Hepatitis A

By Dr. Kayleen Kow (Mbchb, Diploma In Travel Medicine, Atls Instructor)

What is Hepatitis?

Hepatitis can be described as an inflammation of the liver and can be further classified as acute or chronic. It has many varied causes, namely infectious, alcohol, poison or drug-induced and is associated with other conditions such as pregnancy and cardiac failure.

The focus of this article is mainly on the viral causes of Hepatitis, in particular Hepatitis A.  Six types of hepatitis have been identified thus far HAV, HBV, HCV, HDV, HEV and HGV. However it is not known yet whether HGV (G is a newly discovered form of liver inflammation caused by hepatitis G virus (HGV), a distant relative of the hepatitis C virus) is able to cause disease in humans. HAV is by far the commonest acute form found worldwide but HBV is the one that causes the most severe morbidity and mortality. HCV infection results in the chronic form of Hepatitis.

About Viral Hepatitis A (HAV): Viral Hepatitis is the most common form of acute hepatitis found worldwide. It is transmitted when a person puts something in his or her mouth that has been contaminated with the faeces of an affected person. This is the reason for its prevalence in lower socio-economic populations where personal hygiene is not a high priority and clean water is not readily available.

The incubation period is about 15 – 50 days (on average about 28 days). The virus is excreted in the stool a few days prior to the onset of symptoms. The symptoms often vary and seem more severe in adults than children. Sometimes children are asymptomatic (not showing or producing indications of a disease) and may just be carriers. The most common symptoms are fever, malaise, poor appetite, nausea and vomiting, as well as jaundice. The diagnosis is confirmed through laboratory testing with abnormal liver function tests (elevated transaminase levels) and the presence of IgM anti-HAV. The latter disappears a few months after the acute infection. The presence of IgG anti-HAV indicates a past infection of HAV.

Treatment: Various vaccines are now available Havrix 1440® or Avaxim® or in combination with HBV as Twinrix®. Passive post exposure immunoglobulin is also available Beriglobin® or Intragam®. The latter is also recommended for children under the age of 2 years. A majority of these vaccines are available at the MTI Travel Medicine Service based at Constantiaberg Medi-Clinic. The travel medicine service  is run by Dr Kayleen Kow, who is also a specialised Travel Medicine practitioner, she provides all relevant information to corporate and leisure travellers. Special rates are offered for families. The clinic is open on Thursdays, by appointment on Tel: 021 799 2193.

Precautions: For individuals that are travelling through endemic areas, a number of precautionary measures need to be taken. Strict adherence to sanitation and personal hygiene especially hand washing prior to the handling of food, is of paramount importance. Close consideration to preparation and ingestion of foods and water. Fruit and vegetables should only be eaten if cooked or peeled.

The treatment for HAV is mainly symptomatic and supportive as there is currently no specific therapy for HAV. Persistent nausea and vomiting may result in dehydration that may require hospitalisation for volume replacement.