Hepatitis A (HAV) Overview
In 2017 and early 2018, four states reported major outbreaks of hepatitis A (HAV) to the Centers for Disease Control and Prevention (CDC). The list below reflects the numbers provided by the CDC and news reports at the time this article went to print.
- California: As of December 29, 2017: 683 cases; 443 hospitalizations; 21 deaths.
- San Diego is the site of the largest outbreak.
- Michigan: As of January 10, 2018: 658 cases; 539 hospitalizations; 22 deaths.
- Utah: January 10, 2018: 152 cases; 68 hospitalizations; no deaths.
- Kentucky: Reported 44 cases of HAV, but no cases resulted in death.
The majority of the HAV outbreaks were among the homeless population and people who inject or take drugs.
Hepatitis A (HAV) is a virus that affects the liver. It is the most common type of viral hepatitis in the United States.
Hepatitis A virus infection continues to be one of the most frequently reported, vaccine-preventable diseases in the United States. In 1997, there were 180,000 new HAV infections, but the incidence has dramatically decreased by 95% with the introduction of the HAV vaccine and increased prevention measures.
Unlike hepatitis B and C, which are spread through contact with infected blood or body fluids, hepatitis A is spread through food and water contaminated by feces (poop) of people infected with HAV. The virus is spread by hepatitis A virus-infected fecal matter that is ingested (by mouth) or through blood. The hepatitis A virus may be present even if you cannot see it (e.g., a glass of water, ice cubes, food, etc.).
HAV is also transmitted through close, personal contact such as changing diapers and through some types of sexual contact (e.g., analingus, or anal/oral sex) and, rarely, injection drug use.
This virus is extremely hearty. It can survive the body’s highly acidic digestive tract. At room temperature, HAV can live for more than a week. In water, it can survive from 3 to 10 months, which is why it is found in some shellfish in sewage-contaminated bodies of water.
Workers in day care centers and long-term care facilities, such as nursing homes, have a higher risk of getting hepatitis A, as do international travelers to areas that have substandard drinking water.
Risk factors associated with hepatitis A
- People who have contact with an HAV-infected individual (caregivers and household members)
- Sex contacts of infected persons
- Men who have sex with men
- People who inject or use drugs
- International travelers to countries with medium to high rates of HAV
- Persons with clotting-factor disorders
To prevent transmission of HAV, adults and children must wash their hands thoroughly, especially after using the toilet or changing diapers. People infected with HAV should avoid preparing food for others. Clean up spilled blood or body fluids with a 10:1 bleach solution (10 parts water to 1 part bleach). Wear gloves when touching blood, body secretions, or any cuts or sores. Do not share razors, toothbrushes, or needles. Practice safer sex, including condoms and barriers for oral/anal sex.
HAV Symptoms and Progression
Hepatitis A has an incubation period that can be from 15 to 50 days but averages 28 days. When symptoms occur in adults, they appear suddenly and may include fever, exhaustion, loss of appetite, nausea and abdominal discomfort, dark urine, gray-colored stools (poop) and jaundice (yellowing of the skin and eyes).
Children younger than age six who become infected with HAV, usually have no symptoms. Because they are symptom-free, caregivers, parents, household members, childcare workers and other people who come into contact with infected children are at risk of contracting HAV.
Like all types of hepatitis viruses, HAV infects and inflames the liver. People at risk for more severe damage from HAV include those with chronic hepatitis C or B, the elderly, people with a compromised immune system, the homeless population, and people who inject or take drugs. There have also been outbreaks of HAV from contact with food service workers; others who some legislators have advocated for laws to require all food service workers to be vaccinated against HAV.
Hepatitis A usually resolves on its own. Symptoms usually last a few weeks, although fatigue may linger for months. About 10-15% of people experience a relapse over a 6-9 month period. There is no chronic or carrier state. A person may develop fulminant hepatitis A, which is liver failure characterized by severe symptoms and may be fatal; fulminant hepatitis A is more likely in people who already have chronic hepatitis B, hepatitis C, another liver disease, or a compromised immune system.This is why we are experiencing so many deaths. Vaccination against hepatitis A will protect people at increased risk for these complications.
Because hepatitis A typically resolves on its own, there is no standard treatment for HAV. An injection of HAV immune globulin (antibodies) given within 14 days of exposure may prevent the development of illness or lessen the severity of symptoms. During the acute period, general measures such as a healthy diet, plenty of fluids and adequate rest can help make a person feel better. In severe acute infections hospitalization may be necessary.
The HAV Vaccine
The HAV vaccine is considered safe and effective. The two-dose vaccine is administered by injection, with the second dose given 6-12 months after the first. The vaccine has demonstrated protection for 20 years, but it is estimated to protect against HAV for 40 years. Some experts believe that people with compromised immune systems (such as people with HIV or people taking immunosuppressants) may require more doses of the HAV vaccine.
There have been no serious adverse reactions attributed to the HAV vaccine. Common side effects may include soreness/tenderness at injection site, headache, and discomfort.
The recommendations for vaccination against HAV include anyone at risk of exposure to HAV, including men who have sex with men, day care center workers, and certain international travelers. People with hepatitis B or C or other types of liver disease should receive the HAV vaccine to prevent fulminant hepatitis A.
Routine mandatory vaccination of school-age children in some states has reduced the incidence of outbreaks among children. Vaccination programs have the potential to reduce future outbreaks, if not eliminate the disease. There is also a combination HAV/HBV vaccine (Twinrix) that has been FDA approved for an accelerated dosing schedule (three shots within 30 days and a booster shot after one year). People who have already been infected with hepatitis A are immune and do not need to be vaccinated.
For more information about hepatitis A and immunization, visit the following websites.
Centers for Disease Control and Prevention website on hepatitis A- https://www.cdc.gov/hepatitis/index.htm
Immunization Action Coalition- http://www.immunize.org
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Alan Franciscus is the Executive Director of the Hepatitis C Support Project and the Editor-in-Chief of the HCV Advocate Website.Share This Page