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Hepatitis A

What is hepatitis A?
Hepatitis A is a liver disease caused by the hepatitis A virus (HAV). The disease is fairly common; several hundred cases are reported each year in Wisconsin.

Who gets hepatitis A?

Hepatitis A can affect anyone. Those more likely to get HAV include:
persons who share a household or have sexual contact with someone who has hepatitis A
men who have sex with men
persons who use street drugs
children and employees in child care centers where a child or an employee has hepatitis A
travelers to where hepatitis A is common
persons with clotting factor disorders who receive factor concentrates
residents and staff of institutions for developmentally disabled persons when a resident or an employee has hepatitis A
workers who handle HAV-infected animals or work with HAV in a research laboratory setting

How is hepatitis A transmitted?
HAV is found in the stool of persons with hepatitis A. HAV is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A. This type of transmission is called "fecal-oral." For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed.

If careful hand washing with soap is not done, the virus can then be carried on an infected person's hands. From there, the virus can be spread to others by direct contact, or by consuming food or drink that has been handled by that infected individual. Because the virus is passed in the stool, children with hepatitis A who are not toilet trained can be an important source of the infection. Most infections result from contact with a household member or sex partner who has hepatitis A. Casual contact, as in the usual office, factory, or school setting, does not spread the virus. 

What are the signs and symptoms of hepatitis A?
People with hepatitis A may not have any signs or symptoms of the disease.

If symptoms are present, they usually occur abruptly and may include:
fever
tiredness
loss of appetite
nausea
abdominal discomfort
dark urine
jaundice (yellowing of the skin and eyes)
Symptoms usually last less than 2 months; a few persons are ill for as long as 6 months. The average incubation period for hepatitis A is 28 days (range: 15-50 days).

The disease is rarely fatal and most people recover without any complications after several weeks. Infants and young children tend to have very mild or no symptoms, and are much less likely to develop jaundice than are older children and adults. Persons who have pre-existing liver problems, especially those who have hepatitis C, can become extremely ill if they contract hepatitis A.

For how long is an infected person able to spread the virus?
A person can spread HAV about two weeks before the symptoms appear and for about one week after symptoms start. Persons with no symptoms can still spread the virus. This often happens with young children who unknowingly spread HAV to older children and adults.

Does past infection with hepatitis A make a person immune?
Yes. Recovering from the disease produces lifelong immunity from future HAV infection. Once a person recovers from hepatitis A, he or she will never get it again.

What is the treatment for hepatitis A?
Symptoms usually appear 2-3 months after exposure (range: 1 ½- 6 months).

How can hepatitis A be prevented?
The single most effective way to prevent the spread of the hepatitis A virus is careful hand washing after using the toilet, after diapering children, and prior to handling food. The routine use of good hygiene is important because a person with hepatitis A can be infectious to others for about two weeks before they even know they are sick. In addition, infected people should not handle foods during the contagious period.

A vaccine to prevent hepatitis A is available, but should be given at least four weeks before potential exposure takes place. Therefore, its use is currently limited to persons whose activities are likely to put them at risk of exposure to the hepatitis A virus in the future, such as travelers to countries where the infection is prevalent.

Other groups for whom the vaccine is recommended or may be beneficial include:
persons with chronic liver disease (including those who have hepatitis C)
persons who have blood clotting-factor disorders
sexually active men who have sex with men
persons who work or reside in institutions for the developmentally challenged
persons who use street drugs
persons living in communities which have very high levels of hepatitis A and which are subject to periodic community-wide epidemics of the disease
Vaccination consists of two injections, given six to twelve months apart. The initial dose will provide immunity to hepatitis A beginning in about four weeks and lasting about one year. The second dose provides long term immunity, which lasts for years and perhaps is even life-long.

Sources:
CDC - Division of Viral Hepatitis
Wisconsin Division of Public Health - Bureau of Communicable Diseases

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