Hepatitis A Fact Sheet

Hepatitis A - fact sheet

Hepatitis A is also known as "yellow jaundice" or catarrhal jaundice of childhood. It is a relatively common disease (has become less common in the UK) and is caused by a virus. About half the people in this country have been infected at some time before the age of 40 years. it is a disease which is transmitted as a result of poor hygiene or by eating contaminated food. Hepatitis A is a NOTIFIABLE disease. This means that doctors have a legal duty to inform the Consultant in Communicable Disease Control of suspected cases.

The illness.	Fever, malaise, loss of appetite, abdominal discomfort followed within a few days by jaundice, dark urine and pale stools. The disease varies in clinical severity and only rarely presents as a severely disabling disease lasting several months. It is not unusual – especially in children – for the disease to occur without any signs or symptoms, so that it is only never diagnosed retrospectively by a blood test. This makes the disease hard to control.
Outcome.	Nearly always complete recovery. Case fatality rate is very low (0.6%) and is usually in the older patient where liver failure has developed.
Diagnosis	Clinical diagnosis, but antibody (blood) testing is the only way of ensuring which type of hepatitis the patient has.
Treatment	No specific medical treatment. The child is infectious and should be nursed away from the rest of the family until 5 days after the onset of jaundice. Careful toilet hygiene should be observed. Wash crockery and cutlery very carefully. Carers should be very careful about hand washing when handling food.
Occurrence	World-wide. Occurs as sporadic unconnected cases or in epidemics which tend to occur in 10-year cycles. In countries where sanitation is poor infection occurs at an early age, but in developed countries young adults may still be susceptible. The disease is most commonly found in school age children and young adults.
Outbreaks.	More common in some parts of the UK than others, e.g. North West England, West Midlands. Epidemics tend to come in 10-year cycles and evolve very slowly, involve wide geographic areas and last for many months. If the source of the virus is in food then the outbreak evolves more slowly.
Reservoir	Man.
Transmission	Faecal-oral route – person to person. Contaminated water. Food contaminated by food handlers.
Incubation period	15-50 days (average 28-30 days).
Communicability	Most infectious during the latter part of the incubation period and for five days after the onset of jaundice. Infection is common amongst children in poor social circumstances where hygiene or sanitation is poor.
Susceptibility	All persons who have not had the disease or been immunised. School aged children and young adults are most at risk. After acquiring the disease immunity probably lasts for life, but often the person does not know whether or not he/she has been infected.
Control	Educate the public about personal hygiene (toilet hygiene, handwashing and food preparation). Isolation and exclusion of the infected person from school/work until 5 days after the onset of jaundice. Sometimes close contacts may be offered immunisation .
Prevention	Educate the public about personal hygiene (toilet hygiene, handwashing and food preparation). Travellers to third world countries and countries where sanitation is poor should be offered active immunisation (see below) which confers long-term immunity. Travellers should also be advised on foods to avoid, e.g. shellfish (especially oysters, clams etc.), uncooked vegetables, fruits and ice-cubes in their drinks.
Immunisation - Active	Recommended for those at increased risk of transmission, and sometimes used in outbreaks. A number of vaccines are available now, using inactivated virus, grown in a cell culture medium: they are thus free from any risk of blood-borne diseases. Full immunity takes about 2 weeks to develop, and lasts for 6-12 months. A booster dose given at 6 months after the initial dose will extend the period of immunity to 10 years.
Immunisation - Passive	Human normal immunoglobulin (HNIG) contains antibodies to hepatitis A virus. It is derived from blood, and is only recommended in exceptional circumstances. It offers short-term protection, and may be used in outbreak and, exceptionally, for travellers abroad.
Immunisation - Contraindications	Acute febrile illness or reaction to previous doses of the vaccine. Pregnant women should not normally receive active immunisation against hepatitis A.
"At Risk"	Close contacts of hepatitis A cases. Some occupations, e.g. sewer workers, staff working in institutions where they may be exposed to human faeces, such as:- institutions for people with learning difficulties prisons day centres and nurseries Homosexual men, drug abusers, and haemophiliacs. Travellers to countries outside Northern and Western Europe, North America, Australia and New Zealand.

Key points.

Always wash your hands:

after going to the toilet,

before preparing food,

after changing a baby’s nappy.

Keep your infected child at home and away from other children until 5 days after the jaundice appears.

There is more risk of contracting hepatitis A when travelling abroad. Seek advice about immunisation from your doctor or practice nurse well in advance of your journey.

Take advice on hygiene and food and water consumption if you travel abroad.

Peter M B English, based on a fact sheet by Dr Mary Newlands, CCDC in Southern Derbyshire (retired)
Revised: September 17, 2004.