Hepatitis A

Hepatitis A is an acute, short-term viral infection that causes liver inflammation and damage.

The symptoms of hepatitis A can vary from mild to severe and usually appear about two to six weeks after exposure to the virus. The majority of adults experience symptoms, while children seldom show any. Symptoms of hepatitis A may include:

• Nausea
• Vomiting
• Fatigue
• Malaise
• Abdominal pain
• Poor appetite
• Fever
• Itching
• Joint pain
• Dark yellow urine
• Gray or clay-colored stools
• Jaundice

In mild cases, the infection may last about 4 to 6 weeks, while more severe infections can last about 6 months. Unlike hepatitis B and C, hepatitis A does not cause chronic liver disease. However, very rarely, it can cause acute liver failure, which can be fatal.

The hepatitis A virus (HAV) usually spreads through the oral-fecal route, i.e., through direct or indirect contact with an infected person’s stool.

Here are some common ways in which hepatitis A can be spread:

1. Consuming contaminated water or food
   This virus is usually transmitted by consuming water, liquids, or food contaminated with feces that contains the virus. This can occur in some of the following ways:
   • Drinking water from sources such as unprotected wells, boreholes, and standpipes contaminated by feces during transportation or supply.
   • Food, drinks, and ice made from contaminated water.
   • Cooking and eating in utensils washed in contaminated water.
   • Raw fruits and vegetables that are irrigated with water containing human waste or rinsed with contaminated water.
   • Seafood, especially crustaceans and shellfish, grown in contaminated water.
2. Poor hand hygiene
   If someone infected with hepatitis A doesn't wash their hands properly after using the bathroom, they can contaminate objects, surfaces, or food they touch. This can spread the virus to others who touch their mouth after coming into contact with contaminated objects. Optimum hand hygiene lays the foundation for preventing many diseases.
3. Close personal contact with an infected person
   Close personal contact with an infected individual, such as through sexual contact (oral-anal sex), caring for someone who is unwell, or sharing needles and drugs, can spread hepatitis A. Infected individuals who use needles can spread the virus by sharing them or not disposing of them properly. Hepatitis A is highly contagious, and people can spread the infection even before they become ill.
4. Getting tattoos and body piercings from unregulated settings
   Needlestick or instrument-related exposure to blood is more likely in unregulated settings. To minimize the risk of infection, it is advisable to get tattoos or body piercings done in regulated establishments.

Anyone who has not been vaccinated or previously infected can get infected with the hepatitis A virus. The following individuals may be at a higher risk:

• International travellers or individuals travelling to or living in regions with high hepatitis A prevalence.
• Close personal contact or sex with an infected individual.
• Men who have sex with men (MSM).
• Individuals using illicit drugs.
• Living with or taking care of an infected individual.
• Living with or taking care of a child recently adopted from a country where hepatitis A is common.
• Kids and teachers working in childcare centers or institutions.
• People experiencing homelessness or unstable housing.
• Individuals with chronic liver disease, including hepatitis B and hepatitis C.
• Those infected with HIV.
• Personnel who work with primates.

Hepatitis A is typically diagnosed through a combination of medical history, physical examination, and laboratory tests.

Here are some common diagnostic methods used for hepatitis A:

1. Medical history and physical examination: Your doctor will ask you about your symptoms, recent travel and activities, and any potential exposure to the hepatitis A virus (HAV). They may also conduct a physical examination to assess your liver and overall health.
2. Blood tests: Blood tests are used to detect specific antibodies or viral components associated with hepatitis A. These tests include:
   • Hepatitis A IgM antibody test: The body produces IgM antibodies after the first exposure to hepatitis A. They remain in the blood for about 3 to 6 months. This primary test detects IgM antibodies produced in response to the hepatitis A virus.
   • Hepatitis A IgG antibody test: This test checks for IgG antibodies, indicating prior infection or vaccination against hepatitis A. It can help determine if you have had a past infection or received vaccination.
   • Liver function tests: These tests measure the levels of certain enzymes and proteins in the blood that can indicate liver damage or inflammation. Elevated levels of liver enzymes, such as alanine transaminase (ALT) and aspartate transaminase (AST), may suggest hepatitis A infection.
3. Reverse transcriptase polymerase chain reaction (RT-PCR) test: This additional test detects the hepatitis A virus RNA and may require specialized laboratory facilities.

Unsure of where to go for these tests? We are prepared to assist you.

To prevent the spread of hepatitis A infection, it is essential to follow these measures:

1. Get Vaccinated

   The hepatitis A vaccine is highly effective in preventing the infection. It is recommended for:

   • Children aged 12 to 23 months
   • Older children who have not received the vaccine
   • Travellers to areas with high hepatitis A prevalence
   • Men who have sex with men
   • Individuals with occupational risk exposure
   • Pregnant women at risk of severe hepatitis A
   • People with clotting factor disorders or chronic liver disease
   • Those who use illegal drugs
   • Homeless individuals

   Note: Standard adult dosing recommends the administration of two doses of the vaccine 6 to 12 months apart.

2. Maintain Optimum Hand Hygiene

   The spread of hepatitis A can be prevented by following basic hand hygiene. It is advised to thoroughly wash hands with soap and water:

   • After using the washroom
   • Before, during, and after preparing food
   • Before and after eating food
   • Before and after feeding children
   • After changing a child’s diaper or washing their stools
   • After taking care of someone suffering from cholera

   It is also important to avoid touching your face, mouth, or eyes with unwashed hands.

3. Ensure Safe Drinking Water
   • Drink only filtered or boiled water
   • Use filtered or boiled water to prepare food, brush teeth, and make ice
   • Avoid using water bottles without a seal
   • Store water in a clean and covered container
4. Cook and Consume Food Vigilantly
   • Prepare food in filtered or boiled water
   • Wash fruits and vegetables with filtered or boiled water
   • Consume fruits and raw vegetables after peeling
   • Cook food thoroughly, especially seafood such as shellfish, which has the highest chance of contamination.
5. Maintain Cleanliness
   • Clean kitchen surfaces and utensils thoroughly with soap and water
   • Use kitchen utensils and surfaces to cook food only after drying
   • Wash clothes at least 30 meters away from drinking water sources
   • Disinfect any stool-contaminated surfaces with household bleach
6. Improve Sanitation at the Community Level

   Improving sanitation and sewage systems at a community level can help prevent the contamination of water sources and reduce the transmission of hepatitis A.

7. Practice Safe Sex

   Hepatitis A can be transmitted through sexual contact, particularly anal-oral contact. To reduce the risk:

   • Practice safe sex by using barrier methods, such as condoms, during sexual activity.
   • Limit the number of sexual partners and choose partners who have been vaccinated or are known to be free of hepatitis A infection.
8. Avoid the Reuse of Needles

   Sharing contaminated needles is a major risk factor for hepatitis transmission. This includes needles used for tattoos and body piercings as well. It is advisable to get tattoos or body piercings done by regulated establishments.

How to Prevent Hepatitis A if One Comes in Close Contact with an Infected Person?

1. Get Post-exposure Prophylaxis

   If you have been in close contact with someone who has hepatitis A, your doctor may recommend post-exposure prophylaxis (PEP). PEP involves receiving a vaccine or immune globulin injection to prevent infection or reduce the severity of the illness.

2. Isolate Yourself

   To prevent transmission of the virus to others, it's advisable to limit contact with others until you are no longer contagious. Follow the recommendations of your doctor regarding isolation duration.

The treatment for hepatitis A typically focuses on supportive care, as the infection usually resolves on its own without specific medical intervention. The body's immune system clears the virus over time, usually within a few weeks to months. During this period, supportive care is recommended to relieve symptoms and promote recovery.

Various supportive measures include:

• Rest: Getting plenty of rest helps the body recover and conserve energy.
• Fluids: Maintaining adequate hydration is important. Drinking water and electrolyte-rich fluids like oral rehydration solutions and coconut water can prevent dehydration, especially if there is vomiting or diarrhea. It is important to avoid alcohol during this time, as it can cause further liver damage.
• Nutrition: Consuming a healthy, well-balanced diet supports liver function and overall recovery. Avoid packaged, processed, and junk food.
• Medications: Take medications with caution. Acetaminophen and paracetamol should be avoided, as well as medications against vomiting. Medications that are metabolized by the liver should be approached cautiously, as liver function may be impaired.
• Regular monitoring: Regular monitoring of liver function through blood tests may be recommended to ensure proper recovery.

Note: Rarely (in less than 5% of cases), liver failure can occur from hepatitis A. Immediate hospitalization and referral to a transplant center is critical for cases of HAV-associated fulminant liver failure.

The following herbal remedies have been traditionally used to improve liver health and function. However, it's important to seek your doctor's consent before initiating any of these herbal remedies for the management of Hepatitis A:

• Turmeric (Haldi): Turmeric contains a compound called curcumin, which has anti-inflammatory and antioxidant properties. It also aids in the removal of toxins from the body. Turmeric can be cooked with meals, taken alone, or consumed as turmeric tablets or liquid extract.
• Hellebore (Kutaki): It is considered a potent liver tonic in Ayurveda. It has a profound cleansing influence on the liver and promotes liver function. It can be taken in powder, tablet, or capsule form.
• Jamun (Indian blackberry): Jamun possesses antioxidant and anti-inflammatory properties that are helpful in reducing liver inflammation. You can consume jamun as a fruit, fresh juice, powder, capsule, or tablet form.
• Kalmegh: Studies suggest that the use of Kalmegh helped cure 80% of people with infectious hepatitis. Patients who took Kalmegh in the form of a decoction experienced a noticeable decrease in liver enzymes.
• Ginger (Adrak): With its culinary versatility, ginger root is not only a flavorful ingredient but also a medicinal remedy for liver disease. It possesses anti-inflammatory properties, safeguards against cellular damage, and provides potential support for liver health. It can be added while cooking food or consumed in the form of a tablet or capsule.
• Triphala: Triphala is a powerful mixture that aids in regulating metabolism and promoting healthy bowel movements and liver function. Triphala churna can be taken before bedtime to enhance overall wellness. It can be consumed as Triphala juice before meals.
• Amla (Indian gooseberry): Amla is rich in antioxidants and is believed to have liver-protective properties. It can be consumed as fresh fruit and is available in various forms such as powder, tablet, capsule, or candy.
• Green tea: Loaded with antioxidants, green tea has antiviral effects that aid in fighting viral hepatitis.
• Milk thistle (Doodh patra): This Mediterranean herb acts as a potent liver cleanser. It aids in regenerating liver cells, minimizing damage, and eliminating toxins processed by the liver. It can be taken in the form of a tablet, capsule, or powdered form as recommended by a doctor.

Hepatitis A (HAV) is a viral infection that primarily affects the liver. While most cases of hepatitis A resolve on their own without causing long-term complications, in some instances, it can lead to complications such as:

• Prolonged Cholestasis: Hepatitis A causes liver inflammation, which can disrupt bile flow for an extended period. This buildup of bile in the liver can lead to jaundice, dark urine, pale stools, and itching.
• Relapsing Hepatitis: The symptoms of hepatitis A-induced liver inflammation, such as jaundice, can reoccur periodically. However, they are not chronic or long-term.
• Autoimmune Hepatitis: Sometimes, hepatitis A can cause the immune system to mistakenly attack healthy liver cells, leading to autoimmune hepatitis. This condition involves chronic inflammation and can eventually result in liver damage, scarring, cirrhosis, and liver failure.
• Acute Liver Failure: Hepatitis A may cause liver failure in rare cases, particularly in adults over the age of 50, those who are immunocompromised, or individuals with other liver illnesses.
• Acute Renal Failure: Although primarily affecting the liver, hepatitis A can cause acute renal failure in rare cases. This condition occurs when the kidneys suddenly lose their ability to filter waste and regulate fluids, potentially leading to toxin buildup and imbalances.

Here are some complementary and alternative therapies that can augment the conventional treatment and support overall well-being during the recovery phase of hepatitis A:

• Acupuncture: A traditional Chinese medicine practice that can provide relief for chronic pain, such as low-back pain, neck pain, and knee pain, commonly experienced by individuals with hepatitis A.
• Meditation: A mindfulness practice that can boost overall immunity and facilitate faster recovery.
• Tai Chi: This practice appears to help improve balance and stability. Additionally, tai chi can alleviate back pain and knee pain, common symptoms experienced by those with hepatitis A.
• Yoga: An ancient practice that combines physical postures, breathing exercises, and meditation, which can be beneficial for individuals with hepatitis A. Yoga helps relieve stress, supports healthy habits, and improves mental and emotional well-being.
• Relaxation Techniques: Deep breathing exercises help individuals relax, reduce stress, and promote a sense of calmness. Guided imagery also aids in creating positive mental images to reduce anxiety and induce relaxation. These techniques can be employed as self-care strategies to alleviate symptoms and enhance overall well-being in individuals with hepatitis A.

Hepatitis A viral infection is typically a self-limiting disease that resolves on its own without causing long-term complications. However, it can still impact a person's quality of life during the acute phase.

Here are some ways in which hepatitis A can affect quality of life and strategies to cope with them:

1. Physical Symptoms

Hepatitis A can cause physical symptoms such as:

• Fatigue
• Nausea
• Abdominal pain
• Jaundice
• Loss of appetite
• Muscle aches

These symptoms can disrupt daily activities and lower energy levels. Coping strategies include getting enough rest, eating well, staying hydrated, and following your doctor's recommendations, which may include medications to relieve specific symptoms.

2. Emotional Impact

Hepatitis A can cause emotional distress, including anxiety and worry about the disease's impact on personal and professional life. Seeking support from friends, family, or mental health professionals can provide emotional support and help manage anxiety and stress.

3. Social Isolation

Hepatitis A may lead to social isolation due to the need to avoid spreading the infection. While it is necessary to limit close contact with others, you can stay connected through:

• Phone calls
• Video chats
• Social media

Communicate your situation to close contacts to maintain social interactions and prevent misunderstandings.

4. Impact on Work and School

Hepatitis A may necessitate time off from work or school, impacting productivity, finances, and education. Communicate with employers or school administrators, who may provide accommodations or flexible arrangements to manage workload and make up missed studies.