1. HEPATITIS A EISENMAN ARIE, M.D Department of Internal Medicine B Rambam Medical Center Haifa, Israel eisenman@rambam.health.gov.il

2. Hepatitis A -- What Is It? The most prevalent type of hepatitis. The seventh most commonly reported infectious disease in the United States Highly contagious virus. Mainly transmitted through the fecal-oral route; while hepatitis B, C, and D are spread through blood or other body fluids.

3. How Can Hepatitis A Be Prevented? Historically, the most common prevention has been immune globulin administration, which is effective for about three to six months. Now, there are two vaccines that provide longer-term protection and eliminate the need for repeated shots. one initial shot followed by a booster shot in about six to 18 months. Prior infection with hepatitis A confers lifetime protection against a second attack. If in doubt, a blood test can determine if an individual has had hepatitis A in the past or needs protection.

4. How Is Hepatitis A Spread? Close personal contact with someone infected with hepatitis A. Eating foods contaminated by infected food handlers. Contact with infected children (who do not usually show symptoms), who can then infect non-immune children or adults at home or in child-care centers. Ingesting raw or undercooked shellfish from waters contaminated with the hepatitis A virus. Transmission through blood transfusions or sharing needles with infected people using injectable drugs. The virus is transmitted by the fecal-oral route, through close person-to-person contact, or by ingesting contaminated food or water.

5. people potentially susceptible to catching hepatitis A include: Those who travel to less developed areas of the world where hepatitis A is common. Individuals living in areas where hepatitis A is endemic Certain ethnic and geographic populations that experience cyclic epidemics Male homosexuals and others who engage in high-risk sexual activity Hemophiliacs and other recipients of therapeutic blood products Military personnel Youngsters in child-care facilities, their families, and facility staff Food handlers Healthcare workers Institutionalized persons and their caregivers Laboratory workers Handlers of primates that may harbor hepatitis A. Poor sanitation or overcrowded living conditions.

6. There is currently no treatment for hepatitis A Overt hepatitis develops in the majority of infected older children and adults. In adults: approximately 22 percent will be hospitalized. An estimated 100 deaths occur in the U.S. each year from hepatitis A.

7. The incubation period The incubation period for hepatitis A ranges from 20 to 50 days, which means that infectious patients, such as food handlers or children, can spread the disease well before they are even aware they have it. Incubation is shorter with increasing age. Most patients begin recovery within three weeks, although some have prolonged or relapsing symptoms for up to six months.

8. Common Symptoms of Hepatitis A fatigue nausea vomiting fever/chills jaundice Nutrition can relieve some symptoms. The most important factor affecting the severity of the disease is age. Children less than a year old rarely show clinical signs of the illness. Parents and child-care workers handling soiled diapers can catch or transmit the disease without knowing they have been exposed. pain in the liver area dark urine light-colored stools abdominal pain

9. Why Worry About Children? The highest incidence of hepatitis A is in children. Nearly 30% of the reported cases occur in children younger than 15. Children are a silent source in spreading the disease. Approximately 45% of persons with HAV cannot identify a recognized risk factor associated with their disease, but about half of them have children under five years of age living in their households.

10. What Is The Economic Impact Of Hepatitis A? The annual direct and indirect costs of treating cases and controlling outbreaks of hepatitis A in the United States are estimated to be $200.000. Additional economic costs are incurred when adults who contract the disease miss an average of 27 days of work, which translates into approximately $2600 in lost wages for each adult case