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Hepatitis A

Condition Overview:

Hepatitis A is an inflammation of the liver caused by a virus, the hepatitis A virus (HAV). It varies in severity, running an acute course, generally starting within two to six weeks after contact with the virus, and lasting no longer than two or three months. HAV may occur in single cases after contact with an infected relative or sex partner. Alternately, epidemics may develop when food or drinking water is contaminated by the feces of an infected person.

Hepatitis A was previously known as infectious hepatitis because it spread relatively easily from those infected to close household contacts. Once the infection ends, there is no lasting, chronic phase of illness. However it is not uncommon to have a second episode of symptoms about a month after the first; this is called a relapse, but it is not clear that the virus persists when symptoms recur. Both children and adults may be infected by HAV. Children are the chief victims, but very often have no more than a flu-like illness or no symptoms at all (so-called "subclinical" infection), whereas adults are far likelier to have more severe symptoms.

Epidemics of HAV infection can infect dozens and even hundreds (or, on rare occasions, thousands) of persons. In the public's mind, outbreaks of hepatitis A usually are linked with the eating of contaminated food at a restaurant. It is true that food-handlers, who may themselves have no symptoms, can start an alarming, widespread epidemic. Many types of food can be infected by sewage containing HAV, but shellfish, such as clams and oysters, are common culprits.

Apart from contaminated food and water, certain groups are at increased risk of getting infectious hepatitis:

• Children at day care centers make up an estimated 14-40% of all cases of HAV infection in the United States. Changing diapers transmits infection through fecal-oral contact. Toys and other objects may remain contaminated for some time. Often a child without symptoms brings the infection home to siblings and parents.
• Troops living under crowded conditions at military camps or in the field. During World War II there were an estimated five million cases in German soldiers and civilians.
• Anyone living in heavily populated and squalid conditions, such as the very poor and those placed in refugee or prisoner-of-war camps.
• Homosexual men are increasingly at risk of HAV infection from oral-anal sexual contact.
• Travelers visiting an area where hepatitis A is common are at risk of becoming ill.

The time from exposure to HAV and the onset of symptoms ranges from two to seven weeks and averages about a month. The virus is passed in the feces, especially late during this incubation period, before symptoms first appear. Infected persons are most contagious starting a week or so before symptoms develop, and remain so up until the time jaundice (yellowing of the skin) is noted.

Often the first symptoms to appear are fatigue, aching all over, nausea, and a loss of appetite. Those who like drinking coffee and smoking cigarettes may lose their taste for them. Mild fever is common; it seldom is higher than 101°F (38.3°C). The liver often enlarges, causing pain or tenderness in the right upper part of the abdomen. Jaundice then develops, typically lasting seven to ten days. Many patients do not visit the doctor until their skin turns yellow. As many as three out of four children have no symptoms of HAV infection, but about 85% of adults will have symptoms. Besides jaundice, the commonest are abdominal pain, loss of appetite, and feeling generally poorly.

An occasional patient with hepatitis A will remain jaundiced for a month, two months or even longer, but eventually the jaundice will pass. Very rarely, a patient will develop such severe hepatitis that the liver fails. HAV infection causes about 100 deaths each year in the United States. In developed countries, a pregnant woman who contracts hepatitis A can be expected to do well although a different form of viral hepatitis (hepatitis E) can cause severe infection in pregnant women. In developing countries, however, the infection may prove fatal, probably because nutrition is not adequate.

The early, flu-like symptoms and jaundice, as well as rapid recovery, suggest infectious hepatitis without special tests being done. If there is any question, a specialist in gastrointestinal disorders or infectious diseases can confirm the diagnosis-the detection of a specific antibody, called hepatitis A IgM antibody, that develops when HAV is present in the body. This test always registers positive when a patient has symptoms, and should continue to register positive for four to six months. However, hepatitis A IgM antibody will persist lifelong in the blood and is protective against reinfection.