Women's Health

Hepatitis A

Written by Mark Abell

Hepatitis A is getting a lot of attention these days. Although I usually like to create my columns with a timeless perspective, this column is being written in response to all of the public attention to the new outbreaks of the disease within the school systems. It appears (allegedly) that a company that has been selling frozen strawberry desert packages to various school systems across the country have been getting them from foreign markets. There is speculation that the hepatitis (virus) A has come from that source, although at the time of this writing, this remains speculation. The point of writing this article is to inform the public of the disease as well as the ways it is prevented or treated. Otherwise, the information remains timeless.

Hepatitis is an infection of the liver. There are many forms of hepatitis and new forms of the disease are being discovered. This article does not mention the other forms of the virus, at least not in detail (but for comparison only).

Hepatitis A is a virus. It has commonly been referred to as infectious hepatitis or even "short-incubation" hepatitis. The virus is almost exclusively transmitted through the fecal-oral route; in other words, the virus comes (almost always) from food that has been tainted with infected human feces and while the US government has laws that help protect the public from exposure to such a virus, other countries do not (at least not as stringent). The virus is very easily transmitted from one person to the next and has been associated with water-borne illnesses and has been implicated in food handlers, day care centers, as well as homosexuals. There is a direct correlation between the outbreak of the virus and the lack of controls, such as public health and personal hygiene. There is no evidence to indicate the virus becomes a "chronic issue" or that people can become "lifelong carriers" of the disease, which differs significantly from other forms of hepatitis.

It usually takes about two to six weeks for the virus to incubate in the human body. By the 2nd or 3rd week after exposure to the virus, there is usually a period of "fecal shedding" whereas the virus is then present in the infected individual's stool. There are specific ways for the public health departments to check a person for exposure to the virus; there are two "antibodies" which are present in the blood (called IgM and IgG). The IgM antibody would indicate a recent exposure to the virus (which soon disappears) and then the IgG antibody can persist for years, but indicates immunity to the disease. They can also check the feces as an antibody (IgA) would show up indicating fecal shedding several weeks after exposure.

This is not the worse case of hepatitis that one can get; however, there are complications with the disease. The acute illness is very diverse. The majority of the people who come down with the illness (particularly children) are not very "sick" and are sometimes thought to have the flu. If jaundice (yellow skin, usually seen in the "white of the eyes" first), it is mild; and symptoms usually go away within a two to three month period.

Some of the more severe complications of hepatitis could develop. There have been documented reports of cases that develop into a full blown hepatitis (liver) illness, but the cases are rather rare. Additionally, while a full blown failure of the liver to function could theoretically develop, the prognosis remains extremely favorable compared to other forms of hepatitis such as Hepatitis B and C.

The ease at which this virus can be spread from one individual to another with only casual contact underscores the need for the public health system to ensure that everything is being done to "prevent" the disease from occurring in the first place.

Treatment for hepatitis has not changed much during the years. Prevention remains the mainstay of therapy. Mothers who suspect that their children may have been exposed to the virus (based on reports from schools, or other institutions, such as day care centers or even local news from restaurants) should seek the attention of their family physician or the local health department. Since the virus is spread from one individual to the other, then you should teach your child the importance of good hygiene, such as washing the hands before eating, etc. The virus is readily inactivated with chlorine (bleach) or even boiling (water). People who are "suspect" for exposure to the virus can receive "passive immunization" with immune globulin as soon as possible, within the first few days or so. Casual contacts with people in school should not raise a scare unless there is reason to believe that there has been exposure. However, in a situation where a "point-source" outbreak of the virus has been identified or suspected, such as noted in the recent news, then all people who are "suspect" for exposure should receive the immune globulin.

As an added note, if you plan to make a trip to a foreign country, you might want to check with your physician or the public health departments. There is a immune globulin that you can receive for protection from this illness while in a foreign land. The best advice, however, is to stay away from drinking water, fresh fruits, vegetables, and shellfish while visiting foreign countries. The "shot" can provide you with protection up to 3 to 6 months. Talk with your doctor.

Should you want to receive more information or need a question answered that does not appear in this article, e-mail me at mabell@surfsouth.com and I will try to get back with you very soon.

Want to "surf the net" for more information about Hepatitis A? Check out these sites:

Hepatitis A - (very well done)
http://www.travelhealth.com/hepa.htm
Hepatitis A Virus
http://vm.cfsan.fda.gov/~mow/chap31.html
Hepatitis Fast Facts
http://www.hepnet.com/hepafact.html
Ready for a Challenge? Take a quiz about Hepatitis!
http://www.hepnet.com/quiz0.html
Read the CNN Story: USDA: Berries Shipped to Schools may Contain Hepatitis
http://www.cnn.com/HEALTH/9704/02/hepatitis/index.html

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