Hepatitis A

Hepatitis A: description

Hepatitis A is an acute form of hepatitis, often referred to as travel hepatitis referred to as. This is because 40 to 50 percent of those affected get the infection when traveling to countries with poor hygienic conditions. These include above all subtropical and tropical regions such as South and Southeastern Europe, Africa, Asia and South and Central America. The infection is mainly about contaminated water (including ice cubes) as well contaminated food.

Around twenty percent of all hepatitis cases are caused by infection with hepatitis A viruses. These are so-calledRNA viruses (RNA viruses). They belong to the family of the uncontaminated, very resistant Picornaviridae – Environmental influences can not harm them.

For example, the hepatitis A virus can easily withstand disinfectants containing 70% alcohol and mild soaps. Even heat up to 85 ° Celsius or cold to minus 15 ° Celsius does not matter to the pathogen. On top of that, the hepatitis A virus is very variable. Therefore, it can easily escape the protective mechanisms of the human immune system with small changes.

Attention: The hepatitis A virus can also remain infectious on the hands for a few hours.

Hepatitis A: symptoms

Especially in children, hepatitis A infections are usually without symptoms. The disease is then usually not noticed and heals by itself. Experts suggest that about 30 percent of adults in Western industrialized countries are immune to hepatitis A, as they have a childhood asymptomatic infection, so have an infection without discomfort, have gone through.

In adults, hepatitis A infection is generally more severe than in children. Rarely are very severe courses with acute liver failure or severely impaired liver function. Such fulminant hepatitis usually affects older patients (50 years and over) with previously damaged liver or chronic hepatitis B or C.

Note: Hepatitis A always takes an acute course. Chronic cases are unknown.

First of all, non-specific symptoms of hepatitis A occur, for example:

• slight rise in temperature to less than 38 ° Celsius
• loss of appetite
• Nausea and vomiting
• in performance
• Pressure pain in the right upper abdomen

Physicians refer to this phase of the early symptoms as so-called prodromal, It lasts for about two weeks.

In about one third of patients, the so-called prodromal phase closes icteric phase at. The term derives from the medical term for jaundice (Jaundice). In the case of those affected, the color changes Skin and the white part of the eyes (sclera) yellow, This is because bilirubin (breakdown product of the red blood pigment) is released by the liver damage and deposits in the skin and sclera.

In addition, bilirubin is excreted via the kidneys, causing the Urine dark colored. In addition, intestinal bacteria can degrade the bilirubin, which discolors the stool (light stool = Lehmstuhl).

Many patients also report itching of the skin.

Note: The jaundice phase can last for several days to several weeks. It is much less common in children under the age of six than in adults.

Hepatitis A: transmission

Hepatitis A viruses become major transferred fecal-oral: Infected people excrete most of the virus via the stool, and this already one to two weeks before the first symptoms. For example, if patients do not thoroughly wash their hands after having a bowel movement, they can transfer the virus to doorknobs, cutlery or towels. From there they can reach the skin of healthy people and – when touching the mouth – penetrate through the mucous membrane into the body.

In poor hygienic conditions, fecal waste can also enter the groundwater. That’s why hepatitis A is often over contaminated water (Drinking water, ice cubes, bath water) as well as over contaminated food transfer. This may be, for example, vegetables or fruits that have been poured or washed with the contaminated water. Seafood is also a common source of hepatitis A, especially mussels and oysters.

Occasionally hepatitis A transmission occurs about blood and blood products, In this way, drug addicts can infect each other, for example when they use the syringe (like needles) together.

pregnant womanwho are infected with hepatitis A can also infect their unborn child.

Duration of infectivity

Anyone who has been infected with hepatitis A is contagious as long as he or she excretes pathogens through the stool. The highest risk of infection for healthy people is one to two weeks before the patient shows the first symptoms. During this time, the virus multiplies very much in the body of the infected person. Contagiousness usually ends one to two weeks after the onset of jaundice.

Caution: Infected children excrete hepatitis A virus with the stool for a significantly longer period than adults. From the end of the third week of illness, however, the small patients are generally considered to be no longer infectious.

Hepatitis A: incubation period

The period between infection and onset of the first symptoms is called the incubation period. It varies in hepatitis A between 15 and 50 days. On average, the first symptoms appear thirty days after infection with hepatitis A virus.

Hepatitis A: examinations and diagnosis

It is not possible to diagnose a hepatitis A infection because it does not produce clear symptoms. However, nonspecific symptoms such as poor appetite and tiredness as well as a yellowing of the skin are clear indications of a liver disease such as hepatitis – especially after a stay in tropical-subtropical countries. Then you should definitely go to the doctor.

For a hepatitis A diagnosis, a blood test is necessary. Increased liver values like GOT, GPT, Gamma-GT and AP indicate liver inflammation.

The body also forms specific antibodies against the hepatitis A virus, which are detectable in the blood. The exact type of antibodies shows how long the infection lasts. For instance Anti-HAV IgM In response to a recent infection, this type of antibody is detectable just two weeks after infection and for about three to four months. Anti-HAV IgG on the other hand, they only appear four to five weeks after infection. So they indicate that there was an infection, but it is already over. This type of antibody circulates lifelong in the blood. After a living infection, it is therefore immune to a renewed infection with hepatitis A virus.

Note: Even after hepatitis A vaccination, anti-HAV IgG is detectable in the blood.

In addition to a blood sample is also suspected of hepatitis A stool specimen examined by the patient. In an infection one finds therein characteristic components of the exciters.

Hepatitis A: treatment

There are no specific medicines for hepatitis A virus. Therefore patients can only treated symptomatically become. Thus, complaints such as nausea or fever can be alleviated if necessary with appropriate means. In addition, the patients should protect physically and only light food to eat. High-carbohydrate, low-fat foods are particularly suitable to relieve the liver.

Important is also the Refrain from alcohol, The stimulant loads and damages the liver in addition – as a central metabolism it must break down the alcohol namely. For the same reason, patients should only take medicines that are absolutely necessary.

Hepatitis A therapy can generally be given at home. Up to two weeks after the onset of the first symptoms or one week after onset of jaundice, patients should have as little or no contact with healthy people as possible. Consistent hand hygiene and a separate toilet for the patient help reduce the risk of infection for family members.

If necessary, relatives can be vaccinated against hepatitis A as a precaution. In certain cases, it may be useful to simultaneously administer ready-made antibodies against hepatitis A virus (passive immunization).

compulsory registration

Hepatitis A is notifiable. This means that the attending physician must notify the competent health authority by name of all suspected cases and proven illnesses. Deaths from hepatitis A must also be stated. The health department forwards the data to the Robert Koch Institute, where it is statistically recorded.

Hepatitis A: Prognosis

Hepatitis A heals well, unlike other hepatitis infections. There is also no risk of developing chronic hepatitis.

After an infection, you are immune for a lifetime. Once infected, however, patience is needed: it may take a few months for the disease to heal completely.

Rarely, the disease is severe and, if, it was usually favored by alcohol, pre- or drug damage. One possible complication is the liver decay coma, that is, the patient loses consciousness in response to the toxicity of substances from decaying liver cells. Affected persons must be treated as quickly as possible; possibly a liver transplant is necessary.

The older the patient, the higher the risk of complications. For example, the mortality rate for patients over the age of 50 is about three percent. Generally, the mortality rate of Hepatitis A at one to two percent.

Hepatitis A: Prevention

In addition to good hygiene (especially when dealing with food), the best protection against hepatitis A is vaccination.

A hepatitis A vaccine is available for children 12 months and older. It contains killed hepatitis A viruses (HAV inactivated vaccine) and is injected into the muscle. The vaccine is effective after only two weeks, so that there is sufficient protection even for short-term planned trips abroad. After the first vaccination a second vaccination should be given at intervals of six to twelve months. This is important for a long-term effect.

How long the vaccine protection after two hepatitis A vaccine doses exactly holds, is not yet clarified. According to studies, booster vaccination is not necessary because almost all vaccinees are protected from infection for 25 to 40 years, depending on the vaccine used.

Note: There are also vaccines that simultaneously protect against hepatitis A and B viruses. For such combination vaccines, three doses of vaccine must be administered.

The cost of the hepatitis A vaccination of 40 to 60 euros sometimes takes over the statutory health insurance. If you need the vaccine for professional reasons, it usually pays the employer. Check with your cashier and / or company management beforehand.

Generally, the following groups of people become one Hepatitis A vaccine recommended:

• People with a sexual behavior that carries a high risk of infection (eg with frequently changing sexual partners, homosexuality)
• People with certain illnesses who are frequently given blood components (eg people with haemophilia haemophilia)
• People in mental health institutions or similar care institutions
• People with an increased risk of occupational infection in the health service
• Employee in the wastewater supply
• Employee in the food preparation
• People who have contact with hepatitis A sufferers, especially in community facilities
• Travelers in endemic areas at high risk of infection
• People with chronic liver disease

The vaccine against Hepatitis A is generally well tolerated. Possible side effects include fatigue, head and body aches or redness. They usually disappear quickly.