Hepatitis A

KEY POINTS

1. Hepatitis A is the most commonly indicated vaccine for travel to developing countries, where there may be unsafe food and water due to poor sanitation.
2. Although children usually have almost uneventful, mild illness with hepatitis A infection, adults may suffer a serious, prolonged course.
3. Almost everyone who has lived in a developing country without prior vaccination will have acquired hepatitis A virus, and so will have lifelong, natural immunity. This can be verified with a blood test for hepatitis A IgG antibody, making the need for the vaccine unnecessary.

Disease: Hepatitis A virus inflames the liver, causing generalized misery for weeks in adults, but usually minor or unnoticeable clinical illness in young people.

Common Symptoms,

Flu-like illness (without the respiratory symptoms):

• Fever
• Poor appetite
• Muscle/Joint Aches
• Abdominal Pain
• Jaundice (yellow eyes/skin/urine)

Incubation: from exposure to illness = 15-50 days (avg = 4 weeks)

Illness duration = 1-2 months

Only 3-6/1000 cases are fatal.

Hepatitis A virus does not cause permanent liver damage.

Distribution:

• Worldwide, but most prevalent in developing countries.
  • Risk increases with extended and rural travel.

Transmission:

• Person-to-person through fecal-oral route

So, hepatitis A virus is easily passed through household contacts and public exposure to fecally contaminated food and water, most commonly ice, unpeeled fruits/vegetables, and raw/undercooked shellfish.

Hepatitis A virus Treatment: None

Prevention:

1. Chlorinate water.
2. Boil water or cook over 185°F for 1 minute.
3. Strict water and food restriction during travel
4. Avoid uncooked food, salads, puddings, watermelon.
5. Only canned or bottled drinks
6. Fruits and vegetables you peel yourself
7. Use only ice cubes from purified water.
8. Only well-cooked meat and seafood
9. Hepatitis A virus Vaccine
   1. Optimally at least 1 month pre-travel
   2. 2 doses, 6-12 months apart
   3. Lifelong immunity likely
   4. Vaccine Targets
      1. Travelers to underdeveloped countries
      2. Homosexuals
      3. Illicit drug users
      4. Chronic liver disease patients
      5. Households adopting children from countries with prevalent hepatitis A virus
      6. Patients who receive blood clotting factor concentrates (hemophiliacs)
      7. Children ≥ 1 year old
   5. Vaccine Cautions
      1. Those with life-threatening reactions to components of some hepatitis A virus vaccine brands: alum, 2-phenoxyethanol
      2. Delay vaccination if moderately ill until recovered.
      3. Side-Effects: Uncommon and last 1-2 days,
         1. Injection site soreness
         2. Headache
         3. Poor appetite
         4. Fatigue
   6. Safety in pregnancy has not been proven, but, as a killed vaccine, it is unlikely a risk to a fetus.

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