Hepatitis A

The human body is still widely misunderstood by many because of several factors. Some of these may include the sheer disregard for the intricacy and complex makeup of the different systems within the body and the lack of knowledge about the various processes that go on underneath. This cannot be entirely placed on the people themselves as there is not much of a need to know these things and be educated regarding these specific details unless you are trying to pursue higher studies in the medical field, but our recent trends show preventable cases rising in numbers proves that there is now a need for the general public to be aware of these different details. While it is not necessarily a must to be knowledgeable about the complicated things that are going on within the human body, it is at least necessary to be aware that a lot of things could go on and that it is not necessarily as straightforward as many people make it out to be.

Self-medication and diagnoses have been plaguing the medical field for too long, and it is about time that we shed some light on the information that the public needs to know and can use to guide their treatment plans, even before their physician consults them. Sure, it is always necessary to have yourself examined as a proper diagnosis would often always require a more professional and discerning eye along with several laboratory tests, but it is likewise essential that you are aware of the possible conditions that you might have contracted, and that you know where to ask for help or who to approach in cases where you are suspecting a possible infection that you were able to read about online before.

To start, perhaps it will be more efficient to look at a condition that is often mistaken for another that it is highly similar to – providing almost the same symptoms within the same target organs, caused by a similar virus but with a slight distinction that somehow makes the two different.

Let us look at Hepatitis A infections and how these commonly present within the human body.

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Understanding Hepatitis A Infections as a Whole

Hepatitis is essentially a condition that means liver inflammation. These conditions primarily attack the liver and cause damage to this organ if the condition persists for quite some time. There are different types of hepatitis infections, and each one is caused by a distinct hepatitis virus that then causes slightly varying presentations and requires a different treatment approach due to the differing response of the virus to the treatment options of the other. Several things may cause a hepatitis infection, including excessive alcohol use, hepatotoxic medications, systemic ingestion of a particular toxin, and the most common causative agent, the virus that directly causes the hepatitis type that you have. There are three types of hepatitis, namely, hepatitis A, B, and C, which are caused by hepatitis A virus, hepatitis B virus, and hepatitis C, respectively.

What is a Hepatitis A Infection?

The difference between the three hepatitis infections may seem minute at first, but there are several distinctions when it comes to their pathogenesis, diagnosis, onset, and treatment that needs to be considered when addressing one condition or infection as compared to the others.

When it comes to hepatitis A, many people would have to understand that HepA infections are usually short-term, meaning that the disease does not usually persist, unlike other types that would often proceed to a chronic condition that sometimes could even last for a lifetime. HepA infections only last for a few weeks within the liver, but it is considered a highly-contagious form of a hepatitis infection – being able to transmit the virus even when another person is simply in proximity to another infected individual.

On the other hand, hepatitis B and C infections usually start as short-term infections first, similar to hepatitis A infections. However, the problem when it comes to HepB and HepC infections is that if they are not appropriately managed during their short-term acute phase, they would usually proceed to their long-term and chronic form – one which sometimes cannot be cured with medication anymore and would persist as a lifelong infection that would have periods of flare-ups now and then. The difference that can be made between HepB and HepC infections is that HepB infections, similar to HepA infections, have access to vaccines that could either prevent the development or contraction of a disease from an infected individual or act as a prophylactic agent following exposure to a potential high-risk agent that may contain the hepatitis virus. HepC infections do not have any vaccine available for them, and it is usually only managed through early recognition and resolution of the disease.

Again, to make it easier to understand, hepatitis A infections only present as short-term infections that do not proceed to a chronic condition, while hepatitis B and C infections initially present as short-term but later proceed to a chronic illness if not appropriately managed. Hepatitis A and B infections have an available vaccine that can lower the risk of transmission, while hepatitis C infections do not have access to such intervention.

Understanding the Spread and Prevalence of HepA Infections

Hepatitis A infections are highly contagious, and it is not surprising to learn that such an infection has a wide prevalence within the United States as its transmission can occur through several processes like close contact or contaminated food products. While there are hepatitis A vaccines available that the public can avail of to ensure that the virus will not infect them, it is essential to note that a 100% vaccination coverage is not necessarily realistic in today’s community, especially with the rising distrust of vaccine products that arose from several controversies within the medical field coupled with the conspiracies that several groups have concocted online. As such, we can look at these factors when trying to understand why the disease is still as prevalent nowadays when the measures are already there to achieve a 0% infection and transmission rate within the country.

According to the Centers for Disease Control and Prevention, they were able to tally a total of 12,474 new cases in the United States in 2018, but they have likewise added that there is a significant portion that usually goes unrecorded since there are some people that do not get diagnosed for the entirety of their infection. While hepatitis A infections are generally relatively easy to manage and do not leave lasting effects on the liver – explaining the reason behind this underreporting – there are cases wherein the infection may lead to complications such as liver failure and death, albeit the complications usually arise in the elderly where they might have another predisposing disease such as chronic liver failure. Based on the report of the CDC, this underreporting, when considered in crunching the numbers, may constitute around half of the total number of cases during that year – rounding up the total to 24,900 new cases in 2018.

The CDC also noted that person-to-person contact between infected and non-infected individuals has been causing infection outbreaks within the US since 2016. This is heavily associated with people using intravenous drugs or experiencing homelessness. This case added around 32,000 new cases to the total tally – showing just how significant the effect of such mundane activities is to the numbers that are being noted by the CDC when it comes to active hepatitis A infections.

Admittedly, the CDC has observed that there has been a dramatic decline in the number of hepatitis A infections in the United States since 1996 due to the development of several diagnostic procedures, treatment regimens, and vaccination accessibility, albeit the numbers are still currently significant enough for it to be considered a problem within the community. However, there is a trend that is being observed within the public wherein there are sudden outbreaks every so often due to close contact, intravenous drug use, homelessness, and same-sex intercourse – indicating that there needs to be more focus on addressing these predisposing factors and ensure that the numbers will not exceed its current threshold again.

What Predisposes a Person to HepA Infections?

Similar to other infections, there are certain activities and risk factors that somehow put the person at an increased risk of contracting the illness, particularly when they are not protected by the vaccine and they are exposed to some of these avenues where they could obtain the virus one way or another. You must be likewise aware of these risk factors, as understanding these would go a long way in fortifying your defenses and preventing any unnecessary high-risk activities that could unknowingly put you in harm’s way. Of course, these predisposing factors are not necessarily a guarantee that you will contract the infection following these activities, but it does significantly increase the odds of acquiring the disease if you can confirm that you have done one or any of these activities at all.

International Travelers

Traveling internationally, in general, is not necessarily a risk factor as contracting the infection would heavily depend on contact with an infected person or ingesting contaminated food products. What makes international travel a predisposing factor is that there are specific countries wherein the prevalence of hepatitis A infections is at an all-time high, and considering how contagious hepatitis A infections are, chances are, you will contract the condition if you are ever exposed to a crowded place with several infected individuals. Another concern is if the virus contaminates their food products.

Same-Sex Intercourse

Same-sex intercourse, particularly men-to-men intercourse, increases the risk of contracting hepatitis A infections due to the process involved in such an activity, namely, anal penetration. While it can be argued that hepatitis A infections can still be contracted through heterosexual interactions as there is still some close physical contact between the two people, anal intercourse, due to its penetrative and invasive process, causes microtears within the tissues of the anus. Essentially, these microtears are efficient in causing systemic infections as these are openings that the virus can utilize to immediately enter your circulation and access the liver. As such, when the compromised anus comes into contact with infected bodily fluids, it is easier for the person to contract the condition – making them at risk of developing an infection following exposure.

The same is true when the virus is transmitted the other way around, as the feces commonly contains the virus and may cause transmission during penetrative sex with your partner.

Intravenous Drug Use

Similar to how micro-tears may provide increased access to your systemic circulation, intravenous drug use multiplies this risk ten-fold as IV drug users are often known for sharing needles. When this happens, you essentially allow blood from another individual, infected or not, to enter your circulation. While this would not always cause an infection if the other individual is not infected by the virus, exposing yourself to the blood of someone infected would almost always guarantee an infection later on.

Occupational Risk

When discussing occupational risk, this may heavily refer to people in the medical field as they would often be exposed to needles and patient blood samples. There are tendencies when working in the medical field wherein you can be accidentally pricked by a needle that has been used on someone with an infection such as a hepatitis A infection. If this happens, they are then directly exposed to the virus, which may cause a full-blown disease if the person cannot obtain the proper post-exposure prophylactic regimen to prevent its development. Sure, some may argue that being careful would go a long way in almost discrediting this one as a risk factor, but handling multiple patients and simply being at the forefront of such infections already puts them at risk for contracting the condition, even without accidental needle prick injuries happening.

Oral-Anal Sex

Oral-anal sex may seem unlikely for some, but it does occur in several instances, and it is one of the most common transmission pathways of hepatitis A infections among several individuals. While it does not necessarily correlate to the person’s exposure to bodily fluids, it does involve some type of excrement that an infected person might have – the feces. Hepatitis A infections are spread via the fecal-oral route, signifying that the infection can be spread through ingestion of food that the feces of an infected person have contaminated. Oral-anal sex makes this process more direct as there is a direct contact between the oral cavity of a person and the anus of another – making its transmission even more possible in such situations.

Homelessness

While homelessness is not necessarily a direct causative factor for hepatitis A infections, it does, however, predispose the person to the other risk factors that have been mentioned above – making them at risk as well to contracting such an infection, particularly when they are consuming contaminated food that they could have obtained from unsanitary areas.

Are Hepatitis A Infections Considered under Sexually Transmitted Diseases?

Hepatitis A infections are highly contagious, yes, and they are also transmitted sexually through oral-anal sex, anal sex, or exposure to bodily fluids. The condition itself could be classified under sexually transmitted diseases as its transmission may occur through sexual contact, but it could be classified exclusively as an STD as its transmission may also occur through some other means such as close physical contact. The line between the two is relatively thin, so there may be some overlap, but it is much easier to consider the disease as one that is classified under two categories and only understand how it is transmitted in the first place instead of exclusively placing it under one group.

How is HepA Transmission Prevented?

While several predisposing factors could put you at an increased risk of contracting the infection, there are also some things you can do to prevent or lower the risk of transmission when exposure to the virus is almost inevitable, i.e., occupational risk of exposure.

Vaccination for Hepatitis A

As previously mentioned, there is an available vaccine for Hepatitis A infections, which can be given to children and adults. Children aged 12-23 months, people aged 2-18 who have not received the vaccine previously, and pregnant women who may be at risk of contracting the infection are recommended to get vaccinated with the hepatitis A vaccine.

There are two types of hepatitis A vaccine available:

• Single-dose HepA vaccine: given as two shots spaced six months apart for long-term protection against HepA infections. This is primarily indicated if you would only require protection from hepatitis A infections alone and are not considering any protective measures against any other type of viral hepatitis infection.
• Combination vaccine: given to anyone above 18 years old as three shots over six months for long-term protection against HepA and HepB infections.

The vaccines have been proven safe by several regulatory bodies and have shown no significant side effects from their administration over the years. Soreness within the injection site may be observed, but this is true for any vaccine administered to the patient.

Proper Food Preparation

Similar to what has been discussed before, the HepA virus is commonly transmitted through the feces of an infected individual. As such, food products that have been contaminated with the infected fecal matter may cause transmission if they have not been appropriately prepared. Ensure that any food you consume is cooked and cleaned correctly to ensure that you will contract the infection through this means.

Avoidance of Contaminated Water

Using a similar mechanism as to how contaminated food may cause transmission, dirty water is even more notorious for causing transmission, particularly in areas or countries where water sanitation is relatively poor. If you are not confident about the quality of water that you will be consuming, especially when it comes to tap water, opt for bottled water instead. Buying bottled water from trusted sources will go a long way in ensuring that the water you are consuming is not contaminated with any infectious fecal matter that you could otherwise get from improperly treated tap water.

Isolation of Infected Individuals

Since hepatitis A infections are highly contagious, infected individuals must be isolated temporarily from others to ensure minimal close contact and prevent any transmission that could occur through these interactions. The rate of transmission through droplets is relatively low, but it is better to be safe amidst such a contagious disease.

Safe Sexual Practices

Since hepatitis A infections can be transmitted through the fecal-oral route, you must perform safe and hygienic sexual practices that ensure minimal contact with fecal matter. As much as possible, be aware of your and your partner’s sexual health status to be mindful of any preventive measures that you should take before engaging in intercourse.

When is it Advised to be Examined for a Hepatitis A Infection?

Although hepatitis A infections are relatively mild and would usually not result in any severe complications that could potentially be life-threatening if left untreated, it is still vital for you to be examined immediately by a physician if you have done or have experienced any of the following criteria:

Symptomatic Individuals

Suppose, upon closer examination, you are exhibiting the symptoms usually associated with an active hepatitis infection. In that case, you must be examined by your doctor right away to properly diagnose the condition that you might have, treat it accordingly, and prevent any further transmission of the infection in cases where the disease is contagious.

Recent Exposure

Suppose you are working in a high-risk environment and have been exposed to a blood sample that is either known to be infectious or with an unknown background. In that case, you need to be checked immediately for potential infections that can be transmitted through blood transfusions. The same applies if you have been in proximity for quite some time to someone who has an active HepA infection.

Need for Hepatitis A Vaccine

If you are considering having the HepA vaccine anytime shortly, you need to be examined by your doctor first to know if you are qualified to receive the vaccine.

Hepatitis A Infections: Understanding its Pathogenesis and Transmission

Hepatitis A infections are caused by the Hepatitis A virus, a microorganism that causes a highly contagious but short-term hepatitis infection that primarily targets the liver in its pathogenesis. Hepatitis A infections do not proceed to a chronic condition, unlike other types of hepatitis, but it can cause certain severe complications among those who are compromised if the state is left to persist without any proper treatment regimen administered.

Hepatitis A infections are transmitted through several mechanisms, some of which may include the following:

• Oral-anal sex: exposure to the fecal matter could directly cause transmission due to the presence of viral particles in the feces
• IV drug use: sharing of needles containing blood samples could directly transmit the virus from one person to your systemic circulation
• Proximity with infected individuals: although the possibility is low for droplet transmission, taking care of infected individuals could transmit the virus to you without proper protection.
• Consuming contaminated food products: considering that the virus can survive in contaminated food or water for quite some time, the transmission may also occur when these products are ingested.

Hepatitis A Infections: Signs and Symptoms Observed

Hepatitis A infections primarily target the liver and cause manifestations that are sometimes akin to commonly observed liver problems. As such, the presentations of hepatitis A infections may include the following:

Commonly Observed Manifestations

• Yellowish color of the skin and eyes
• Poor appetite
• Upset stomach
• Vomiting
• Stomach pain in the upper right quadrant of the abdomen
• Fever
• Darkening of the urine
• Light-colored stool
• Diarrhea
• Joint pain
• Weakness, fatigue, and tiredness
• Itchy skin

Possible Complications

Complications are relatively rare in cases of HepA infections as the condition is usually short-term and could not cause any long-term structural damages that are often associated with a chronic illness. However, in cases where the HepA infection has been exacerbated, it is possible to encounter complications such as liver failure, wherein the liver fails to respond anymore, causing death in the most challenging situations.

Who are At Risk for HepA-induced Liver Complications?

Complications are only common among those who already have preexisting liver diseases, such as chronic liver diseases, and those who are already frail enough, such as older adults. Risk factors may vary.

Hepatitis A Infections: Diagnosing the Condition

To identify the following steps to resolve your condition, the infection must be adequately diagnosed initially.

Medical History Taking

In this case, the physician will ask you several questions regarding your symptoms, exposures, and medications, as these three will point towards a common initial diagnosis if you have an ongoing hepatitis A infection. Your symptoms would often be consistent with liver problem manifestations, your exposures will help your doctor figure out your risk, and your previous medications could point towards a possible medicine that may have caused liver damage.

Physical Examination

Similar to how your symptoms were assessed during the history-taking process, your doctor will then try to look at your eyes and skin to see if you are showing any signs of jaundice or yellowing.

Blood Testing

To fully confirm that you have a hepatitis A infection and not any other type of hepatitis or any condition entirely, it is essential for you to undergo serological testing to figure out the specific virus that you have in your system.

Hepatitis A Infections: Management and Treatment Strategies

Considering that Hepatitis A infections are usually self-limiting except in cases where the patient has developed any severe complication that dampens their recovery, the most commonly recommended treatment strategy of the CDC is to provide adequate nutrition, fluids, and rest as the body fights off the virus and restores your health to its tip-top shape. However, if the patient somehow develops any severe symptoms that might signify some liver damage or other manifestations that might require a more intensive approach, it is highly recommended that they are brought to the hospital for a closer observation as they recover. Note that these cases are relatively rare and are only commonly observed among elderly individuals.

Frequently Asked Questions (FAQs)

What is the virus's incubation period before it starts an infection and shows symptoms?

It usually takes 15 to 20 days for symptoms to appear following exposure.

How should I cook my food to remove any contamination?

You should heat your foods to 185F or 85C for at least 1 minute to completely kill the virus.

Can adequate chlorination of water avoid HAV transmission through water?

Yes. However, chlorination of water should only be performed by qualified personnel as improperly and highly chlorinated water, when consumed, may cause adverse effects on your body.

How long do HepA symptoms usually last?

Symptoms may usually last for less than two months, but some cases usually observe a relapse after around six months.

Is it possible to get a HepA infection from kissing?

The possibility is low, but deep kissing or exchanging large quantities of saliva may trigger transmission.

Additional Resources

Centers for Disease Control and Prevention

• https://www.cdc.gov/hepatitis/abc/index.htm
• Learn more about the different types of hepatitis through the integrated information hub of the Centers for Disease Control and Prevention on viral hepatitis infections.

Testing.Com

• https://www.testing.com/tests/hepatitis-a-test/
• Understand the testing process involved in Hepatitis A diagnosis and learn about what you should do before, during, and after your test.

World Health Organization

• https://www.who.int/news-room/fact-sheets/detail/hepatitis-e
• Read about the novel type of hepatitis, Hepatitis E, and explore some key facts associated with this emergent threat.

References

• Centers for Disease Control and Prevention. (n.d.). Hepatitis A Questions and Answers for Health Professionals. https://www.cdc.gov/hepatitis/hav/havfaq.htm#general
• Centers for Disease Control and Prevention. (n.d.). Hepatitis A Questions and Answers for the Public. https://www.cdc.gov/hepatitis/hav/afaq.htm#A4
• Kahn, A. (2022). Hepatitis A: Symptoms, Causes, and Treatments. https://www.healthline.com/health/hepatitis-a
• Khatri M. (2021). Hepatitis A (Hep A). https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-a
• Mayo Clinic. (n.d.). Hepatitis A. https://www.mayoclinic.org/diseases-conditions/hepatitis-a/symptoms-causes/syc-20367007
• Medline Plus. (n.d.). Hepatitis A. https://medlineplus.gov/hepatitisa.html
• NHS. (n.d.). Hepatitis A. https://www.nhs.uk/conditions/hepatitis-a/
• San Francisco Department of Public Health. (n.d.). Hepatitis A. https://www.sfcdcp.org/infectious-diseases-a-to-z/hepatitis-a/
• US FDA. (2021). Hepatitis A Virus (HAV). https://www.fda.gov/food/foodborne-pathogens/hepatitis-virus-hav
• World Health Organization. (2022). Hepatitis A. https://www.who.int/news-room/fact-sheets/detail/hepatitis-a