| Viral hepatitis type A, formerly called infectious hepatitis, is a highly contagious inflammatory liver disease spread by the hepatitis A virus (HAV). Rarely fatal, the disease typically runs its course in 2 to 6 months.
Because the virus is spread primarily by food or water contaminated with feces, the disease is very common in developing countries with inadequate sanitation systems. Many cases occur among travelers who have recently returned from an area where the virus is prevalent and hygiene standards are low. Consumption of raw shellfish from contaminated waters may also cause infection.
Hepatitis A infections may be spread through daycare centers where good hygiene such as hand-washing is absent or through restaurants by food handlers with poor hygiene–frequently the source of epidemics. Person-to-person contact is a confirmed transmission route, although individuals spreading the infection may have no apparent symptoms. The disease may also be transmitted sexually through oral or anal contact.
In approximately 42% of reported cases, the cause is unknown ("Hepatitis A").Risk: HAV has been infrequently transmitted by blood transfusion and the use of blood products. Individuals who share needles or other injecting equipment contaminated with HAV-infected blood are at higher risk of getting the disease. Incidence and Prevalence: In 2001, 10,616 acute cases of hepatitis A were reported in the US. The estimated number of new hepatitis A infections was 93,000, a decrease from 143,000 new infections in 2000 ("Disease Burden"). In the US, about 1 in 3 people have HAV antibodies, which means they have been exposed to the virus but did not become ill (Mukherjee). An estimated 100 Americans die each year from hepatitis A ("The ABC's"). Worldwide, hepatitis A virus is responsible for approximately 1.4 million cases each year ("Surveillance"). |
Source: Medical Disability Advisor
| History: Individuals may have an abrupt onset of the disease, accompanied by loss of appetite, nausea, body aches, and fatigue. Fever is common but rarely higher than 102° F (38.9° C). Dark urine and light-colored stools may also be reported, along with a yellowing of the eyes and skin (jaundice). Symptoms develop within 3 to 6 weeks after exposure. Individuals may report recent travel to underdeveloped countries or close contact with an individual infected with HAV. Physical exam: Even when an individual is infected, the physical examination may reveal few clinical signs. The liver may be enlarged (hepatomegaly) and tender. Occasionally, the spleen is also enlarged (splenomegaly). A yellow discoloration of the eyes and skin (jaundice) may be present. Tests: Blood tests of liver function show significantly elevated levels of AST, ALT, and bilirubin. Positive results on a test specific for HAV (Hepatitis A IgM antibody) are necessary for a definitive diagnosis. Blood tests for hepatitis B and hepatitis C viruses may also be performed. |
Source: Medical Disability Advisor
| Rest is usually the only treatment for hepatitis A infection. The duration of recommended rest depends on the severity of symptoms. Appropriate fluid and food intake are also recommended. Alcohol and other substances toxic to the liver should be avoided. In the unlikely event that abnormalities persist for more than 6 months, a liver biopsy may be indicated. Those in close contact with someone with hepatitis A infection should consider receiving a protective injection of immune globulin, which is effective for about 3 to 6 months. Hepatitis A vaccines are available for those in high-risk occupations or traveling to high-risk countries, but must be given prior to exposure to HAV. The vaccine offers longer-term protection and consists of an initial shot followed by a booster shot in about 6 to 18 months. Serious reactions to the vaccine are rare, but local reactions including pain, redness, tenderness, and warmth, are common at the vaccination site. Fever, abdominal pain, headache, fatigue, and allergic reactions may also occur. Preventive measures also include washing hands frequently before handling food and after using the toilet or changing diapers. Travelers should avoid drinking untreated tap water and eating unpeeled fruit, raw vegetables, and raw shellfish when traveling to high-risk areas. |
Source: Medical Disability Advisor
| Most people with hepatitis A infection recover. In 1 to 2 months, the liver is completely healed. The first signs of recovery are the disappearance of nausea and the return of appetite. |
Source: Medical Disability Advisor
| Hepatitis A infection rarely has complications. Recovery usually begins within 3 weeks, but rarely, jaundice and other symptoms can last for 2 to 6 months or more (prolonged cholestatic jaundice). Chronic liver disease does not occur, but relapse or recurrent hepatitis is possible. |
Source: Medical Disability Advisor
| Absence of jaundice is not required before returning to work, but employees who have significant social interaction may need to limit their contact with the public. Good hygiene is crucial. Customers at a restaurant or other place of business may be wary of employees who are jaundiced for fear of exposure to a contagious disease. Employees required to perform strenuous tasks may need to limit their job-related activities in the first few days after returning to work. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Did individual travel to a country where contaminated food or water is prevalent?
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Is individual an intravenous drug user?
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Does individual live or work in a place where people are congregated?
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Was diagnosis of viral hepatitis type A confirmed by testing for hepatitis A IgM antibody?
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Were other conditions, such as other types of viral hepatitis (hepatitis B, C, and E), infectious mononucleosis, cytomegalovirus, or jaundice caused by prescription drugs, poisons, alcohol, or gallstones, ruled out?
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Does individual have an underlying condition such as liver transplant or blood clotting disorder such as hemophilia that might affect recovery?
Regarding treatment:
- Has individual been compliant with prescribed treatment plan?
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Has individual been receiving sufficient rest to recover from the disease?
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Has individual avoided substances toxic to the liver, such as alcohol?
Regarding prognosis:
- If symptoms have persisted past the expected duration, should diagnosis be revisited?
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Does individual's condition demonstrate a relapsing pattern?
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If abnormalities persist, is a liver biopsy indicated?
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Source: Medical Disability Advisor
| "Disease Burden From Hepatitis A, B, and C in the United States." Centers for Disease Control and Prevention. U.S. Department of Health and Human Services. 14 Oct. 2004 <http://www.cdc.gov/ncidod/diseases/hepatitis/resource/dz_burden02.htm>. "Hepatitis A Factsheet." American Liver Foundation. 14 Oct. 2004 <http://www.liverfoundation.org/db/articles/1061>. Mukherjee, Sandeep. "Hepatitis A." eMedicine. Ed. Simmy Bank. 9 Aug. 2004. Medscape. 14 Oct. 2004 <http://www.emedicinehealth.com/articles/11320-1.asp>. "Surveillance and Control." World Health Organization. World Health Organization. 15 Dec. 2004 <http://who.int/csr/disease/hepatitis/whocdscsredc2007/en/index4.html#incidence>. "The ABC's of Hepatitis." Hepatitis Foundation International. 14 Oct. 2004 <http://www.hepfi.org/living/liv_abc.html#basics_hep_A>. |
Source: Medical Disability Advisor
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