Transmission of hepatitis a

Hepatitis C

What is hepatitis C?

Hepatitis C is a virus (a type of germ) that causes liver disease. The hepatitis C virus is found in the blood and liver of people with hepatitis C infection.

How is hepatitis C spread?

The virus is spread primarily through blood. People most at risk are those who have had a blood transfusion or an organ transplant before 1992, or people who use or have used needles contaminated by blood (for example, the injection of drugs). Since July 1992, the blood supply has been carefully checked for this virus and the blood supply is considered to be safe.

The hepatitis C virus can be spread whenever blood (or fluids containing blood) come in contact with an opening of the skin or other tissues. This can occur even when these openings cannot be seen. Hepatitis C virus can also be transmitted by sexual contact, but this does not happen as easily as the spread of HIV, the virus that causes AIDS.

The hepatitis C virus is not spread by casual contact like hugging, sneezing, coughing, or sharing food and drinks. You cannot get hepatitis C by donating blood.

How serious is hepatitis C?

Hepatitis C infection can be very serious. Most people who become infected will carry the virus for the rest of their lives. Some of these people will develop liver damage and feel very sick. Other people may feel healthy for many years after being diagnosed with hepatitis C infection. This virus can eventually cause cirrhosis (scarring of the liver) and/or liver cancer in some infected people. While most people will not develop liver failure or liver cancer with hepatitis C, we cannot tell who will or will not have these problems.

Who is at risk of getting hepatitis C?

People are at risk for developing hepatitis C infection if they:

  • have used street drugs or shared needles, even just once
  • have received blood transfusion, blood products, or an organ transplant before July 1992
  • have had many sexual partners, especially if they did not use condoms
  • are health care workers (like doctors or nurses) who may be exposed to blood or needles
  • are babies born to mothers who have hepatitis C
  • have been on kidney dialysis

Is there a treatment for hepatitis C?

A drug called interferon may sometimes be used to treat hepatitis C infection. It is usually used in combination with other drugs, such as Ribavirin. People diagnosed with hepatitis C infection should not drink any alcohol or take certain medicines that can cause liver damage. It is recommended that persons infected with hepatitis C be vaccinated for hepatitis A and hepatitis B, two other viruses which cause liver damage if they are at risk for those infections. Antibiotics (medicine to fight an infection from bacteria) do not work against the hepatitis C virus. Ask your doctor about treatment options and steps you can take to protect your liver.

How can hepatitis C be prevented?

There is no vaccine for hepatitis C. The best way to keep from getting the hepatitis C virus is to avoid any contact with blood. This includes not sharing needles, razors or toothbrushes. Blood banks now screen donated blood for hepatitis C virus, so your risk of getting infected from a blood transfusion is extremely low. You can also get hepatitis C from sex with an infected partner; using a condom may reduce your risk of becoming infected.

To prevent the spread of hepatitis C:

  • If you shoot drugs, never share works with anyone. Don’t share cocaine or other snorting straws, since these can get blood on them too. Find out about treatment programs that can help you stop using drugs.
  • Use a latex condom every time you have sex.
  • Only get tattoos or body piercings from places using sterile equipment.
  • Health care workers and people who clean up in hospitals or places where needles or sharps are used should follow standard (universal) precautions for every patient.
  • If you have hepatitis C, don’t share razors or toothbrushes.
  • If you have hepatitis C, don’t donate blood, sperm or organs.

What about other kinds of hepatitis?

There are several different kinds of hepatitis viruses. If you have had one type, you can still get any of the others. The hepatitis A virus is spread by feces (stool) through close personal contact or contaminated food and water. Even a very small or not visible amount of feces can carry this virus. There is a vaccine to prevent hepatitis A infection. The hepatitis B virus is spread through blood and body fluids, like semen. There is also a vaccine to protect you from hepatitis B infection. If you have hepatitis C, ask your doctor about getting vaccinated for hepatitis A and B. Blood tests can be done to see if you have been exposed to the different types of hepatitis viruses.

Where can you get more information?

  • Call your doctor, nurse or health clinic
  • Call your local board of health, listed in the phone book under government
  • Contact:
    • The Massachusetts Department of Public Health (MDPH) Division of Epidemiology and Immunization, at (617) 983-6800, or visit the MDPH hepatitis C website at www.masshepc.org or the MDPH general website at: www.state.ma.us/dph/
    • The Hepatitis Hotline, at The Centers for Disease Control and Prevention (CDC), at 1-888-4HEPCDC (1-888-443-7232) or the CDC website at: www.cdc.gov/ncidod/diseases/hepatitis/

Information provided by Massachusetts Department of Public Health

Hepatitis A

What is hepatitis A?

The liver is a large, hard-working organ that protects the body from toxins. It can handle all sorts of insults, but it also has its weaknesses. It doesn’t like too much alcohol, and it definitely doesn’t like viruses that cause hepatitis or inflammation of the liver.

There are five types of hepatitis viruses: hepatitis A, B, C, D, E, and F. Of these, A, B, and C are by far the most common. Fortunately, cases of hepatitis A in the United States and the rest of the industrialized world have plummeted thanks to widespread vaccinations and improved sanitation practices. In 2008, there were fewer than 25,000 new cases of hepatitis A in this country, although many of them were never reported, according to the Centers for Disease Control and Prevention (CDC). The number of children in the United States who get hepatitis A has declined, but it is a major threat in the developing world, where most people who catch the virus do so during childhood.

Unlike some other types of viral infections of the liver, hepatitis A is a short-lived illness that almost always goes away on its own without causing lasting damage. Although hepatitis A is not dangerous in most cases, you definitely want to avoid catching it. In rare instances, hepatitis A can cause liver failure and death, usually in people older than 50 or who have other liver diseases, such as hepatitis B or C.

How do people catch hepatitis A?

The hepatitis A virus is just one of many disease-causing germs found in human feces. People usually catch hepatitis A by getting the virus in their mouths, often because they eat food or drink water that has been contaminated by human waste. Children who don’t wash their hands after using the bathroom can easily spread the germ to caregivers and other children. If the germ gets on your hands — perhaps while you are changing a diaper — your hands will need a good wash before you touch food or put one of your fingers in your mouth.

A person can also develop the disease if they have sex that involves oral-anal contact with someone who has hepatitis A.

People with hepatitis A are usually contagious for a couple of weeks after they start feeling sick. Once you’ve had the disease, you can’t catch it again.

What are the symptoms of hepatitis A?

When someone is infected with hepatitis A, the illness can range from mild, lasting a few weeks, to severe, disabling the patient for several months. Some people, especially children, never have symptoms at all. When it strikes, most of us can expect a sudden fever along with headache, nausea, stomach pain, vomiting, joint pain, dark urine, pale or clay-colored bowel movements, and a lack of energy or appetite. Some people may also have chills, diarrhea, constipation, and itchy skin. The skin and the whites of the eyes may start to turn yellow. This is called jaundice, and it’s a classic sign of liver trouble. In some rare cases the brain can be affected, causing confusion, unusual eye and body movements, and even coma. While the symptoms may fade relative quickly for children, adults are usually sick for about two months. Some people continue to feel ill off and on for up to six to nine months.

How is hepatitis A diagnosed?

Since all sorts of liver problems tend to cause similar symptoms, your doctor won’t be able to diagnose hepatitis A just by looking at you. He or she will run a blood test that can confirm the source of the illness.

What is the treatment for hepatitis A?

There is no treatment for hepatitis A — antibiotics won’t help because it’s caused by a virus, not a bacterium — but you can take steps to make yourself feel better while you recover. You may need to rest for several weeks, and you’ll have to avoid alcohol and acetaminophen (Tylenol) until you feel better and your liver is up to snuff again. Nearly one-third of people who get hepatitis A need to be hospitalized for dehydration and other complications while they recover.

How can hepatitis A be prevented?

The surest way to avoid hepatitis A is to get vaccinated. Two doses of the hepatitis A vaccine given at least six months apart will provide protection for a lifetime. The CDC now recommends that the vaccine, first introduced in 1995 be given to children routinely starting at 12 to 23 months of age.

Adults who have never been vaccinated should definitely roll up their sleeves before visiting a developing country or trekking in backcountry areas. Ideally, travelers should get the shot at least one month before they leave. If there isn’t time for that, a doctor can combine the vaccination with a shot of immune globulin (IG), a medication that provides a temporary boost of disease-fighting antibodies. Vaccinations might also be recommended if there’s an outbreak of hepatitis A in your community or if you already have a chronic liver disease. People who use street drugs, those who receive regular clotting factor medicine, and anyone who has anal sex are at extra risk for infection, so a vaccination makes sense for them, too.

Whether or not you’ve been immunized against hepatitis A, good hygiene is an important step toward good health. Always wash your hands thoroughly before eating and after using the bathroom or changing a diaper. When traveling to countries without modern sanitation, don’t drink water unless it has been boiled for at least one minute or comes in a bottle or can. Avoid ice, too, unless you know it was made with clean water. Make sure all your food is thoroughly cooked, and don’t eat raw fruits and vegetables unless you can peel them yourself with clean hands.

Centers for Disease Control and Prevention. Hepatitis A fact sheet. June 2009.

American Academy of Family Physicians. Hepatitis A: What you should know. 2006.

Brundage, S. and A. Fitzpatrick. Hepatitis A. American Family Physician. 2006. 73: 2162-2168.

World Health Organization. Hepatitis A.

National Institute of Diabetes and Digestive and Kidney Diseases. What I need to know about hepatitis A. April 2009.

Centers for Disease Control and Infection. FAQs for the Public.

Mayo Clinic. Hepatitis A. Treatment and Drugs. September 5, 2009.

The following tips can help reduce your risk of spreading or catching the virus:

  • Always wash your hands well after using the restroom, and when you come in contact with an infected person’s blood, stools, or other bodily fluid.
  • Avoid unclean food and water.

The virus may spread more rapidly through day care centers and other places where people are in close contact. Thorough hand washing before and after each diaper change, before serving food, and after using the toilet may help prevent such outbreaks.

Ask your provider about getting either immune globulin or the hepatitis A vaccine if you are exposed to the disease and have not had hepatitis A or the hepatitis A vaccine.

Common reasons for getting one or both of these treatments include:

  • You have hepatitis B or C or any form of chronic liver disease.
  • You live with someone who has hepatitis A.
  • You recently had sexual contact with someone who has hepatitis A.
  • You recently shared illegal drugs, either injected or noninjected, with someone who has hepatitis A.
  • You have had close personal contact over a period of time with someone who has hepatitis A.
  • You have eaten in a restaurant where food or food handlers were found to be infected or contaminated with hepatitis.
  • You are planning to travel to places where hepatitis A is common.

Vaccines that protect against hepatitis A infection are available. The vaccine begins to protect 4 weeks after you get the first dose. You will need to get a booster shot 6 to 12 months later for long-term protection.

Travelers should take the following steps to protect against getting the disease:

  • Avoid dairy products.
  • Avoid raw or undercooked meat and fish.
  • Beware of sliced fruit that may have been washed in unclean water. Travelers should peel all fresh fruits and vegetables themselves.
  • DO NOT buy food from street vendors.
  • Get vaccinated against hepatitis A (and possibly hepatitis B) if traveling to countries where outbreaks of the disease occur.
  • Use only carbonated bottled water for brushing teeth and drinking. (Remember that ice cubes can carry infection.)
  • If bottled water is not available, boiling water is the best way to get rid of hepatitis A. Bring the water to a full boil for at least 1 minute to make it safe to drink.
  • Heated food should be hot to the touch and eaten right away.

PMC

Hepatitis A virus (HAV) is the most common agent of acute viral hepatitis in industrialized countries. HAV is a small, particularly resistant, nonenveloped RNA virus that survives on human hands and inanimate objects. Infection is spread chiefly via the fecal-oral route through contact with an infected person. Ingestion of contaminated food or water may also be responsible for outbreaks (4). Investigation of outbreaks often relies on epidemiological and serological studies, but the molecular investigation of HAV cases and contacts is precious since only sequence information will be able to link apparently sporadic cases or apparently distinct outbreaks (9), allowing the implementation of corrective measures. Usually, HAV sequences are isolated from feces or serum. Infected people can excrete HAV in feces for 3 months or longer, and viremia is detectable by reverse transcription-PCR (RT-PCR) in the majority of patients at the onset of symptoms and can persist several weeks after aminotransferases peak (3). Serological investigation of HAV outbreaks has often relied on saliva testing, particularly of children (5, 10), due to the simplicity of obtaining material. Early studies have shown that the saliva of acutely infected patients may be infectious (7); we thus examined the excretion of HAV in saliva and its reliability for sequence investigation.

From November 2002 to November 2003, six patients were referred to our hospital for acute hepatitis with jaundice. Acute HAV infection was diagnosed on the positivity of anti-HAV immunoglobulin M (Biomérieux, Marcy l’Etoile, France). Risk factors and laboratory findings are shown on Table ​Table1.1. The median age was 31 years (range, 15 to 47 years). Sera were collected at admission and stored at −20°C. Saliva samples were collected 1 to 11 days after serum sampling with a disposable Salivette (Sarstedt, Mercey le Grand, France) and stored at −20°C until use. Viral RNA was extracted from 140 μl of serum or saliva by using the QIAmp viral RNA kit (QIAGEN, Les Ulis, France). Ten microliters of extracted RNA was subjected to RT and PCR amplification by using the One-Step RT-PCR kit (QIAGEN). A 512-bp fragment encompassing the VP1/2A junction was amplified with previously described primers (3). The sensitivity of this RT-PCR assay was 43 IU/ml, as assessed with serial dilutions of the World Health Organization HAV RNA standard purchased from the National Institute for Biological Standards and Control (Hertfordshire, United Kingdom). HAV RNA was quantified by using a real-time RT-PCR assay on the LightCycler instrument with an HAV quantification kit (Roche Diagnostics, Mannheim, Germany) and 10 μl of extracted RNA per reaction. The sensitivity of this quantification assay was assessed with the National Institute for Biological Standards and Control HAV RNA working reagent and was found to be 600 genome equivalents/ml. Nucleotide sequencing was carried out by Genome Express (Meylan, France), with a a BigDye Terminator cycle sequencing ready reaction kit and an Applied Biosystems 3730 automatic sequencer, according to the manufacturer’s protocol. Sequences were aligned with Clustal X software. Phylogenetic trees were constructed with the MEGA software by the Neighbor-Joining method from a Kimura two-parameter distance matrix, and bootstrap values were determined from 1,000 bootstrap resamplings of the original data. HAV genotypes were determined by the phylogenetic analysis of a 168-nucleotide fragment of the VP1/2A junction, including reference sequences belonging to HAV genotypes IA, IB, II, IIIA, and VII (8).

TABLE 1.

Features of HAV infection for six patientsa

aM, male; F, female; ALT, alanine aminotransferase level; MSM, men having sex with men; +, presence; −, absence; /, not performed.

HAV RNA was detected in and quantified from the serum samples of all six patients. Serum viral loads ranged from 7.3 × 103 to 2.3 × 107 copies/ml. HAV RNA was detected in the saliva from five of six patients, but the viral loads in only four samples, ranging from 9.3 × 102 to 1.9 × 104 copies/ml, fell within the linearity range of the real-time PCR assay. Phylogenetic analysis of patients’ sequences is shown on Fig. ​Fig.1.1. Five out of six sequences amplified from the serum were assigned to genotype IA. Three of these showed 100% identity within the 168-bp fragment studied. The corresponding three patients (patients 1 to 3) lived in or near Paris and had a common behavioral risk factor for HAV infection (Table ​(Table1).1). It was not possible to identify a risk factor for patient 4, whose sequence differed from the previous sequences by just 1 nucleotide. The fifth IA HAV strain was presumably acquired in Morocco by patient 5, while the only IB sequence was isolated from a patient who had traveled to Cape Verde (patient 6). The sequences isolated from the saliva samples of the five available patients were homologous to the corresponding serum sequence within the studied fragment.

Phylogenetic analysis of HAV VP1/2A sequences recovered from serum and saliva.

In the 1980s, titers of infectious virus in saliva were found to be 2 to 3 logs lower than titers of virus in serum and 5 to 8 logs lower than titers in stool, as determined with intravenously inoculated chimpanzees (7). Animal experiments have further shown that infectious virus is shed in saliva during the incubation period and in the early acute phase (2) and that HAV RNA may be detected in saliva from 6 h postinoculation until several weeks after hepatitis onset (6). We show here the frequent presence of HAV RNA in the saliva of acutely infected patients and we confirm by real-time PCR quantification a difference of about 2 logs between serum and saliva viral loads. Furthermore, RT-PCR of this noninvasive clinical sample may allow the molecular investigation of HAV cases and contacts similar to that previously shown for measles or mumps outbreaks (1). In this small series of apparently unrelated cases, phylogenetic analysis revealed a cluster of identical sequences corresponding to three human immunodeficiency virus (HIV)-positive men having sex with men in Paris. Each year, patients sharing this risk factor are referred for acute HAV infection, as were the three patients studied in 2003 for this report. A retrospective phylogenetic analysis of these cases has evidenced an annual shift of the epidemic strain, with all strains belonging to genotype IA (unpublished data).

In conclusion, molecular investigation of HAV cases from saliva samples appears to be a promising tool for a larger understanding of HAV epidemiology.

What Is Hepatitis A?

Generally acquired through contaminated food, hepatitis A is an acute, viral-borne inflammation of the liver.

Hepatitis is an inflammation of the liver, an organ with several important functions.

Your liver converts dietary nutrients into useful substances and breaks down toxins and chemicals.

Hepatitis A is a type of hepatitis caused by the hepatitis A virus (HAV).

Numerous other types of viral and non-viral hepatitis also exist, including hepatitis B, hepatitis C, and alcohol-related hepatitis.

Hepatitis A Transmission

You can get hepatitis A if HAV, which is present in feces and blood, gets into your body through your mouth.

The virus is passed between people through the “fecal-oral route,” which can occur:

  • When an infected person touches objects or food after going to the bathroom and failing to wash his or her hands properly
  • When someone doesn’t wash properly after handling diapers or cleaning up the stool of an infected person
  • During sex with an infected person, particularly if it involves direct or indirect anal-oral contact, or anal sex in which sanitary measures aren’t taken afterwards

You can also get hepatitis A by ingesting food or water contaminated with feces containing HAV.

Common sources of HAV transmission include fruits, vegetables, shellfish, ice, and water.

This mode of transmission is far less common in the United States and other developed countries, which have better sanitation measures in place, such as treating the water supply with chlorine or chloramine.

You cannot get HAV through casual contact with an infected person, such as through hugging or even being coughed or sneezed on.

And babies cannot get HAV from breast milk.

Hepatitis A Risk Factors

You are at an increased risk for hepatitis A if you:

  • Live in or travel to a developing country where hepatitis A is common
  • Live with someone who has hepatitis A
  • Have oral-anal sexual contact with someone who is infected
  • Are a man who has sex with men
  • Use illegal drugs, including those that aren’t injected
  • Have hemophilia or other disorders that affect blood clotting
  • Work in the health care, food, or sewage industries

Prevalence

Hepatitis A is one of the most common causes of foodborne illness, according to the World Health Organization (WHO).

Each year, there are about 1.5 million reported cases of hepatitis A around the world, according to a 2012 report in the World Journal of Hepatology.

However, the actual rate of infection is likely up to 10 times higher because many cases go unreported, the article notes.

In 2012, there were 1,562 reported cases of hepatitis A in the United States, according to the CDC, which adds that the actual number is likely closer to 3,050 cases, if asymptomatic infections and under-reporting are taken into consideration.

What’s more, about half of all infections in the United States are actually acquired outside of the country, according to the CDC.

Learn More About Hepatitis A Symptoms

Learn More About Hepatitis A Vaccine

Learn More About Hepatitis A Treatment

Hepatitis A is a liver disease caused by the hepatitis A virus (HAV). The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the faeces of an infected person. The disease is closely associated with unsafe water or food, inadequate sanitation, poor personal hygiene and oral-anal sex.

Unlike hepatitis B and C, hepatitis A does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is often fatal. Overall, WHO estimated that in 2016, 7 134 persons died from hepatitis A worldwide (accounting for 0.5% of the mortality due to viral hepatitis).

Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. The hepatitis A virus is one of the most frequent causes of foodborne infection. Epidemics related to contaminated food or water can erupt explosively, such as the epidemic in Shanghai in 1988 that affected about 300 000 people1. They can be also prolonged, affecting communities for months through person-to-person transmission. Hepatitis A viruses persist in the environment and can withstand food-production processes routinely used to inactivate and/or control bacterial pathogens.

The disease can lead to significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school, or daily life. The impact on food establishments identified with the virus, and local productivity in general, can be substantial.

Geographical distribution

Geographical distribution areas can be characterized as having high, intermediate or low levels of hepatitis A virus infection. However, infection does not mean disease because children infected young do not experience any noticeable symptoms.

Areas with high levels of infection

In low- and middle-income countries with poor sanitary conditions and hygienic practices, infection is common and most children (90%) have been infected with the hepatitis A virus before the age of 10 years, most often without symptoms2. Epidemics are uncommon because older children and adults are generally immune. Symptomatic disease rates in these areas are low and outbreaks are rare.

Areas with low levels of infection

In high-income countries with good sanitary and hygienic conditions, infection rates are low. Disease may occur among adolescents and adults in high-risk groups, such as PWIDs, MSMs, people travelling to areas of high endemicity, and in isolated populations, such as closed religious groups.In the United States of America, large outbreaks have been reported among homeless persons.

Areas with intermediate levels of infection

In middle-income countries, and regions where sanitary conditions are variable, children often escape infection in early childhood and reach adulthood without immunity. Ironically, these improved economic and sanitary conditions may lead to accumulation of adults who have never been infected and who have no immunity. This higher susceptibility in older age groups may lead to higher disease rates and large outbreaks can occur in these communities.

Transmission

The hepatitis A virus is transmitted primarily by the faecal-oral route; that is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. In families, this may happen though dirty hands when an infected person prepares food for family members. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water.

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.

Symptoms

The incubation period of hepatitis A is usually 14–28 days.

Symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the skin and whites of the eyes). Not everyone who is infected will have all of the symptoms.

Adults have signs and symptoms of illness more often than children. The severity of disease and fatal outcomes are higher in older age groups. Infected children under 6 years of age do not usually experience noticeable symptoms, and only 10% develop jaundice. Among older children and adults, infection usually causes more severe symptoms, with jaundice occurring in more than 70% of cases. Hepatitis A sometimes relapses. The person who just recovered falls sick again with another acute episode. This is, however, followed by recovery.

Who is at risk?

Anyone who has not been vaccinated or previously infected can get infected with hepatitis A virus. In areas where the virus is widespread (high endemicity), most hepatitis A infections occur during early childhood. Risk factors include:

  • poor sanitation;
  • lack of safe water;
  • living in a household with an infected person;
  • being a sexual partner of someone with acute hepatitis A infection;
  • use of recreational drugs;
  • sex between men;
  • travelling to areas of high endemicity without being immunized.

Diagnosis

Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis. Specific diagnosis is made by the detection of HAV-specific Immunoglobulin G (IgM) antibodies in the blood. Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA, and may require specialized laboratory facilities.

Treatment

There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and may take several weeks or months. Most important is the avoidance of unnecessary medications. Acetaminophen / Paracetamol and medication against vomiting should not be given.

Hospitalization is unnecessary in the absence of acute liver failure. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhea.

Prevention

Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A.

The spread of hepatitis A can be reduced by:

  • adequate supplies of safe drinking water;
  • proper disposal of sewage within communities; and
  • personal hygiene practices such as regular hand-washing before meals and after going to the bathroom.

Several injectable inactivated hepatitis A vaccines are available internationally. All are similar in terms of how well they protect people from the virus and their side-effects. No vaccine is licensed for children younger than 1 year of age. In China, a live oral vaccine is also available.

Nearly 100% of people develop protective levels of antibodies to the virus within 1 month after injection of a single dose of vaccine. Even after exposure to the virus, a single dose of the vaccine within 2 weeks of contact with the virus has protective effects. Still, manufacturers recommend 2 vaccine doses to ensure a longer-term protection of about 5 to 8 years after vaccination.

Millions of people have received injectable inactivated hepatitis A vaccine worldwide with no serious adverse events. The vaccine can be given as part of regular childhood immunizations programmes and also with other vaccines for travellers.

Immunization efforts

Vaccination against hepatitis A should be part of a comprehensive plan for the prevention and control of viral hepatitis. Planning for large-scale immunization programmes should involve careful economic evaluations and consider alternative or additional prevention methods, such as improved sanitation, and health education for improved hygiene practices.

Whether or not to include the vaccine in routine childhood immunizations depends on the local context. The proportion of susceptible people in the population and the level of exposure to the virus should be considered. Generally speaking, countries with intermediate endemicity will benefit the most from universal immunization of children. Countries with low endemicity may consider vaccinating high-risk adults. In countries with high endemicity, the use of vaccine is limited as most adults are naturally immune.

  • Countries with immunization schedules that include hepatitis A

As of May 2019, 34 countries used or were planning to introduce hepatitis A vaccine in routine immunization of children in specific risk groups.

While the 2 dose regimen of inactivated hepatitis A vaccine is used in many countries, other countries may consider inclusion of a single-dose inactivated hepatitis A vaccine in their immunization schedules. Some countries also recommend the vaccine for people at increased risk of hepatitis A, including:

  • users of recreational drugs;
  • travellers to countries where the virus is endemic;
  • men who have sex with men; and
  • people with chronic liver disease (because of their increased risk of serious complications if they acquire hepatitis A infection).

Regarding immunization for outbreak response, recommendations for hepatitis A vaccination should also be site-specific. The feasibility of rapidly implementing a widespread immunization campaign needs to be included.

Vaccination to control community-wide outbreaks is most successful in small communities, when the campaign is started early and when high coverage of multiple age groups is achieved. Vaccination efforts should be supplemented by health education to improve sanitation, hygiene practices and food safety.

WHO response

In May 2016, The World Health Assembly adopted the first “Global Health Sector Strategy on Viral Hepatitis, 2016-2021”. The strategy highlights the critical role of Universal Health Coverage and the targets of the strategy are aligned with those of the Sustainable Development Goals. The strategy has a vision of eliminating viral hepatitis as a public health problem and this is encapsulated in the global targets of reducing new viral hepatitis infections by 90% and reducing deaths due to viral hepatitis by 65% by 2030. Actions to be taken by countries and WHO Secretariat to reach these targets are outlined in the strategy.

To support countries in moving towards achieving the global hepatitis goals under the Sustainable Development Agenda 2030 WHO is working in the following areas:

  • raising awareness, promoting partnerships and mobilizing resources;
  • formulating evidence-based policy and data for action;
  • preventing transmission; and
  • scaling up screening, care and treatment services.

WHO published the “Progress report on HIV, viral hepatitis and sexually transmitted infections, 2019”, outlining its progress towards elimination. The report sets out global statistics on viral hepatitis B and C, the rate of new infections, the prevalence of chronic infections and mortality caused by these 2 high-burden viruses, as well as coverage of key interventions, all current as at the end of 2016 and 2017.
Since 2011, together with national governments, civil society and partners, WHO has organized annual World Hepatitis Day campaigns (as 1 of its 9 flagship annual health campaigns) to increase awareness and understanding of viral hepatitis. The date of 28 July was chosen because it is the birthday of Nobel-prize winning scientist Dr Baruch Bloomberg, who discovered the hepatitis B virus and developed a diagnostic test and vaccine for the virus.
For World Hepatitis Day 2019, WHO is focusing on the theme “Invest in eliminating hepatitis” to highlight the need for increased domestic and international funding to scale up hepatitis prevention, testing and treatment services, in order to achieve the 2030 elimination targets.

  • An epidemic of hepatitis A attributable to the ingestion of raw clams in Shanghai, China.
    Halliday ML1, Kang LY, Zhou TK, Hu MD, Pan QC, Fu TY, Huang YS, Hu SL. J Infect Dis. 1991 Nov;164(5):852-9.
  • Hepatitis A virus seroprevalence by age and world region, 1990 and 2005.
    Jacobsen KH, Wiersma ST. Hepatitis A virus seroprevalence by age and world region, 1990 and 2005. Vaccine 28 (2010) 6653–6657.

Hepatitis A Basic Information

  • More than 30 states have been affected by hepatitis A outbreaks since 2016.
  • The outbreaks are occurring mostly among people who use drugs and people who are homeless.
  • There is a safe and effective vaccine that prevents hepatitis A and all people with substance use disorder and people who are homeless should receive the two-dose vaccine series.

Topics on this page: What is Hepatitis A? | How Many People Have Hepatitis A ? | Who Is Most Affected? | How Is Hepatitis A Transmitted? | Hepatitis A Prevention | Testing | Treatment | Help Raise Awareness about Hepatitis A Outbreaks | Learn More About Hepatitis A

Hepatitis A is a liver infection caused by the hepatitis A virus (HAV). Hepatitis A can be transmitted when a person ingests the virus from food, drinks, or other objects that have been contaminated by small amounts of stool from an infected person. This can happen through unwashed hands when an infected person prepares food, by close personal contact such as during sex, or caring for someone who is ill. HAV is highly contagious and can range from a mild illness lasting a few weeks to severe illness lasting several months. Unlike hepatitis B and C, HAV does not cause a long-term, chronic liver infection. Although most people who get hepatitis A are only sick for a few weeks, in rare cases, HAV can cause liver failure and death. This is more common in individuals with existing liver disease and other illnesses often seen in homeless persons.

Most children under 6 years of age do not have symptoms when they get hepatitis A. Older children and adults will usually have symptoms. The symptoms will generally clear-up within 2 months of infection and may include:

  • Fatigue
  • Loss of appetite
  • Stomach pain
  • Nausea
  • Jaundice

Once a person becomes infected with HAV, the person develops antibodies that protect from getting the virus again. The best way to prevent HAV is by getting vaccinated.

How Many People Have Hepatitis A?

Since the release of the first vaccine in 1995, HAV infections in the United States have declined by more than 95%. From 2012 through 2016, HAV infections fluctuated because large foodborne outbreaks occurred. From 2016, through 2019 30 states reported HAV outbreaks spread through person to person contact resulting in close to 30,000 infections with high numbers of hospitalizations and deaths.

Globally, HAV is most common in countries with poor sanitary conditions and hygienic practices and transitional economies according to the World Health Organization.

Who Is Most Affected?

Anyone who has not been vaccinated or previously infected can get HAV. The most common risk factors among people with new HAV infections include: 1) coming in direct contact with persons who have HAV; 2) traveling to countries where HAV infection is more common; 3) drug use (injection and non-injection); 4) homelessness and 5) having sex with an infected person.

For countries where HAV infection is common, the risk factors are poor sanitation and lack of clean, safe drinking water.

How Is Hepatitis A Transmitted?

HAV is highly contagious. It is spread primarily when a person ingests the virus from food, drinks, or objects that have been contaminated by small amounts of stool from an infected person; sex with an infected person, particularly if it involves anal-oral contact; and through injection drug use. In crowded, unsanitary conditions, HAV can be spread quickly and cause outbreaks by exposure to contaminated water or food (such as eating raw shellfish from water polluted with sewage).

Hepatitis A Prevention

Hepatitis A is a vaccine-preventable disease. The hepatitis A vaccine is safe and effective and is usually given in 2 shots with a booster dose six months following the first. It is recommended that children aged 1 year and older be vaccinated to prevent HAV, as well as other persons with a common risk factor. Find out if you should get the hepatitis A vaccine and then use the HealthMap Vaccine Finder to help get your hepatitis A vaccine.

Because not all people are vaccinated for hepatitis A, it is important to know that it can also be prevented by maintaining good hygiene and food preparation practices. Hand washing after using the bathroom and before preparing any food along with proper cleaning of surfaces before and after food preparation can help prevent the spread of hepatitis A and other food-borne infections.

Testing

Healthcare providers can diagnose HAV based on a blood test. The blood test will detectif there are antibodies to the hepatitis A virus. In most cases, HAV can be detected in a blood test 5-10 days before symptoms appear. The best way to protect yourself and your family members from getting HAV is by getting everyone vaccinated.

People who are at increased risk for HAV should get vaccinated. Individuals who are at an increased risk for HAV include those who:

  • Travel to developing countries
  • Have sex with an infected person
  • Are men who have sex with men
  • Use drugs (injection and non-injection)
  • Are homeless
  • Live with or care for someone who has HAV.

Unlike treatment for hepatitis B and C, there are no curative treatments available for hepatitis A. The best way to prevent hepatitis A infection is by getting vaccinated.

Once a person is infected with HAV, the best way to recover is to rest, drink plenty of fluids, eat a balanced diet, and work with your healthcare provider to manage any nausea. Depending on how severe the infection is, it may take several weeks or even months to fully recover from symptoms of hepatitis A.

Help Raise Awareness About Hepatitis A Outbreaks

Get the latest from CDC about outbreaks in the United States.

Learn More About Hepatitis A

Centers for Disease Control and Prevention, Division of Viral Hepatitis

  • Hepatitis A information

National Institutes of Health:

  • What do I need to know about Hepatitis A

What is Hepatitis?

Hepatitis is a group of diseases that affect the liver and can lead to serious health consequences such as cancer or cirrhosis of the liver. Health professionals have identified many forms of the virus, including types A, B, C, D, E and G. In Canada, types A, B and C are thought to cause about 90% of acute cases in the country. For some people, symptoms of the virus may be mild and short-lived, while others become carriers of the disease and can spread it to others unknowingly. Hepatitis is known as a “silent disease” because symptoms may not appear until considerable damage to the liver has been done. Early diagnosis and treatment can help to lessen damage to the liver and can prevent you from spreading the virus to others unknowingly. Prevention of hepatitis is the key and there are many steps Canadians can take to protect themselves.

How can I protect myself from hepatitis exposure?

  • Practice good personal hygiene (wash hands after using the washroom, after changing a diaper and before preparing or eating food).
  • Avoid raw or undercooked food.
  • Ensure produce is washed thoroughly before eating.
  • Use bottled water for drinking, making ice cubes, and washing fruits and vegetables when visiting a developing country.
  • Be cautious when eating and drinking in locations with poor sanitation or unsafe food handling practices (especially when travelling to foreign countries).
  • Practice safe sex.
  • Do not share personal materials that may have come into contact with blood (i.e. needles, razors, tooth brushes, nail clippers, etc.).
  • Do not share needles or syringes with others.
  • If getting a tattoo or body piercing, ensure the establishment is using proper sterilization and infection control practices such as using single-use sterile needles and safe disposal of used needles.
  • Get vaccinated, particularly if travelling to areas of high hepatitis activity (i.e. The Caribbean or South America).

Typical symptoms of acute hepatitis are:

  • Fever;
  • Appetite loss;
  • Nausea;
  • Abdominal pain;
  • Jaundice (yellowish colour of the skin and eyeballs).

Hepatitis A, also known as HAV, is generally associated with poor sanitation and hygiene practices and it is one of the most common vaccine-preventable illnesses in travellers. Hepatitis A is typically transmitted by eating or drinking something that is contaminated. A common source is through raw or undercooked food, food handled by people who have not washed their hands, or water contaminated by animal or human waste. Although it is mainly thought of a “traveller’s disease”, it is still possible to contract it in Canada, and even travellers visiting luxury hotels have been known to contract the virus. Travellers are encouraged to take an HBV vaccine before travel, which should be taken six weeks before you leave and can offer up to 20 years of protection. Currently there is no treatment for hepatitis A; only supportive care to help relieve symptoms. Generally, recovery takes a few weeks; however, it can take months before the disease runs its course. Most people recover without side effects and have a lifelong immunity against HAV.

Hepatitis B

Hepatitis B or HBV is the most prevalent hepatitis strain in the world. HBV is transmitted through sexual contact as well as blood and bodily fluids. It is estimated that 35% of those infected don’t know they have the virus. Many people infected with the Hepatitis B virus recover completely and develop lifelong immunity to the virus. Unfortunately, about 90% of babies born to mothers who are hepatitis B carriers have a high chance of developing chronic HBV later in life. The good news is it is possible to receive an HBV vaccine for those at risk, and HBV immune globulin is an option for those people who have had recent contact with infected body fluids.

Hepatitis C

In Canada, is estimated that between 210,000 and 275,000 people are currently infected with hepatitis C; of those, only 30% know they have the virus. Injection drug use is thought to be responsible for at least half of HCV infections but you can also contract HCV through tattooing and body piercing. Up to 90% of infected persons carry HCV indefinitely, and there is no vaccine against HCV. Over the long term, infected persons are at risk of profound fatigue, cirrhosis, and liver cancer.

Sometimes, your work may take you out of Canada. Many people must travel for work to developing countries where the risk of contracting hepatitis is greater. To protect yourself and others from contracting potentially harmful diseases such as hepatitis, precautions should be taken seriously. For those workers travelling to foreign countries, vaccination should be taken prior to departure. Health care workers can protect themselves from hepatitis exposure by using gloves and taking extra care when handling bodily fluids, syringes and needles. Your doctor can test for hepatitis with a series of blood tests; antibody and antigen tests can detect each of the different hepatitis viruses.

SureHire is now pleased to offer the Twinrix® vaccine, which offers combined protection against hepatitis A and C infections. to inquire about this service.

Further reading:
Health Canada: Hepatitis

Photo credit: stevendepolo via Foter.com / CC BY

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