Hepatitis A and E virus infection

Hepatitis A

Hepatitis A is an inflammation of the liver caused by the hepatitis A virus (HAV). The virus is spread when an uninfected person ingests food or water that is contaminated with the faeces of an infected person.

People who get hepatitis A may feel sick for a few weeks to several months but usually recover completely and do not have lasting liver damage. In rare cases, hepatitis A can cause liver failure and even death; this is more common in older people and in people with other serious health issues, such as chronic liver disease.

How is hepatitis A spread?

The hepatitis A virus is transmitted primarily by the faecal-oral route. This means that the virus is passed out in bowel motions (faeces) and finds its way into the mouth (orally); usually through close contact with someone who has the virus, or through food and water contaminated by sewage or the hepatitis A virus.

The virus can also be transmitted through close physical contact (such as oral-anal sex) with an infectious person, although casual contact among people does not spread the virus.

The virus can also be spread through blood to blood contact but this is rare.

What are the symptoms of Hepatitis A?

Not everyone with hepatitis A has symptoms. Adults are more likely to have symptoms than children. If symptoms develop, they usually appear 2 to 7 weeks after infection and can include:

·       Jaundice (yellow skin or eyes)

·       Loss of appetite

·       Stomach pain

·       Vomiting

·       Diarrhoea

·       Joint pain

·       Fatigue

·       Fever

·       Dark-coloured urine

Symptoms usually last less than 2 months, although some people can be ill for as long as 6 months.

Who is at risk of hepatitis A?

Anyone who has not been vaccinated or previously infected can get infected with the hepatitis A virus. Risk factors include:

·       Travel to or live in areas where hepatitis A is common

·       Live with someone who has hepatitis A

·       Men who have sex with men

·       Use illegal drugs, whether injected or not

·       Have clotting-factor disorders, such as haemophilia

·       Have sexual contact with someone who has hepatitis A

·       Are experiencing homelessness

How is hepatitis A diagnosed?

Diagnosis is made by the detection of HAV-specific antibodies in the blood. Your doctor can tell if you had hepatitis A in the past by testing your blood for the hepatitis A IgG antibody. This antibody will always be positive if you have had hepatitis A in the past, or been vaccinated for hepatitis A. If you are currently, or were very recently, infected with hepatitis A, you will have both the IgG and the IgM antibody in your blood.

Treatment for hepatitis A

There is no specific treatment of hepatitis A - it normally gets better without any treatment. It is common to feel more tired than normal, so you may need to get plenty of rest. Any treatment given is usually aimed at easing the symptoms of the virus.

Prevention

·       Practice good personal hygiene

o   Because so many cases of hepatitis A are due to close contact with an infected person, you should always practice good personal hygiene, especially by washing your hands.

·       Be careful in high-risk environments

o   Boil water or drink bottled water in areas where there is a risk for hepatitis A contamination.

o   Eat cooked foods and fruits that you can peel and avoid eating vegetables or fruits that could have been washed with contaminated water, such as lettuce.

o   Avoid eating raw or steamed shellfish, such as oysters, that live in contaminated waters.

o   Use condoms correctly and every time you have sex.

·       Get vaccinated

o   The best way to prevent hepatitis A is to get vaccinated. The vaccine is very effective and can keep you from ever getting hepatitis A.

Hepatitis E

Hepatitis E is inflammation of the liver caused by the hepatitis E virus (HEV)

Most people who have a hepatitis E infection will have no symptoms and will get better quickly. Serious or long term (chronic) hepatitis E is rare but can happen in people who are immunosuppressed, have had a transplant, are pregnant, or already have another liver condition.

What causes Hepatitis E?

The hepatitis E virus is usually spread through food or water that has been contaminated with stools from people or animals with the infection.

People who have the virus should avoid preparing food for others for two weeks after symptoms begin. If possible they should also limit contact with anyone who is pregnant, immunosuppressed or has a liver condition.

There is no evidence of the hepatitis E virus being transmitted through sharing needles, bodily fluids or through sexual contact. However, there is a risk of transmission if there is mouth contact with the anal area.

What are the symptoms of Hepatitis E?

The incubation period following exposure hepatitis E (after the virus enters the body) ranges from 2 to 10 weeks. Symptoms of hepatitis E infection are like those of many other liver diseases and can include:

·       flu-like symptoms

·       fatigue

·       Jaundice (yellow skin or eyes)

·       Dark-coloured urine

·       abdominal pain

·       fever

·       loss of appetite

·       itching

·       nausea and vomiting (sickness)

·       joints and/or muscles ache

·       tingling, numbness and weakness in your arms and legs.

Treatment for hepatitis E

There is no specific treatment capable of altering the course of acute hepatitis E. Most people with hepatitis E will get better by themselves and will not need any medical treatment.

Immunosuppressed people with chronic hepatitis E benefit from specific treatment using ribavirin, an antiviral drug.

Hospitalisation is required for people with fulminant hepatitis and should also be considered for symptomatic pregnant women.

Prevention

To reduce the risk of becoming infected with hepatitis E:

·       Ensure you thoroughly cook all meat before eating it.

·       Wash your hands after touching uncooked meat or meat products.

·       When travelling to an area where hepatitis E is common, it is advisable to AVOID:

o   drinking tap water (drink bottled water where possible)

o   having ice cubes in your drinks

o   cleaning your teeth with tap water

o   drinking unpasteurised milk

o   eating uncooked meat and shellfish

o   eating unpeeled fruit and uncooked vegetables, including salads, that have not been prepared by you.

If you have another liver disease, are pregnant or have a suppressed immune system, you should be particularly careful with raw meats, shellfish and pork products.

Currently there is no vaccine available for hepatitis E.