How is Hepatitis A Tested & Diagnosed?

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The modern problem in the medical field is the rampant cases of self-medication, self-diagnoses, and the improper use of treatment means – resulting in repercussions that could have been avoided, or better yet, conditions that would have been treated and appropriately resolved had there been no instances of improper medication and medical device use. Several information reform programs have brought forward self-medication that many groups pushed forward to help the public become more educated regarding these matters and decide sufficiently for themselves regarding the treatment strategies they could receive in primary care. However, what many people did not realize is that this information slowly started to make even laypeople feel complacent about their understanding of their condition – leading them to believe that they no longer need professionals and they could take whatever they think is best for their supposed condition.

They have never been more wrong.

The issue regarding self-medication and self-diagnosis is that it completely disregards the expert opinion of the physician who has studied the disease in question for years on end, as well as the necessary tests to diagnose a particular condition as such fully. While it might be efficient indeed to help educate the public to ensure that there is better comprehension during patient-physician conversations, it is also crucial that we look at the weight of the information that is being disseminated and simultaneously ensure responsible intake of information in the sense that they will not use such details to skip over the essentiality of a proper diagnosis when trying to manage specific conditions. After all, what constitutes the next step you are about to take when trying to resolve your situation is the proper and accurate diagnosis of what exactly is causing the disease that you might or might not have – and this all starts with proper consultation with the appropriate physician.

Again, it is vital not only to be educated regarding these matters but also to be responsible when consuming these types of information to ensure that you will be receiving the best care possible while still being aware of what you are going through and what strategies you are receiving exactly to resolve the condition that you have. Education is one thing, but using that information for reasonable use is another.

Defining Hepatitis A Infections

Hepatitis infections are necessary conditions that primarily affect the liver, causing an inflammation that subsequently results in presentations commonly associated with liver problems such as jaundice. Hepatitis may be caused by several factors that may include medications being taken, heavy alcohol use, toxin ingestion, or, most commonly, infections. There are three common types of hepatitis; namely, hepatitis A, hepatitis B, and hepatitis C. Hepatitis B and C usually start as a short-term infection but may develop as a long-term chronic condition when not appropriately managed and immediately during its early stages. Hepatitis A, on the one hand, is caused by the hepatitis A virus, and it is usually a short-term infection that may resolve on its own, except in cases where the patient is at high risk for complications and severe liver damage.

Common Signs and Symptoms

Since hepatitis A is a liver infection that causes inflammation, the manifestations of the disease resemble the presentation of any other liver condition. However, please note that some individuals stay asymptomatic, but symptomatic individuals usually show sure signs and symptoms 2 to 7 weeks following their exposure to a potential infected source. The manifestations of a hepatitis A infection typically last for around two months, and the presentations may include:

  • Yellowing of the skin and eyes
  • Lack of appetite
  • Pain within the upper right quadrant of the stomach
  • Upset stomach
  • Vomiting
  • Fever
  • Dark-colored urine
  • Pale-colored feces
  • Joint pain
  • Diarrhea
  • Weakness

It might also be essential to note that even asymptomatic individuals may be able to transmit the infection as the virus is transmitted through the fecal-oral route and not through physical contact with any exposed areas.

Possible Complications

As previously mentioned, hepatitis A infections are only short-term conditions that do not usually result in any long-term damages that are often associated with chronic injuries to the organ. However, in patients who are at high risk for developing the severe liver damage, i.e., older people and those with chronic liver problems, it might be possible for them to develop severe liver damage on top of their current condition – a complication that could very well lead to death if the situation is not managed correctly still. It is therefore essential to note that even though the condition itself is thought to be self-limiting and would often resolve on its own without any significant intervention, it is still crucial for you to be correctly diagnosed and checked by a physician to rule out any impending complication arising from this initial infection.

Management Strategies

As discussed, hepatitis A infections are commonly self-limiting and would therefore not require significant interventions to ensure that the virus will not proceed to anything more severe or life-threatening. With this in mind, the recommended management strategy by the Centers for Disease Control and Prevention when trying to cure hepatitis A infections is to provide adequate fluids, nutrition, and rest for the patient – allowing their own body to sufficiently heal on its own and fight off the infection using their immune system, given that their defenses are still strong enough to withstand such an infection by a very prevalent virus.

Preventive Measures

Like any other disease, there are certain things that you can do to prevent the further transmission of the virus, and this would primarily stem from the avoidance of any possible sources of the infection and preventing any events that would usually heighten one’s risk from contracting a disease. Some of the things that you could do to minimize the risk of transmission include:

  • Avoiding contaminated water sources: hepatitis A is transmitted through the fecal-oral route, and any sources of water that have been contaminated with infected feces could cause transmission.
  • Cooking and preparing food products properly: similar to how contaminated water may cause transmission, eating food products exposed to or contaminated with the virus could still cause transmission. You must cook your food at sufficient heat levels for at least 1 minute to guarantee that the virus, if it ever was in your food, has been killed.
  • Practicing safe sex hygiene: while somehow unconventional, particular couples like to perform oral-anal sex with their partners. While this could be relatively safe for as long as you are aware of your and your partner’s sexual health status, doing this with someone unaware of their status could increase the risk of contracting the infection by tenfold or even more.
  • Do not use intravenous drugs or share needles: intravenous drug use and needle sharing are classified under the same thing as the latter often occurs during the former. Many people do not realize that sharing needles provides free access to your body for whatever is present in your friend or partner’s systemic circulation. If they have any contagious condition or an infection that can be transmitted through bodily fluids, sharing needles could almost guarantee the transmission of the virus.
  • Avoid areas with high infection rates: the suggestion pretty much explains itself, and this primarily relates to the understanding that areas with high infection rates would always be correlated with a higher risk of transmission. Considering that hepatitis A infections are relatively highly contagious, it is crucial that you will not be knowingly exposing yourself to high-risk situations, especially if your health has already been compromised and you might be at risk of developing severe complications that could eventually lead to death.
  • Hepatitis A vaccination: considered as probably the most foolproof way of ensuring utmost protection against the virus is by getting vaccinated with the hepatitis A vaccine. There are two variations that you may opt for, but your choice would mainly depend on whether you would like a dose spacing that is farther apart but is more catered towards HepA infections alone or a shorter-duration combination vaccine that protects against both hepatitis A and B infections. This is particularly important for those planning to travel to countries with high infection rates.

The Significance of Hepatitis A Testing and Diagnosis

To fully understand why we are trying to educate the public regarding how Hepatitis A infections are diagnosed in the first place, perhaps it might be more efficient to have you understand the reason behind this movement in detail – tackling every little point that will be critical in your comprehension of why these tests and diagnostic procedures are essential in ensuring the best possible care and treatment plan that you will be receiving. Please do note, however, that while we do promote the understanding of these somehow complicated tests, this still does not warrant any instances of self-medication as diagnostic test results, even when obtained through proper means, would still have to be assessed and reviewed by your doctor to tailor the therapy that will be prescribed to you.

Understanding the Need to Take the Test

As we have previously discussed, hepatitis A is a short-term infection of the liver that subsequently causes the inflammation and enlargement of the liver – causing specific presentations commonly associated with liver diseases such as jaundice and weakness. These symptoms are hard to diagnose alone as they are non-specific, meaning that while these presentations could be traced back to the liver, there are no guarantees that you will be able to provide an accurate diagnosis from just the presentations that you were able to see alone. As such, this is where accurate diagnostic tests come in, wherein professionals would have to obtain a sample of your blood or serum and identify the presence of any hepatitis virus antibodies – indicating an active hepatitis infection within your body. While many would still argue that the symptoms could be immediately attributed to a hepatitis infection when the patient has a comprehensive note of their medical and exposure history, there again comes the question of “what type of hepatitis does the patient have in the first place?”

Hepatitis A infections are relatively easy to deal with as they are usually self-limiting and would only last for quite a month or two. However, in cases where the patient might have a hepatitis B or C infection instead, the misdiagnosed disease could just as quickly progress to a chronic lifelong condition that could no longer be treated with conventional means – leaving the patient with the burden of having their livers checked for long-term damages consistently just because a simple diagnostic test has been missed. Similar to this point, the issue of complications likewise comes to mind when trying to understand the importance of having hepatitis infections diagnosed, considering that even hepatitis A infections could cause severe liver damage and death, albeit in rare cases where the patient is already predisposed to such a development.

Despite all this, the fact remains that immediate diagnosis is the key to proper liver infection treatment, and the earlier the disease has been recognized and diagnosed, the better the prognosis will be for the patient, and the fewer the complications will be if in case any further delays will be met by the patient down the road.

On another note, physicians would commonly answer the question regarding the importance and purpose of hepatitis A diagnosis with two points:

  • Diagnose the infection: understand the cause of the disease, pinpoint the type of hepatitis causing the manifestations, and treat the patient’s condition accordingly.
  • Determine immunity: identify whether the person has had a previous hepatitis infection, as this might mean that they are already immune to the virus and could no longer be infected. This could be used primarily when patients request a hepatitis A vaccine, as administering the vaccine is no longer necessary for naturally immune individuals.

When is the Test Prescribed?

Several factors can be considered when answering the question about when the test should be performed, but professionals are mainly insisting that hepatitis A diagnostic tests should be administered when there are specific significant points in the patient's symptomatology, medical history, and recent exposures that could have caused a hepatitis A or any hepatitis infection for that matter in this context.

When looking at the symptoms of a patient when assessing the need for a hepatitis A diagnostic exam, it is essential to note that symptomatic manifestations would often appear around 28 days following a potential exposure case – meaning that if the symptoms presented within this period, there is a good chance that the patient has contracted the disease. However, please note that children under six years old may not have any symptoms, and some adults may also be asymptomatic despite the persistence of an infection within their system. If you would like a guide on what you should look for when trying to examine the onset of symptoms, the following symptoms are the most common ones observed in reported cases:

  • Dark-colored urine
  • Gray stool
  • Diarrhea
  • Fatigue
  • Low-grade fever
  • Abdominal and joint pain
  • Vomiting
  • Appetite loss
  • Yellowing of the eyes and skin

According to physicians, it is also crucial for you to be diagnosed with a potential hepatitis A infection if you have knowingly been exposed to a potential HAV source, mainly if you are already showing symptoms of a possible liver condition. These scenarios may include:

  • Recent travel to a high-risk country
  • Using IV drugs and sharing needles
  • Living in a nursing home
  • Working in an industry that deals with food processing
  • Eating raw food products
  • Working in the hospital, particularly those who are involved in blood drawing practices

What Should the Expectations be for the Test?

To fully prepare you for the test you might take when you have a suspected hepatitis A infection case, you can expect the following things to occur before, during, and after your testing procedure.

Before the Test

The blood tests are not as sensitive to various factors, so no special preparation is necessary for you before taking the test. However, if you are taking any medication, it is crucial that you first relay it to your doctor, as these medications may interfere with the test and cause problems with the results.

During the Test

Considering that the tests for hepatitis A diagnosis are mostly serological, you would have to expect that a blood sample will be collected from you to begin the procedure. A blood sample will be collected either using a syringe or a lancet for children, and this will then be processed within the laboratory to identify the presence of any antibodies for the hepatitis A virus.

After the Test

Although a blood sample has been collected from you for the test, bleeding tendencies are very rare, and there are no limitations that should be observed from your day-to-day activities following the testing procedure.

Is the Test Necessary for Me?

Unfortunately, it is hard to answer whether the test is appropriate for you or not without a prior examination from your doctor first. That would mainly be comprised of medical history taking and physical exams. As such, you must consult your doctor first regarding your symptoms to determine whether you would need the following procedures to identify what is causing your presentations.

What are the Tests that are Available, and What are their Differences?

Three tests can be availed of for Hepatitis A diagnosis, and the following table highlights the variation between the three when it comes to the sample collected for each, the usual waiting time, the tools used, and the indication for each procedure.

Anti-HAV IgM Antibody Test

Anti-HAV IgG Antibody Test

Total Hepatitis A Antibody Test

Sample Required

Blood Sample

Blood Sample

Blood Sample

Waiting Time

2-6 working days

2-6 working days

2-6 working days

Tool Used

Syringe or Lancet

Syringe or Lancet

Syringe or Lancet

Indication

Early detection of HAV infection

Detection of previous or pre-existing HAV infection

Identification of both current and past infections

Hepatitis A Testing and Diagnosis: The Available Tests for You

To have a deeper understanding of the tests that are usually administered to patients to determine their current hepatitis A status, the following section describes each test in detail, from their procedure to the accuracy of each test when applied to its respective indications.

Hepatitis A Immunoglobulin M (IgM) Antibody Test

Mechanism of Action of the Test

The hepatitis A immunoglobulin M antibody test or anti-HAV IgM test is a procedure utilized for diagnosing hepatitis A cases using the immunoglobulin M produced by the body in response to an underlying infection. The test itself is indicated for use in patients who are showing sure signs and symptoms indicative of an acute hepatitis infection – meaning that it is a procedure that is commonly prescribed to identify a recent or current condition that the patient has and is not indicated for the detection of a previous infection that may have been contracted by the patient being tested. IgM antibodies usually appear in response to an acute HAV infection in the patient’s serum, and the levels of IgM antibodies typically reach their peak within the first month of infection.

Depending on the type of assay performed by the laboratory handling the test, the antibodies present within the patient’s collected serum sample will be exposed to a particular reagent that will contain marked HAV antigens – providing a complex that will either be isolated through chemical or physical means or be illuminated using luminogenic substances that will qualitatively show the presence of these antibodies in the sample through luminescence. The signals could then be read by the system, and the respective results will be reflected in the report that will then be relayed to the patient.

Duration and Waiting Time

Depending on the laboratory that is performing the test, the waiting time necessary before you could collect your test could be as long as 2 to 6 working days, albeit this could still widely change depending on several factors.

Sample Collected

Considering that the procedure is a serological test aimed at detecting antibodies in the patient’s serum, the sample collected in this process is a blood sample.

Cost and Expenses

The price may vary depending on the testing site, but HAV anti-IgM antibody tests would cost around $10.00 on average.

Insurance Coverage

Yes, insurance companies usually cover viral hepatitis infection diagnosis and vaccinations.

The Sensitivity and Specificity

The anti-HAV IgM antibody test for hepatitis A has a 93.3% sensitivity and around 96.9% specificity for diagnosing the said condition.

Hepatitis A Immunoglobulin G (IgG) Antibody Test

Mechanism of Action of the Test

The hepatitis A immunoglobulin G antibody test or anti-HAV IgG test is a procedure that is indicated for diagnosing a previous infection or a pre-existing condition that has persisted for quite some time, considering that IgG antibodies usually appear a few weeks after the initial infection. IgG antibodies are likewise produced in response to a disease, but the antibody itself is aimed towards the development of immunity to the illness – preventing subsequent infections when you are exposed to the virus again. As such, IgG antibodies are not used to detect a current or recent disease but rather to assess the patient’s immunity to the virus.

It is essentially a qualitative procedure used by professionals to assess the need for a hepatitis A vaccine or rule out an HAV infection diagnosis following a medical history review and physical exam. Anti-HAV IgG tests would utilize almost the same procedure as an anti-HAV IgM test that would expose the antibodies to a reagent containing HAV antigens – detecting the presence of antibody-antigen complexes qualitatively through chemiluminescence and reflecting these observations in the results that will then be released to the patient.

Suppose the detected levels exceed the threshold of the assay. In that case, it can be declared that the patient is already immune to the virus and has sufficient antibodies to prevent further infections.

Duration and Waiting Time

The waiting time may vary, but 2 to 6 working days is usually the standard waiting time for such a procedure.

Sample Collected

Considering its serological procedure, a blood sample is commonly required for this test.

Cost and Expenses

The prices would vary depending on the testing laboratory, but anti-HAV IgG tests could cost up to $9.00 on average.

Insurance Coverage

Yes, hepatitis A screening and shots are usually covered by insurance agencies.

The Sensitivity and Specificity

Based on studies, anti-HAV IgG tests have a 96.6% sensitivity and 97.1 specificity rate in diagnosing hepatitis A infections.

Total Hepatitis A Antibody Test

Mechanism of Action of the Test

The total hepatitis A antibody test is simply a combination of the two tests that have been mentioned above and therefore utilizes the procedure for each respective antibody detection to produce a collective result that assesses the patient’s current and past infections simultaneously.

Duration and Waiting Time

Similarly, the total hepatitis A antibody test would require around 2 to 6 working days for results to be released.

Sample Collected

Blood samples are likewise required in the serological assessment of these antibodies in the patient’s serum.

Cost and Expenses

While it might seem like the total hepatitis A antibody test is a simple combination of two different procedures, the test is relatively more affordable, with an average price of around $10.00 depending on the laboratory performing the test.

Insurance Coverage

The test is covered under most insurance policies, but check your terms to ensure it is within your premium.

The Sensitivity and Specificity

The specificity and sensitivity of the procedure are the respective accuracies of its component procedures.

Hepatitis A Diagnosis: A Summary of Possible Expenses

The following section describes the summary of costs that a hepatitis A diagnosis procedure may incur, as well as whether insurance policies within the United States cover the tests:

Anti-HAV IgM Antibody Test

Anti-HAV IgG Antibody Test

Total Hepatitis A Antibody Test

Price

Around $10.00

Around $9.00

Around $10.00

Insurance Coverage

Yes

Yes

Yes

Frequently Asked Questions (FAQs)

How long do IgM antibodies usually last within the patient’s system?

IgM antibodies are usually cleared from the patient’s system after 3 to 12 months following the resolution of the infection.

If my other tests show that I have liver problems, is it a good idea to be tested for a possible viral hepatitis case?

Yes, as a viral hepatitis infection may be causing your liver problems.

What are the risks of performing the diagnostic tests for hepatitis A?

There are minimal to no risks in performing these tests to diagnose hepatitis A, albeit some bruising may be observed within the blood collection site.

If I have been vaccinated for HAV before, will my IgG test results return positive?

In some instances, yes, it would show that you have antibodies for the disease.

Are there other tests that the doctor can perform or request for a confirmed hepatitis A infection?

Yes, and these are mostly imaging tests that would show possible liver damage caused by the infection.

Further Reading

NHS

WebMD

NYU Langone Health

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
  • Health Link BC. (n.d.). Hepatitis A Virus Test. https://www.healthlinkbc.ca/tests-treatments-medications/medical-tests/hepatitis-virus-test
  • 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
  • Maryland. (n.d.). Hepatitis A Specimen Submission Guidelines. [PDF]. https://health.maryland.gov/laboratories/docs/Hepatitis%20A%20Specimen%20Submission%20Guidelines.pdf
  • Mayo Clinic Laboratories. (n.d.). Hepatitis A IgM Antibody, Serum. https://microbiology.testcatalog.org/show/HAIGM
  • Mayo Clinic. (n.d.). Hepatitis A. https://www.mayoclinic.org/diseases-conditions/hepatitis-a/symptoms-causes/syc-20367007
  • Mayo Clinic. (n.d.). Hepatitis A. https://www.mayoclinic.org/diseases-conditions/hepatitis-a/diagnosis-treatment/drc-20367055
  • Medline Plus. (n.d.). Hepatitis A. https://medlineplus.gov/hepatitisa.html
  • Nainan, O. V., Xia, G., Vaughan, G., & Margolis, H. S. (2006). Diagnosis of hepatitis a virus infection: a molecular approach. Clinical microbiology reviews, 19(1), 63–79. https://doi.org/10.1128/CMR.19.1.63-79.2006
  • National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. (2019). Laboratory Procedure Manual. [PDF]. https://wwwn.cdc.gov/nchs/data/nhanes/2017-2018/labmethods/HEPA-J-MET-HEPATITIS-A-ANTIBODY-508.pdf
  • NHS. (n.d.). Hepatitis A. https://www.nhs.uk/conditions/hepatitis-a/
  • Paula, V. (2012). Laboratory Diagnosis of Hepatitis A. Future Virology, 7(5): 461-472. https://www.medscape.com/viewarticle/765040_4
  • San Francisco Department of Public Health. (n.d.). Hepatitis A. https://www.sfcdcp.org/infectious-diseases-a-to-z/hepatitis-a/
  • Testing.com. (n.d.). Hepatitis A Testing. https://www.testing.com/tests/hepatitis-a-test/
  • 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

Written by Mark Riegel, MD

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