How Is Hepatitis A Caused

Distinctive Properties Of Hcv

The genome of HCV resembles those of the pestiviruses and flaviviruses in that itcomprises around 10,000 nt of positive sense RNA, lacks a 3 polyAtract and has a similar gene organization. It has been proposed that HCV shouldbe the prototype of a third genus in the family Flaviviridae.

The non-structural region of the HCV genome is divided into regions NS2 to NS5.In the flaviviruses, NS3 has two functional domains, a protease which isinvolved in cleavage of the non-structural region of the polyprotein and ahelicase which is presumably involved in RNA replication. Motifs within thisregion of the HCV genome have homology to the appropriate consensus sequences,suggesting similar functions. NS5 seems to be the replicase and contains thegly-asp-asp motif common to viral RNA-dependent RNA polymerases .

Who Should Be Tested

Testing for hepatitis A is not routinely recommended.

CDC recommends hepatitis B testing for:

• Men who have sex with men
• People who inject drugs
• Household and sexual contacts of people with hepatitis B
• People requiring immunosuppressive therapy
• People with end-stage renal disease
• People with hepatitis C
• People with elevated ALT levels
• Pregnant women
• Infants born to HBV-infected mothers

CDC recommends hepatitis C testing for:

• All adults aged 18 years and older
• All pregnant women during each pregnancy

• About 24,900 new infections each year

• About 22,600 new infections in 2018
• Estimated 862,000 people living with hepatitis B

• About 50,300 new infections in 2018
• Estimated 2.4 million people living with hepatitis C

Can Hepatitis A Be Treated

There is no drug treatment for hepatitis A. The disease will eventually run its course and an infected person will recover completely although recovery time varies for each person. Recovery from this virus infection means that you are protected for life from getting it again.

The following are some ways of dealing with the symptoms:

• You will feel tired and may have very little energy. You may need to take time off from daily activities, work or school to recover.
• Nausea and vomiting may cause you to lose your appetite. Try to eat small snacks and soft foods such as soup or toast.
• You may look yellow. Once you become yellow, you are no longer infectious. There is no need to isolate yourself. Let people around you know it is OK to be near you.
• Try not to drink alcohol. Your liver may not be able to process alcohol and alcohol may make your symptoms worse.
• Talk to your doctor before taking over-the-counter medications or complementary medicine. None of the alternative therapies have proved helpful in treating hepatitis A.

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Hepatitis A And E Symptoms

Hepatitis A and hepatitis E present with similar symptoms. The diseases may develop without any signs or symptoms, or symptoms may be nonspecific. If you experience any of the symptoms below for more than two weeks, make an appointment with a gastroenterologist.

There are three phases of hepatitis A and E, and symptoms may differ depending on the stage. Early in the disease, called the prodromal phase, symptoms may include:

• Fever

When To See A Doctor

The good news is recovering from the hepatitis A virus doesnt usually lead to life-threatening complications. An individual can often recover in a few weeks . And after getting it, your body will build immunity to help you from getting it again. So when should you see a doctor?

You should contact your doctor if your symptoms dont go away. It can also be serious for older individuals or those with chronic liver disease, or other health problems. Its also a good idea to contact your doctor to ensure you have the hepatitis A vaccine.

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How Do You Get Hepatitis A

Hepatitis A can be spread by sexual contact with an infected person or close personal contact . However, it is most often spread by what scientists call the fecal-oral route. This happens when one person eats or drinks something that has small amounts of fecal matter from another person who has hepatitis A. This can happen by touching something that has the virus on it and then putting your hands in your mouth. It can happen when food is grown, picked, processed or served. Water can also be contaminated.

Mothers do not pass on hepatitis A in breast milk. You cannot be infected with HAV by sitting near to or hugging someone with hepatitis A. It does not spread through coughs or sneezes.

How Hepatitis A Is Spread

Hepatitis A is most commonly spread when someone eats food or drinks water that contains the hepatitis A virus. This is more likely when travelling outside Canada in areas of the world where hepatitis A is more common. Contaminated sources may include:

• ice
• raw or frozen fruits and vegetables

Hepatitis A can also spread:

• from person to person through:
• sexual contact with an infected person
• contact with the feces of an infected person
• blood transfusions or sharing needles for drug use
• changing diapers or cleaning up stool from an infected person

Even if you do not have symptoms, you can still infect others. Infected infants and children are more likely to be without symptoms than infected adults.

You can spread the virus starting 2 weeks before you show any symptoms. You can continue to infect others until about a week after you get jaundice .

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History And Physical Exam

To diagnose hepatitis, first your doctor will take your history to determine any risk factors you may have for infectious or noninfectious hepatitis.

During a physical examination, your doctor may press down gently on your abdomen to see if theres pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam.

People At Risk Of Hepatitis A In The Uk

Although the chances of getting hepatitis A in the UK are much smaller than in other parts of the world, certain groups have an increased risk.

These include:

• close contacts of someone with hepatitis A
• men who have sex with other men
• people who inject illegal drugs
• people who may be exposed to hepatitis A through their job this includes sewage workers, people who work for organisations where levels of personal hygiene may be poor, such as a homeless shelter, and people working with monkeys, apes and gorillas

People in these groups are usually advised to have the hepatitis A vaccine to minimise their risk of infection.

Page last reviewed: 11 March 2019 Next review due: 11 March 2022

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What Are The Symptoms Of The Hepatitis A Virus

Low energy is the most common symptom of HAV. Other symptoms include fever, tiredness, loss of appetite, nausea, headache, itchy skin, muscle soreness, pain near the liver, and jaundice .

Symptoms of HAV can occur two to seven weeks after infection and are often mild. Children may not have any symptoms. Symptoms usually go away within two months. If you think you have HAV, it is important to see a doctor symptoms of HAV are similar to other more serious liver diseases.

Precautionary Treatment After Exposure

If a person has not been vaccinated, and they know they have been exposed to HAV, they can still receive either the vaccine or immune globulin within 2 weeks of the exposure.

This may include:

• colleagues of a food handler who has tested positive for HAV
• employees and children in a daycare center where someone has received a diagnosis of HAV
• anyone in close personal contact with a person who has HAV, including nurses or carers

Which treatment they should receive will depend on the age and health status of the person.

Prevention depends on immunization and good hygiene practices.

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How Serious Is It

• People can be sick for a few weeks to a few months
• Most recover with no lasting liver damage
• Although very rare, death can occur

• 15%25% of chronically infected people develop chronic liver disease, including cirrhosis, liver failure, or liver cancer

• More than 50% of people who get infected with the hepatitis C virus develop a chronic infection
• 5%-25% of people with chronic hepatitis C develop cirrhosis over 1020 years

Complications Of Hepatitis A

Around 10% of people who have had hepatitis A experience a relapse . Most people who have a relapse fully recover.

Hepatitis A does not cause chronic liver disease.

The severity of the disease is more severe in older age groups.

Complications of hepatitis A are rare, but the infection can lead to fulminant hepatitis. This is an acute form of hepatitis that can cause liver failure. The risk of death from fulminant hepatitis increases with age.

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Prevention: Wash Your Hands Regularly

Another great prevention tip is to always wash your hands regularly. Medical News Today says, HAV can survive for up to 4 hours on the fingertips, so handwashing and safe food practices can help prevent transmission.

Be sure to wash your hands effectively with soap and water before eating, drinking, and after using the bathroom.

Causes And Risk Factors Of Hepatitis A

The hepatitis A virus is passed between people through the fecal-oral route, which can occur:

• When an infected person touches objects or food after going to the bathroom and failing to wash his hands properly
• When someone doesnt wash properly after handling diapers or cleaning up the stool of an infected person
• During sex with an infected person, particularly if it involves direct or indirect anal-oral contact, or anal sex in which sanitary measures arent taken afterward

An infected person does not have to have symptoms to spread the virus.

Many U.S. states have reported hepatitis A outbreaks in recent years among people who use illegal drugs and people who are homeless or have unstable housing. In these outbreaks, the virus is spread primarily person-to-person.

You can also get hepatitis A by ingesting food or water contaminated with feces containing HAV.

Common sources of HAV transmission include fruits, vegetables, shellfish, ice, and water.

This mode of transmission is far less common in the United States and other developed countries, which have better sanitation measures in place, such as treating the water supply with chlorine or chloramine.

You cannot get HAV through casual contact with an infected person, such as through hugging or even being coughed or sneezed on.

Babies are not believed to get HAV from breast milk.

You are at an increased risk for hepatitis A if you:

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Alternative And Complementary Therapies

Because hepatitis A resolves on its own, there havent been many studies on alternative or complementary therapies to treat it.

A case report published in Integrative Medicine Research in December 2019 treated a patient with HAV with herbal medicines, twice daily acupuncture, and moxibustion.

Moxibustion is a traditional Chinese healing technique in which mugwort is burned on top of an acupuncture point.

The authors concluded that this Korean-based medicine treatment may be effective in shortening how long a person took to recover from hepatitis A, compared with no treatment at all.

Looking After Yourself When You Have Hepatitis A

AlcoholSome people with acute hepatitis develop an aversion to alcohol in the acute phase. Previously people with this condition were told to avoid alcohol for six months following the illness. This advice is no longer thought necessary.

SmokingSmoking is dangerous to everyones health. Smoking can increase the severity of liver damage. People with liver disease are more vulnerable to infection and to poor health overall, so smoking or exposure to passive smoking is not advisable.

DietIf you have a short-term hepatitis infection, for example hepatitis A, you should try to eat a normal diet. However, some people may need extra nutrition to prevent unplanned weight loss, and may benefit from a high-energy and high-protein diet. A dietitian can advise on this.

If you develop nausea and vomiting, our coping with eating difficulties may help. Read more here.

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How Common Is Hepatitis A

In the United States, hepatitis A has become relatively uncommon. After the hepatitis A vaccine became available in 1995, the rate of hepatitis A infections declined by 95 percent in the United States. The number of reported cases of hepatitis A fell to 1,239 in 2014, the lowest yearly number of cases reported since the disease could be tracked.1 However, the number of reported cases increased to 3,366 in 2017, almost 3 times higher, mostly due to outbreaks among people who use drugs and people experiencing homelessness.1 Early reports suggest that the numbers of cases and outbreaks of hepatitis A increased further during 2018 and continue at these higher rates in 2019.2

Hepatitis A is more common in developing countries where sanitation is poor and access to clean water is limited. Hepatitis A is more common in parts of Africa, Asia, Central and South America, and Eastern Europe than it is in the United States.

How Do People Get Hepatitis A

Hepatitis A virus is found in the stool of people with HAV infection. It enters the body through the mouth after someone handles something contaminated with HAV, or eats or drinks something contaminated with HAV.

People usually get hepatitis A by having close contact with a person who is infected, from food or drinks prepared by someone who is infected, or by eating shellfish harvested from sewage-contaminated water. After the virus enters the body, there is an incubation period lasting 2 to 7 weeks until illness begins.

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What Are The Symptoms Of Hepatitis A

Some people have symptoms 2 to 7 weeks after they come in contact with the virus.3 People with hepatitis A typically get better without treatment after a few weeks. In some cases, symptoms can last up to 6 months. These symptoms may include

• vomiting
• yellowish eyes and skin, called jaundice

Some people infected with hepatitis A have no symptoms, including many children younger than age 6.3 Older children and adults are more likely to have symptoms.

How Is Viral Hepatitis Prevented

Prevention of hepatitis involves measures to avoid exposure to the viruses, using immunoglobulin in the event of exposure, and vaccines. Administration of immunoglobulin is called passive protection because antibodies from patients who have had viral hepatitis are given to the patient. Vaccination is called active protection because killed viruses or non-infectious components of viruses are given to stimulate the body to produce its own antibodies.

Avoidance of exposure to viruses

Prevention of viral hepatitis, like any other illness, is preferable to reliance upon treatment. Taking precautions to prevent exposure to another individual’s blood , semen , and other bodily secretions and waste will help prevent the spread of all of these viruses.

Use of immunoglobulins

Immune serum globulin is human serum that contains antibodies to hepatitis A. ISG can be administered to prevent infection in individuals who have been exposed to hepatitis A. ISG works immediately upon administration, and the duration of protection is several months. ISG usually is given to travelers to regions of the world where there are high rates of hepatitis A infection and to close or household contacts of patients with hepatitis A infection. ISG is safe with few side effects.

Hepatitis A

Individuals at increased risk of acquiring hepatitis A are:

Some local health authorities or private companies may require hepatitis A vaccination for food handlers.

Hepatitis B

Hepatitis B vaccine is recommended for:

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Side Effects Of Immunisation Against Hepatitis A

Immunisations against hepatitis A are effective and safe. All medications can have side effects.

For most people, the chance of a serious side effect from a vaccine is much lower than the chance of serious harm if you catch the disease.

Common side effects from the hepatitis A vaccine include:

• localised pain, redness and swelling at the injection site
• low-grade temperature
• headache.

Hepatitis A Vaccine And Travel

If youâre going to a country where hepatitis A is common and youâve never had the virus or the vaccine, start the vaccination process as soon as you can. It takes 2 to 4 weeks after the first dose for the vaccine to work, but even one shot a few days before you leave will give you some protection.

People who are allergic to something in the vaccine and children younger than 6 months might instead get a shot of immune globulin , which will protect against hepatitis A for up to 2 months.

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Who Is Likely To Be Affected By Hepatitis A

Certain people are more at risk than others for hepatitis A. These include:

• People who use recreational drugs, both injected and non-injected types.
• Men who have sex with men.
• People who have close contact with someone who already is infected.
• People who have close contact with someone adopted from a country where hepatitis A is common, or people who travel to countries where hepatitis A is common.
• People who work with non-human primates.
• People who have clotting factor issues, including hemophilia.
• People who work in child care, or children who are in childcare.

Who Is At Risk For Infection

Anyone who is not immune to hepatitis A can get hepatitis A infection. Food-borne outbreaks occur sporadically throughout the USA. Certain groups of people do have a higher risk of developing HAV infection and should be vaccinated:

• Persons experiencing homelessness
• People who eat raw or under-cooked shellfish

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