HEPATITIS A

What is Hepatitis A ?

Hepatitis A is a virus infection of the liver. This organ is situated beneath the lower right ribs and in the upper right abdomen. It has many functions, including the breakdown of unwanted substances and the production of proteins. Infection of the liver produces a striking loss of appetite and abdominal pain. The whole disorder may begin with a vague flu-like illness. Apart from the loss of appetite, vomiting may occur and then jaundice occurs (yellow discoloration seen in the white of the eye but also the skin). If the infection is caught as a young child it is usually very mild and not all infected individuals will develop signs of the disease. The infection can be prevented by advance vaccination which is very effective as well as safe.

How does Hepatitis A occur ?

The responsible virus usually enters by the mouth from contaminated food or drink. It is caught directly or indirectly from another person who has the infection. After a period of about a month (the incubation period), the first signs of infection are felt. The virus reproduces within the liver and the infected liver cells are attacked by the immune system and destroyed.

Why does Hepatitis A occur ?

Poor hygiene, contaminated water, food, milk and shellfish are the main culprits. This infection is fortunately becoming less common due to better hygiene. In Western Europe sanitation is generally high. The virus is therefore often not met until patients are old enough to travel to countries with poorer hygiene levels. There appear to be no particular conditions which make a person more likely to contract the infection.

Treatment Involved for Hepatitis A

Blood tests may need to be taken to exclude other causes of hepatitis. The main treatment is rest. No special diet is of any value although alcohol and fatty food should be avoided. Occasionally if there is severe vomiting or no one to look after you at home, hospitalisation may be needed. An intravenous drip of fluids may be necessary, and anti-vomiting medicines may also be given. Antibiotics are of no value, since they are ineffective against viruses. Drugs are available for dealing with the itchy skin, should the jaundice be severe. If you are on the contraceptive pill, this should be stopped and another form of contraception used.

During Treatment for Hepatitis A

Initially there may be a lot of weight loss, depending on how severe the infection is. Patients may begin to improve after 1 - 2 weeks when the appetite returns and jaundice fades. The stools and urine return to their normal colour. Patients regain their weight, although it may take 3 - 4 months, or occasionally longer, to get back to normal. If vomiting or other symptoms become severe, contact the doctor for advice about whether the symptoms can be relieved or if hospital admission is needed.

After Treatment for Hepatitis A

Hepatitis A never recurs: one infection produces lifelong immunity. There are usually no long-term complications. Once better, no alcohol should be drunk until the liver blood tests return to normal.

If Hepatitis A is Left Untreated

In most cases, the illness improves by itself and does not need treatment. It is only patients who get severe symptoms, such as vomiting, who need treatment. If vomiting continues untreated, then dehydration can occur which may lead to serious illness. In a tiny proportion of patients a more severe illness leads to liver failure which may be life threatening.

Effects on Family of Hepatitis A

Close contacts are clearly at risk of getting the infection from you. Simple hygiene measures such as washing hands after visiting a toilet and before handling food, not sharing the same cutlery or towels, are important. Family members can be given treatment with immunoglobulin to reduce the effects of the disease. This is especially likely to be effective if it is given as soon as possible after likely contact.