Hepatitis A is a well-known disease of “dirty hands”, which has recently been spreading in Ukraine. In particular, an outbreak of hepatitis A was recorded in Vinnytsia.
Isolated cases were registered in Ivano-Frankivsk Region and Transcarpathia. Another one was recently recorded in the Ternopil region.
What is hepatitis A, what are the symptoms of this disease, how to prevent it, who needs to be vaccinated and when?
A children’s infectious disease specialist, head of the National Technical Group of Experts on Immunoprophylaxis helped to understand the topic “UP. Life” Fyodor Lapiyas well as materials of the Ministry of Health and the World Health Organization.
What is hepatitis A?
Hepatitis A, or Botkin’s disease, is a liver disease caused by the hepatitis A virus, which is spread through the fecal-oral route, most commonly through dirty hands, contaminated water and food. It can also be transmitted during oral-anal sex with an infected person.
“It is this disease, hepatitis A, that should be called Botkin’s disease. At one time, Serhiy Botkin described an outbreak of jaundice – he knew nothing about the causative agent, about viruses, but he described the disease.
According to tradition, then his name began to be used in the post-Soviet space for all jaundice or for all hepatitis that turned into jaundice. To be fair, Botkin is only related to hepatitis A.” Fedir Lapiy explains.
Lifelong immunity is formed in people who have contracted hepatitis A.
Unlike hepatitis B and C, hepatitis A does not develop a chronic form of infection. In general, the course of hepatitis A is characterized by a good prognosis, rarely ending in death.
According to WHO estimates, 7,134 people died from hepatitis A in the world in 2016 (which is 0.5% of the mortality from viral hepatitis).
However, in some cases, the disease causes complications, so the best way to protect yourself is vaccination.
What are the symptoms of hepatitis A?
Botkin’s disease can be mild or severe.
The most common signs are:
- elevated temperature;
- unpleasant sensations in the stomach;
- darkening of urine;
- jaundice (yellowing of the skin and whites of the eyes).
Note that not always infected people have all the symptoms. Also, jaundice can be not only a sign of hepatitis A.
Fedir Lapiy explains that the first symptoms are very non-specific manifestations in the form of abdominal pain, fever, and there may also be pain in the joints.
When jaundice appears (yellow skin, whites of the eyes, mucous membranes), this often prompts people to consult a doctor with suspicion of hepatitis.
“The virus enters us through the mouth, with unwashed hands. It first multiplies in the intestine. That is, it is not surprising that the first symptoms of the disease of the gastrointestinal tract will appear.
Then the virus enters the liver and destroys its cells. Then jaundice appears. It is precisely jaundice that indicates problems with bile. And this can be one of the signals that you have liver damage.”– emphasizes the infectious disease specialist.
Also, hepatitis A can be suspected in a person who had contact with the patient and noticed symptoms of a gastrointestinal tract disorder for at least 2 weeks.
How does the disease progress?
The incubation period of hepatitis A is 14-28 days. And the peculiarities of the course of the disease are related to age.
For example, if a child encounters a virus in the first years of life, jaundice develops very rarely (less than 10% of cases). Symptoms of infection are usually short-term diarrhea and vomiting.
“In adults, it is the opposite. 90% of adults have jaundice and are quite seriously ill. In school-age children, it is 50/50”the doctor explains.
The older the person, the more severe the course of Botkin’s disease. A severe form of the disease and fatal consequences are most often recorded in people aged 65+, say the Ministry of Health.
There can also be complications if the patient has a serious concomitant liver disease (for example, chronic hepatitis B or C), congenital liver diseases, metabolic disorders.
What are the complications of hepatitis A?
Liver failure is a major complication that manifests itself in a number of symptoms and threatens death. If you notice symptoms of liver failure, you need to call an ambulance immediately!
Among the symptoms are hallucinations, impaired consciousness, a characteristic “liver smell”, hemorrhages, because the liver is very important as an organ in the blood coagulation system.
“There is a so-called “lightning” or fulminant form of hepatitis A with the development of liver failure.
The patient’s condition deteriorates very quickly, hepatic coma may develop with corresponding consequences.” – explains the infectious disease specialist.
There are other, more rare complications. Example, cholestatic hepatitis (disturbance of bile outflow),encephalopathy (non-inflammatory brain diseases).
How can you get hepatitis A?
You can get hepatitis A through food or watercontaminated with the feces of an infected person.
However, according to the WHO, outbreaks of the disease, when the infection occurred through water, are recorded infrequently.
“In Ukraine, the use of cesspools is widespread in rural areas. And the virus is very resistant. The virus gets into the cesspool from a person and, if there is a flood or water spill, it gets into reservoirs.
The danger associated with the terrorist act of the Russian Federation at the Kakhovskaya HPP was that the water flooded homesteads, in particular, cesspools in the summer. Where will it go? On Odessa beaches. That’s why we said: don’t swim, it’s dangerous.” – adds Lapiy.
The risk of hepatitis A arises if you drink water from questionable sources, for example, from mountain rivers – especially along roads where tourists walk.
At home, hepatitis A is most often transmitted through dirty handswhen an infected person prepares food for all family members.
You can also get infected through close physical contact with an infected person.
It is worth remembering that in a dry environment at room temperature, the virus persists for a week, in water – from 3 to 10 months, in feces – up to 30 days.
Where is hepatitis A common and what are the risks of infection?
Depending on where you were born and lived, you have different chances to meet the causative agent of the disease, says the infectious disease specialist.
There are countries with high, medium, low and very low endemicity. For example, Scandinavian countries belong to the latter, and high endemicity in Africa and some regions of Asia.
The infection is common in low- and middle-income countries with poor sanitation, and 70-90% of children become infected with hepatitis A before the age of 18.
The rate of infection is low in countries with a high level of income and good sanitary and hygienic conditions.
Ukraine belongs to the countries of medium endemicity of hepatitis A.
“Ukrainians usually acquire immunity in childhood. By the time of adulthood, about 70% or even more of Ukrainians already have immunity to hepatitis A and do not know about it.
But there are about 20-30% of adults who do not have immunity. They are seriously ill and can undergo routine vaccination”the doctor explains.
All people who have a relationship with a possible source of infection and do not have immunity to it are at risk of infection. In particular, unvaccinated.
“An infected person excretes the virus with feces. If you come into contact with a person and they do not wash their hands after using the toilet, or if you come into contact with products that this person prepares, this is a risk.
For example, workers at water treatment facilities are at risk of spreading and becoming infected, as the virus is very persistent in the external environmentretains its ability to infect for a long time and is not afraid of freezing”– says Fedir Lapii.
According to WHO, people who suffer from unsanitarydo not have access to clean water, are engaged same-sex sexhave sexual contact with an infected person a person and travel to countries with high spread of the virus.
What to do if you or your relatives have hepatitis A?
The main recommendations are symptomatic treatment. Hospitalization is usually optional, if there is no severe course of infection, there is no liver failure.
Fyodor Lapii also gives the following general recommendations:
- drink a lot of water;
- observe bed rest, rest;
- do not use medicines that are potentially toxic to the liver (eg paracetamol/acetaminophen, which are often used to reduce fever).
If you are in contact with a person suffering from hepatitis A, you do not need to “settle” him.
“This infection is not transmitted through the air like, for example, the causative agent of COVID-19, measles, chicken pox or influenza.
This virus is transmitted by the fecal-oral route, that is, the patient excretes the pathogen with feces, and the person who becomes infected does it through his hands.” Fedir Lapiy emphasizes.
To avoid the spread of the virus, both sick and healthy people need to wash their hands thoroughly, especially after using the toilet and before eating.
Also, the doctor advises to avoid oral-anal sex. Transmission of the virus through kissing is unlikely.
“The virus multiplies in the epithelial cells of the gastrointestinal tract and is excreted in the feces. Theoretically, it can be assumed that a patient can put some amount of the virus into his mouth with contaminated hands and then transmit it through a kiss. But this is unlikely. Basically, this fecal-oral route.
Are medical workers in a special group of risk of contracting hepatitis A virus? According to the definition of the World Health Organization, medical workers are not in the risk group, because they must be able to wash their hands after a patient.” says the doctor.
Prevention. When and how to get vaccinated against hepatitis A?
To avoid infection with hepatitis A, it is necessary:
- wash your hands thoroughly, especially after using the toilet, before eating and preparing food, after using public toilets;
- do not buy products at spontaneous markets;
- use clean drinking water;
- boil water (1 minute of boiling kills the virus);
- avoid dubious bodies of water, do not drink from them;
- get vaccinatedif in childhood you did not receive immunity as a result of meeting with the virus.
Vaccination against hepatitis A is allowed from 12 months of age. The vaccine is very highly effective (almost 100% percent), says Fedir Lapii.
Several injectable inactivated vaccines against viral hepatitis A are registered in Ukraine: Havryx (hepatitis A vaccine) and Twinrix (combined vaccine against hepatitis A and hepatitis B). Both vaccines are paid.
But there are vaccines given as humanitarian aid that are used for certain population groups. They are free.
“If you are an adult and you are at risk of severe hepatitis A, you can test yourself for the presence of antibodies.
If you have them positive, then you have immunity. If you have negative antibodies, you will continue to live in Ukraine, you do not plan to move to Denmark or Norway, then you should get vaccinated against hepatitis A, because the infection is severe in adulthood.” – the infectious disease specialist advises.
Manufacturers recommend two doses for longer protection after vaccination.
If the child received one vaccination and did not receive the second dose, a second vaccination can be given as an adult.
“Usually one dose is enough. But here there will be a second dose for insurance, if suddenly you did not develop immunity to the first dose.
When it comes to the second dose that you missed as a child, you do not need to start vaccinations again. You can either get your second dose or have your antibodies determined. If you have them positive, then, in principle, you are protected.” – adds the infectious disease specialist.
Also, vaccines against hepatitis A can be used for emergency vaccinationif an unvaccinated person has been in contact with a hepatitis A patient.
If the vaccine is administered within 2 weeks, infection can be prevented. Of course, the sooner this is done, the more effective the vaccination will be, the doctor emphasizes.
Read also: Hepatitis is not a sentence. How to diagnose and treat the disease on time and for free?
Olena Barsukova, Ukrainian Pravda. Life