Viral hepatitis A: Is lack of hygiene to blame for transmission?

Viral hepatitis A - pathology and risks

Viral hepatitis A is an acute inflammatory disease of the liver caused by the RNA virus of hepatitis A. It is a very resistant virus. It resists not only very acidic pH, but also temperatures from -70 ºC to 60 ºC.

There is no chronic form and prolonged disease lasting more than half a year is very rare. It usually occurs as an acute form and the incubation period until the first symptoms appear is approximately 28 days. Less commonly, it can be as long as two months.

The disease is usually not very serious, with a spontaneous improvement of the condition. Treatment with glucocorticoids in a medical facility is rarely necessary. In immunodeficient patients, the elderly and the sick, the course can be more complicated.

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Is it possible to get vaccinated?

In addition to a good prognosis, the long-term availability of the vaccine is a positive thing. It is time-tested, safe and also highly effective.

As a safety precaution, vaccination should be given to health and social workers or tourists who plan to travel to a high-risk country with an increased incidence of the disease. Members of the fire and police services should also be vaccinated.

How does hepatitis A manifest itself?

The course of hepatitis A varies depending on the age of the patient and associated diseases. It can be asymptomatic, mild, non-specific or typical of hepatitis. The most typical symptoms are yellow discoloration of the skin, hence the name hepatitis, and pain under the right rib arch.

Asymptomatic course of the disease

Up to 90 %, mainly in paediatric patients, the disease is asymptomatic. It is detected purely incidentally by laboratory results, when antibodies and bilirubin (a yellow dye) are present in the blood.

Nonspecific accompanying symptoms

In older children and adults, it presents as an acute form with typical manifestations. The illness begins with non-specifically raised temperature, weakness, malaise, fatigue, headache and muscle aches, nausea, vomiting. Symptoms resembling a respiratory tract infection such as cough and increased nasal secretions are associated.

Typical acute course of the disease

The basic symptoms include icterus. This is a yellow discoloration of the skin and sclerae (similar to liver cirrhosis or liver failure). The urine is also darkly coloured. The stool is chollic - pale coloured. Patients have abdominal pain in the liver area below the right rib arch. The liver is enlarged, sometimes the spleen is also enlarged.

Fulminant form with acute liver failure

Occurs sporadically. Affects about one patient in a thousand. The patient's life is threatened by liver failure. It presents with the same symptoms as acute hepatitis A, together with neurological symptoms.

Disease retreatment

After about two weeks to a month, the disease begins to resolve spontaneously. Symptoms become milder and the yellow discolouration of the skin also subsides.

How can you get infected?

Hepatitis A occurs mainly in people with low standards of hygiene, i.e. mainly in the socially disadvantaged population. An isolated occurrence does not represent a major social problem. However, the spread of the disease and the epidemic occurrence is a serious social as well as economic problem.

Possible routes of transmission

1. The source of infection is the sick person. It is transmitted during the period when the disease has not yet manifested itself externally, but the virus is shed in the faeces. Infection occurs via the faecal-oral route, through direct contact - dirty hands.
2. Transmission also occurs via the alimentary route, through contaminated water and food.
3. Sexual transmission is also possible but rare, mainly between homosexual partners.
4. Infection can also occur through contaminated needles in drug addicts or health care workers.

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How to protect yourself from hepatitis A?

Vaccination is important for at-risk individuals, such as laboratory technicians, health care workers, police, firefighters, social workers, crisis center workers, or workers and volunteers in Roma communities. The possibility of infection in these individuals is high if safety precautions are not followed.

Interesting fact: Hepatitis A vaccination with human immunoglobulin was used by American soldiers in 1945, at the end of the Second World War, during which time there was a major hepatitis epidemic. The vaccine reduced the incidence of the disease by almost 80%.

The basis of prevention is hygiene. Good hygiene habits are important not only in relation to hepatitis, but also to other diseases that can be contracted from dirt.

Treatment of viral hepatitis A

The disease resolves spontaneously without the need for medical treatment. Rest, fluids, rehydration, and dietary modification focusing on easily digestible and degradable substances are important for the patient.

• bed rest
• adequate fluid intake
• infusion rehydration therapy in the worse course of the disease
• infusion of glucose in case of persistent vomiting
• diet with increased carbohydrate intake
• restriction of protein and fat in the diet
• B and C vitamins

Which areas are at risk?

In general, areas or communities of socially deprived people, with low standards of hygiene, are most at risk. Even jaundice can be called a disease of dirty hands.

Where to travel with extreme caution?

Poor countries are most at risk. The highest incidence of hepatitis is recorded in North Africa, South America, especially Brazil and Venezuela, Mongolia, Indonesia, Iran and India. Less affected countries are Greenland, Russia, China, Kazakhstan, Argentina and Chile.

Interesting information.

Where, when and who gets sick most often?

Despite the statistics, hepatitis occurs worldwide, especially in the communities mentioned above. It can be contracted at any time of the year, but especially in September and October. The disease most often affects children between the ages of one and four.