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5. Hepatitis A Virus (HAV) Infection

What is HAV?

Hepatitis A is one of many hepatitis viruses causing inflammation of the liver. HAV is an acute infection that goes away often within a couple of weeks. Once an individual recovers from HAV, the individual cannot acquire it again because of natural immunity. HAV is excreted in feces and is the most common source of food or waterborne hepatitis epidemics. Most infections are the result of an outbreak within a community or group of people who have close contact. Globally, areas of high prevalence include Mexico, Central America, Sub-Saharan Africa, Southeast Asia, and the Middle East (8). Statistics Each year an estimated 180,000 HAV infections occur in the U.S. Medical care can cost $2,800 for each hospitalized case of HAV. The annual cost associated with HAV is estimated at $200 million in the U.S. (9).

Click below Hepatitis A Virus   Geographic Distribution of Hepatitis A Virus Infection

Clinical Features (10)

Incubation Period	Average: 30 days Range: 15 – 50 days
Clinical Illness (jaundice)	<6 years: <10% 6 – 14 years: 40 – 50% >14 years: 70 – 80%
Complications	Fulminant Hepatitis Cholestatic Hepatitis Relapsing Hepatitis
Chronic Sequale	None

Signs & Symptoms (11)

Most adults who contract HAV typically develop symptoms within 10 to 40 days of exposure. Children rarely have symptoms but are capable of spreading the infection to others. The following symptoms may also be present:

• Jaundice
• Fatigue
• Abdominal pain
• Loss of appetite
• Nausea
• Diarrhea
• Headache
• Muscle Aches
• Fever
• Flu like symptoms

Transmission of HAV (11)

HAV is most commonly transmitted by close personal contact such as household contact, sexual contact, and child day care centers. Consuming contaminated food or water is also a common mode of transmission.

Here is a little story to help you remember how easily hepatitis can be spread! We like to refer to this incident as the “hepatitis A buffet!” Several years ago, when casinos began opening in the south, people from all around flocked to “the boat” to gamble and partake of the elaborate buffet that was offered for a really good price. Hundreds of people went home with more than a full stomach! One of the kitchen staff was infected with HAV, had a bowel movement while at work, and did not wash his hands. He was assigned to the salad bar and contaminated the lettuce and the salad tongs. People, especially those with a weak immune system who consumed the food, got HAV.

Blood to blood contact can spread infection.  Usually this occurs by sharing contaminated needles to inject drugs, pierce a body part or make a tattoo.

Sexual contact can also be a mode of transmission.

• HAV occurs more commonly in men who have sex with men (MSM).

• People who have oral-anal contact could also be at increased risk.

• Women are at increased risk if they have sex with men who also have sex with other men.
  • It is important when assessing risk in women to explore the extent to which they are aware of their partner’s sexual habits and recommend vaccination for those at risk.

Who is at Risk of HAV Infection? (11)

• Individuals who have contact with infected persons

• Persons who have sexual contact with infected persons

• Children living in areas with high incidence of HAV

• Persons who travel to countries with high incidence of HAV

• Individuals who have anal sex with men, specifically those who have sex with men who have sex with men (MSMs)

• Persons who share needles for any reason

Prevention (11)

• Hep A vaccine is the best prevention
• Wash hands frequently

• Wash hands with soap and water after using the bathroom, changing a diaper, and before preparing and eating food.

• Avoid raw or undercooked food

• Use a barrier method such as a condom if you have sex

• Do not share needles for any reason

Immune Globulin

Immune globulin is a preparation of antibodies that can be given before exposure for short-term protection against HAV and for persons who have already been exposed to the virus.  It must be given within two weeks after exposure to HAV for maximum protection.

Hepatitis A Vaccine

The HAV vaccine provides the best protection against the disease and has been licensed in the US for use in persons two years of age and older. It is recommended for persons who are more likely to get HAV infection or are more likely to get seriously ill if they do get hepatitis A.

HAV Vaccination is recommended for:

• Individuals who travel to countries with increased rates of HAV

• Men who have sex with men (MSM) and women who have sex with MSM

• Injecting and non-injecting drug users

• Persons with chronic liver disease or other immune disorders

• Children in high incidence areas

For information about available vaccines, doses and schedules, go to:

• Immunization Action Coalition and Hepatitis B Coalition

• CDC's Childhood & Adolescent Immunization Schedule

• The World Health Organization's Viral Hepatitis A Vaccines, Immunization and Biologicals Information

• Stophep: Hepatitis A and B immunization and prevention program

Treatment

Most individuals with HAV recover after a few weeks without treatment. However, bed rest may be advised and no alcohol should be consumed for a few weeks. People who have a weak immune system or existing liver disease could have much more severe illness. For this reason, it is important to assess other risk behaviors and advise testing when indicated.

Diagnosing HAV

 A blood test showing the presence of IgM anti-HAV in serum confirms the diagnosis of acute hepatitis A infection. Once infected and recovered, the antibodies to the virus provide protection from future infections with HAV. Following this, HAV blood tests will always return a positive result. In most states, HAV is reportable by law.  You must report infections to your local or state department of health (please see the resources section).

For more information on Hepatitis A, go to:

• National Institute of Diabetes & Digestive & Kidney Diseases' (NIDDK) How is hepatitis a treated?

• Hepatitis A Fact Sheet in PDF format

• CDC's Viral Hepatitus Slidesets

• CDC's Viral Hepatitis A - Frequently Asked Questions

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URL: http://65.163.14.21/training/hep/5hepA.htm
 Last update: 03/05/08