Viral hepatitis

The hepatitis A virus is found in the stools, blood, and semen of an infected person about 15 to 45 days before symptoms occur and during the first week of illness.

You can catch hepatitis A if:

• You come in contact with food or water contaminated by the virus
• You come in contact with a person who currently has the disease

There are approximately 100,000 hepatitis A infections in the United States every year.

Risk factors include:

• International travel, especially to Asia or South or Central America
• IV drug use
• Living in a nursing home or rehabilitation center
• Working in a health care, food, or sewage industry

Other common hepatitis virus infections include hepatitis B and hepatitis C , but hepatitis A is the least serious and most mild of these diseases. Both of the others may become chronic illnesses, but hepatitis A does not.

• Dark urine
• Fatigue
• Itching
• Loss of appetite
• Low-grade fever
• Nausea and vomiting
• Pale or clay-colored stools
• Yellow skin (jaundice)

The doctor will perform a physical examination and may discover that you have an enlarged and tender liver.

Hepatitis serology tests may show:

• IgM and IgG antibodies to hepatitis A (IgM is usually positive before IgG)
• Elevated liver enzymes (liver function tests )

There is no specific treatment for hepatitis A. Rest is recommended during the acute phase of the disease when the symptoms are most severe. People with acute hepatitis should avoid alcohol and any substances that are toxic to the liver, including acetaminophen (Tylenol).

Fatty foods may cause vomiting, because secretions from the liver are needed to digest fats. Fatty foods are best avoided during the acute phase.

The virus does not remain in the body after the infection has gone away.

Over 85% of people with hepatitis A recover within 3 months. Nearly all patients get better within 6 months.

There is a low risk of death, usually among the elderly and persons with chronic liver disease.

There are usually no complications. One in a thousand cases become fulminant hepatitis, which can be life threatening.

Call for an appointment with your health care provider if you have symptoms of hepatitis.

The following tips can help reduce your risk of spreading or catching the virus:

• Always wash your hands thoroughly after using the restroom and when you come in contact with an infected person's blood, stools, or other bodily fluid
• Avoid unclean food and water

The virus may spread more rapidly through daycare centers and other places where people are in close contact. Thorough hand-washing before and after each diaper change, before serving food, and after using the restroom may help prevent such outbreaks.

Immune globulin should be given to people in close contact with people with hepatitis A, unless the person is already immune to the virus.

Vaccines that protect against hepatitis A infection are available. The vaccine begins to protect 4 weeks after receiving the first dose; the 6- to 12-month booster is required for long-term protection. See: Hepatitis A vaccine

Travelers should take the following precautions:

• Avoid dairy products.
• Avoid raw or undercooked meat and fish.
• Beware of sliced fruit that may have been washed in contaminated water. Travelers should peel all fresh fruits and vegetables themselves.
• Do not buy food from street vendors.
• Get vaccinated against hepatitis A (and possibly hepatitis B) if traveling to countries where outbreaks of the disease occur.
• Use only carbonated bottled water for brushing teeth and drinking. (Remember that ice cubes can carry infection.)
• If no water is available, boiling water is the best method for eliminating hepatitis A. Bringing the water to a full boil for at least 1 minute generally makes it safe to drink.
• Heated food should be hot to the touch and eaten right away.

American Academy of Pediatrics Committee on Infectious Diseases. Recommended immunization schedules for children and adolescents--United States, 2008. Pediatrics. 2008 Jan;121(1):219-20.

Recommended Immunization Schedule for Persons Aged 7–18 Years--United States, 2008. MMWR. October 19, 2007 / 56(41);Q1-Q4.

Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, October 2007-September 2008. Ann Intern Med. 2007 Nov 20;147(10):725-9.