Liver Health

Updated 18 May 2015

Hepatitis A

The hepatitis A virus infects the gut and the liver cells, multiplying inside them.

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Summary

  • Hepatitis A is a common infection in South African children.
  • The hepatitis A virus infects the gut, them moves to infect the liver cells, multiplying inside them.
  • Recovery is dependent on the person's own immune response to the viral infection.
  • There is a safe and effective vaccine against hepatitis A.

Cause

The hepatitis A virus is found in the faeces of an infected person and is usually acquired from hands soiled after using the toilet or changing a nappy, or by swallowing water or food that have been contaminated by human faeces. Uncooked shellfish and raw vegetables contaminated by sewage can also be a route of infection. Sexual contact with an infected person is also a recognised route of infection.

Hepatitis A infects the liver cells and multiplies inside them. As the body's immune system attempts to destroy the virus, the immune response causes liver cell damage and inflammation. Certain enzymes, usually active inside the liver cells, are released from damaged cells into the blood and can be detected by blood tests, thus confirming the presence of a hepatitis virus.

The swelling of the liver causes blockage of the bile ducts, trapping bile that should flow into the gall bladder inside the liver. The yellow-green bile being absorbed into the bloodstream from the liver causes the yellow discoloration known as jaundice. A health care professional will often be able to detect during examination of the abdomen that the liver is enlarged and tender.

Symptoms

Early symptoms:

  • loss of interest in food, especially fatty food,
  • distaste for cigarettes (if you are a smoker),
  • loss of ability to drink any alcohol,
  • feeling unwell,
  • headache,
  • muscle aches, and/or
  • fever.

Once infection is established, symptoms are:

  • nausea, with or without vomiting,
  • discomfort or pain in the right upper quarter of the abdomen,
  • urine that is an unusual dark reddish-brown,
  • faeces unusually pale in colour, and/or
  • a yellowish tinge to the whites of the eyes and the skin.

These symptoms can last from a week to months, depending on the response of the person infected. Generally, adults experience worse symptoms for a longer period. Pregnant women are at slightly increased risk of severe hepatitis A.

Complications

A small number of people (approximately 1 in 100) who get any one of the viral hepatitis viruses may experience early severe liver damage at the outset of the illness, in which much of the liver can be destroyed, and the person goes into liver failure. This is known as 'fulminant hepatitis'. Signs that this may be occurring include drowsiness that progresses to coma, and bleeding, usually in the gut. This is an extremely serious situation that will require the person to be cared for in an intensive care unit.

Prevalence

Hepatitis A is common in all undeveloped parts of the world where it is mostly acquired by young children. In highly developed countries, exposure to Hepatitis A is low, with only 10 percent of adults having been infected.

When to see a doctor

The symptoms of hepatitis A described in Symptoms would require a visit to the doctor.

Diagnosis

The symptoms of hepatitis will usually lead a health care professional to suspect the disease early on. Blood tests can be done to confirm that there is a hepatitis, and its severity, and these tests can even give some clues as to whether the cause is viral.

Specific straightforward blood tests are required to diagnose hepatitis A:

  • Hepatitis A IgM antibody - if positive indicates current or recent infection, and/or
  • Hepatitis A IgG antibody - in the absence of hepatitis A IgM antibody, indicates past infection with Hepatitis A and immunity.

Treatment

Home
  • Bed-rest, if the person feels unwell enough. If there is no fever, normal activities can be continued.
  • A temperature of greater than 39 deg Celsius can be treated with paracetamol, but use with caution because this drug is usually processed by the liver and this ability will be impaired in a person with viral hepatitis.
  • A regular diet can be followed. If their appetite is poor, then fruit juice and other liquids should be encouraged.
  • Avoid alcohol.
Medical treatments

There is no effective treatment available to treat an acute hepatitis (a new infection), recovery being dependent on the person's own immune response to the virus infection. Any complications might require medical treatment in hospital.

Prevention

As treatment possibilities are limited, avoiding viral hepatitis is most important. The spread of hepatitis A is prevented by:

  • good sanitation systems:
  • clean tap water:
  • basic hygiene, such as washing one's hands after using the toilet, after changing a nappy and before preparing food. The virus is present in the faeces of an infected person from two weeks before symptoms begin to about a week after the start of the illness;
  • a person with hepatitis A should not prepare food at home or at work;
  • if your child has hepatitis A and attends a crèche or school, the staff and parents should be notified so that preventive steps can be taken.

If well, children can return to school and adults to work one week after the onset of hepatitis A, as they will no longer be significantly infectious.

Immunoglobulin for preventing hepatitis A and B

The immunoglobulin, given by injection, can provide an 'instant immunity' against the virus. However, it will not be effective if given too late after exposure to the virus, and the “instant immunity” only lasts for a few months. Immunoglobulin is commonly used for the protection of staff, parents and other children in a nursery school outbreak and can be given simultaneously with a first dose of hepatitis A or B vaccine.

Vaccination

The hepatitis A vaccination, recommended for the following groups, is given in two doses at least one month apart:

  • health care workers,
  • staff in centres where young children are cared for,
  • clients and staff in institutions for the mentally handicapped,
  • workers in the food industry, and
  • travellers from countries with low rates of hepatitis A.
 

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