Health care 13 Report Hepatitis A Presented by Vanessa S. Ediza

Introduction  Hepatitis A is a general term meaning inflammation of the liver  One of the oldest diseases known to humankind  A self-limited disease which results in fulminant hepatitis and death in only a small proportion of patients  Formerly called Infectious Hepatitis, Epidemic Hepatitis, Epidemic Jaundice, Catarrhal Jaundice, Type A Hepatitis, HA

History The manifestations of liver disease such as Hepatitis B included jaundice characterized by Hippocrates and found to be infectious as early as the 8 th century. Hippocrates

By 1885, hepatitis was found to be transmittable through blood transfusions and syringes when epidemics of jaundice broke out during the wars of the 17 th – 19 th centuries. During the World War II, between 1939 – 1945, a series of outbreaks occurred after vaccination for measles and yellow fever, implying further that the virus is blood-borne. In 1947, MacCallum classified viral hepatitis into two types: Viral Hepatitis A or infectious hepatitis and Viral Hepatitis B or serum hepatitis. By 1963, research concerning hepatitis finally paid off.

In 1965, Baruch Blumberg, then working at the National Health Institute (NIH), discovered the Australian antigen ( later known to be Hepatitis B surface antigen, HBsAg ) in the blood of aborigines. He had been studying samples of sera from multiplying transfused hemophiliacs for polymorphic antibodies, and showed that the antigen HBsAg had high presence in leukemia and Down’s syndrome patients. Baruch Blumberg

Later in 1968, Prince and Okochi isolated the Australian antigen in Hepatitis B patients, and from this information, along with the discovery of the Dane particle in 1970, the first vaccine for hepatitis B was produced in 1981 and licensed as “Heptayax.” More than a decade later, the nationwide vaccination program on newborns in Taiwan originally launched in 1984 showed successful results, with reported in annual decrease of hepatocellular carcinoma in children

Risk of Hepatitis A Dark red: High, Red: Medium-High, Yellow: Low-Medium, Grey: Low

Geographic Distribution of Hepatitis A Prevalence, 2005 Obtained from US Centers for Disease Control and Prevention Traveler's Health Section

What Causes the Disease?  Caused by Hepatitis A Virus (HAV), a nondeveloped, positive stranded RNA virus, first indentified by electron microscopy in 1973, classified within the genus hepatovirus of the picornavirus family.  The virus interferes with the liver’s functions while replicating in hepatocytes. The individual’s immune system is then activated to produce a specific reaction to combat and possibly eradicate the infectious agent. As a consequence of pathological damage, the liver becomes inflamed. Hepatitis A Virus

How is HAV spread?  HAV is transmitted from person-to-person via the fecal-oral route  As HAV is abundantly excreted in feces and can survive in the environment for prolonged periods of time, it is typically acquired by ingestion of feces-contaminated food or water. Direct person-to-person spread is common under poor hygienic conditions.  Occasionally, HAV is also acquired through sexual contact (anal-oral) and blood transfussions.

Who is Susceptible to Infection?  People who have never contracted HAV and who are not vaccinated against hepatitis A, are at risk of infection.  The risk factors for HAV infection are related to resistance of HAV to the environment, poor sanitation in large areas of the world, and abundant HAV shedding in feces.  In areas where HAV is highly endemic, most HAV infections occur during early childhood.

Signs and Symptoms  Many people with HAV infection have no symptoms at all. Sometimes, symptoms are so mild that they go unnoticed. Older people are more likely to have symptoms than children. People who do not have symptoms can still spread the virus.  Symptoms of hepatitis A usually develop 2 and 6 weeks after infection. The symptoms are usually not too severe and go away on their own, over time.

 The most common symptoms are as follows:  Nausea  Vomiting  Diarrhea, especially in children  Low-grade fever  Loss of appetite  Rash  Tiredness, fatigue  Jaundice  Urine is dark brownish in color, like cola or strong tea  Pain in the area of liver  Symptoms usually last less than 2 months, although they may last as long as 9 months.  Hepatitis does not occur simply from being near someone who has the disease at work or at school.

Treatment  No specific treatment exists for Hepatitis A  The main focus is on making sure you get adequate nutrition and avoid any permanent liver damage.  Those who acquire fulminant hepatitis require hospitalization for monitoring and additional treatment such as providing adequate fluids and nutrition and managing complications such as bleeding. In some cases, people with fulminant hepatitis may even require a liver transplant.

Why is there no treatment for the acute disease?  Hepatitis A is viral disease, and as such, antibiotics are of no value in the treatment of the infection.  Antiviral agents, as well as corticosteroids, have no effect in the management of the acute disease  The administration of immune globulins (IG) may help preventing or improving the clinical manifestations of the disease if given 2 weeks of infection, but it is of no help in the acute phase of hepatitis A.  Therapy can only be supportive and aimed at maintaining comfort and adequate nutritional balance.  Complete recovery without therapy is generally the rule.

Prevention Protecting yourself  Receive immune globulin or a hepatitis vaccine.  Immuno globulin – provides short-term protection for up to 3 months  Hepatitis vaccine – protect you for up to 20 years  2 hepatitis vaccines approved by FDA  Havrix and Vaqta – contain inactivated forms of hepatitis A virus and are safe for children older than 2 years as well as for most adults  Twinrix – protects people age 18 and older against both hepatitis A virus (HAV) and the Hepatitis B virus (HBV)

 If you’ve already had hepatitis A, you won’t need to be immunized because you’ve developed your own protective antibodies. These antibodies won’t protect you form other forms of hepatitis, however.  Follow safety precautions for international travelers.  Peeling and washing all your fresh fruits and vegetables yourself  Avoiding raw or undercooked meat and fish  Practice good hygiene

Protecting others  Avoid sexual activity.  Wash your hands thoroughly after using the toilet.  Use clean utensils.  Don’t prepare food for others while you’re actively infected.

The End