• People who eat raw or undercooked shellfish

CLINICAL PRESENTATION

The incubation period averages 28 days (range, 15–50 days). Infection can be asymptomatic or range in severity from a mild illness lasting 1–2 weeks to a severely disabling disease lasting several months. Clinical manifestations include the abrupt onset of fever, malaise, anorexia, nausea, and abdominal discomfort, followed within a few days by jaundice. The likelihood of having symptoms with HAV infection is related to the age of the infected person. In children aged <6 years, most (70%) infections are asymptomatic; jaundice is uncommon in symptomatic young children. Among older children and adults, the illness usually lasts <2 months, although approximately 10%–15% of infected people have prolonged or relapsing symptoms over a 6- to 9-month period. Severe hepatic and extrahepatic complications, including fulminant hepatitis and liver failure, are rare but more common in older adults and people with underlying liver disease. Chronic infection does not occur. The overall case-fatality ratio is 0.3%; however, the ratio is 1.8% among adults aged >50 years.

DIAGNOSIS

HAV cannot be differentiated from other types of viral hepatitis on the basis of clinical or epidemiologic features. Diagnosis requires a positive test for antibody to HAV (anti-HAV) IgM in serum, detectable from 2 weeks before the onset of symptoms to approximately 6 months afterward.

Serologic tests for total anti-HAV (IgG and IgM) are available commercially. A positive total anti-HAV result and a negative IgM anti-HAV result indicate past infection or vaccination and immunity. The presence of serum IgM anti-HAV usually indicates current or recent infection and does not distinguish between immunity from infection and vaccination. Acute hepatitis A is a nationally notifiable disease.

TREATMENT

Supportive care. There are many natural treatments to deal with the symptoms of Hepatitis A.

Immunity

• People who have hepatitis A infection become immune to HAV for the rest of their lives once they recover. They cannot get hepatitis A twice.
• The blood test for immunity to hepatitis A is called the “Hepatitis A Total Antibody test.” People who have had hepatitis A and those who have received hepatitis A vaccine show positive antibodies to hepatitis A on this test for the rest of their life.

Healthy Habits

• Good personal hygiene and proper sanitation help prevent the spread of the HAV virus. Always wash your hands with soap and water after using the bathroom, changing a diaper, and before preparing, serving, or eating food.
  • Alcohol-based hand sanitizers do not kill the hepatitis A virus
• People who have hepatitis A should not be preparing or serving food, or caring for the elderly or for young children, until at least 2 weeks have passed since the first sign of hepatitis A illness.
• Boiling or cooking food and drinks for at least 1 minute to 185°F (85°C) inactivates HAV. Foods and drinks heated to this temperature and for this length of time do not transmit HAV infection unless they become contaminated after heating. Travelers can lower their risk of hepatitis A (and other food-borne illnesses) in developing countries by drinking only water that has been boiled or chemically purified, by eating only foods that have been properly heated, and by avoiding fruits or vegetables that are not peeled or prepared by the traveler personally.
• Adequate chlorination of water as recommended in the United States does inactivate HAV.

VacCine PRECAUTIONS AND CONTRAINDICATIONS

Hepatitis A–containing vaccines should not be administered to individuals with a history of hypersensitivity to any vaccine component, including neomycin. Twinrix should not be administered to people with a history of hypersensitivity to yeast. The tip caps of prefilled syringes of Havrix and Twinrix and the vial stopper, syringe plunger stopper, and tip caps of Vaqta may contain dry natural rubber, which may cause allergic reactions in latex-sensitive people. Because hepatitis A vaccine consists of inactivated virus and hepatitis B vaccine consists of a recombinant protein, no special precautions are needed for vaccination of immunocompromised travelers. Providers should check precautions and contraindications before administering IG.

PREGNANCY

The safety of hepatitis A vaccine for pregnant women has not been determined. 

BIBLIOGRAPHY

1. Averhoff FM, Khudyakov Y, NP N. Vaccines. 7th ed. Philadelphia: Saunders Elsevier; 2016.
2. CDC. Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2007 Oct 19;56(41):1080–4.
3. CDC. Updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for use of hepatitis A vaccine in close contacts of newly arriving international adoptees. MMWR Morb Mortal Wkly Rep. 2009 Sep 18;58(36):1006–7.
4. CDC. Viral Hepatitis Surveillance—United States, 2013 [cited 2016 Sep. 23]. Available from: http://www.cdc.gov/hepatitis/statistics/2013surveillance/pdfs/2013hepsurveillancerpt.pdf.
5. Collier MG, Khudyakov YE, Selvage D, Adams-Cameron M, Epson E, Cronquist A, et al. Outbreak of hepatitis A in the USA associated with frozen pomegranate arils imported from Turkey: an epidemiological case study. Lancet Infect Dis. 2014 Oct;14(10):976–81.
6. Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006 May 19;55(RR-7):1–23.
7. Mohd Hanafiah K, Jacobsen KH, Wiersma ST. Challenges to mapping the health risk of hepatitis A virus infection. Int J Health Geogr. 2011;10:57.
8. Moro PL, Museru OI, Niu M, Lewis P, Broder K. Reports to the Vaccine Adverse Event Reporting System after hepatitis A and hepatitis AB vaccines in pregnant women. Am J Obstet Gynecol. 2014 Jun;210(6):561.e1–6.
9. Mutsch M, Spicher VM, Gut C, Steffen R. Hepatitis A virus infections in travelers, 1988–2004. Clin Infect Dis. 2006 Feb 15;42(4):490–7.
10. Nelson NP, Murphy TV. Hepatitis A: the changing epidemiology of hepatitis A. Clin Liver Dis. 2013 Dec 20;2(6):227–30.