Hepatitis A

The hepatitis A virus (HAV) is present in all parts of the world with very different consequences: In developed countries, infections occur only very rarely. In countries with a shortage of clean water and poor sanitation, the virus can lead to epidemics with countless infections. The virus is robust and survives even high temperatures and disinfectants. Around the globe, an estimated 1.4 million people are infected with hepatitis A each year. In Switzerland, about 100 cases of hepatitis A are reported every year. Because only some of the infected fall ill, the number is probably up to four times as high. An acute hepatitis A infection always leads to lifelong immunity. It never develops into a chronic illness.

Transmission

Because the hepatitis A virus is eliminated via the digestive system, it is transmitted mainly through contaminated drinking water or food. Mussels or vegetables, which have been fertilised with faecal manure, are particularly dangerous. Further ways of transmission are close personal contact, in particular sexual contact (anal sex), or inadequate hand hygiene. Infection occurs most often when travelling in countries with low hygienic standards. That is why hepatitis A is sometimes called “travellers’ hepatitis”.

People Most at Risk

Everyone who is not vaccinated against hepatitis A or has not gained immunity through a past infection can fall ill. Most at risk are people in developing countries with poor sanitation. In Switzerland, it was injecting drug users who typically became infected in the past. Today it is people who travel to tropical countries, the Mediterranean and Eastern Europe who are most likely to catch the virus. People who practice anal sex and employees who come into contact with faeces also face an increased risk of infection.

Symptoms

In small children, the infection usually does not present any symptoms. In 50 to 70 per cent of adults, an acute hepatitis A occurs, accompanied by nonspecific symptoms of the gastrointestinal tract. The incubation period, i.e. the time between infection and outbreak of the disease, is about 15 to 50 days. Signs can be mild flu symptoms, fatigue, headaches and a slight fever, often accompanied by nausea, constipation or diarrhoea. Eyes and skin can become yellow. Most symptoms will subside after a few weeks. The infection is never chronic and always leads to lifelong immunity.

Diagnosis

Raised levels of certain liver enzymes in the blood indicate a hepatitis A infection. Close examination of the hepatitis A virus antibodies shows if it is a recent infection or immunity from an old infection.

Prevention

Only vaccination provides reliable protection against hepatitis A. The hepatitis A vaccine, as well as the combined hepatitis A and B vaccine, has been proven to be highly effective and safe. Two injections six months apart (or three vaccinations in the case of the combination vaccination) provide lifelong protection. Doctors recommend the vaccine before travelling to high-risk regions, for high-risk groups of people and for patients with chronic liver disease or another hepatitis infection.

You can reduce the risk of an infection with hepatitis A by avoiding contact with contaminated faeces and by maintaining the following hygiene standards when eating and drinking (especially in developing countries):

• Only drink bottled drinks
• Avoid ice cubes and ice cream
• Eat only fruit you peeled yourself
• Beware of salad, raw vegetables and seafood
• Wash your hands often and with soap, especially after using the toilet

When travelling, adhere to the motto: Cook it, boil it, peel it or leave it.

Therapy

There is no antiviral therapy nor are there any other medicines available to treat hepatitis A. Recovery from an acute hepatitis A infection requires bed rest and can take several weeks or months of taking it easy. A balanced, low-fat, high carbohydrate diet and drinking sufficient fluids are important. Alcohol and liver-harming medicines should be avoided in order to not burden the liver further. Hepatitis A patients are not contagious, as long as the rules for hand hygiene are being followed when caring for or touching a patient.