|
Recommendations for the Diagnosis and Management of Patients with Hepatitis A Infection
Definition Hepatitis A is a highly contagious acute viral infection of the liver once called "infectious hepatitis," and responsible for cyclic epidemics every 5-12 years. There is no known chronic condition and the infection is spread primarily through close person-to-person contact by the fecal (stool)-oral route. Contaminated drinking water and food may be another source of infection. Symptoms similar to the flu develop (sudden lack of energy, fever, nausea, vomiting and diarrhea with abdominal discomfort) about 2-6 weeks after exposure. Although children 5-14 years old are most affected, those under three years old are seldom symptomatic but are still contagious (with babies under a year of age shedding virus in their stool for up to a year after infection.) Adults often (88%) turn icteric with jaundice (yellow) eyes/skin, dark urine, and white stools and can be severely ill. The course of disease varies from mild illness lasting 1-2 weeks to more severe cases taking 4-6 weeks to recover, occasionally as long as six or more months to fully recover. Very rarely do cases of fulminant hepatitis develop that end in subsequent liver failure, but there are situations that result in the need for liver transplant and even death. Diagnosis of hepatitis A includes ruling out hepatitis B and C, becoming anti-HAV IgM positive at 0-14 days of exposure and anti-HAV total positive at 3-4 weeks (usually within one week of symptoms) of illness. Evaluation The following guidelines are suggested for the evaluation of persons suspected of having hepatitis A infection. Initial testing besides the anti-HAV IgM and total include: LFT (liver function tests); ALT, AST, and GGTP, complete bilirubin, hepatitis C antibody, hepatitis B core IgM and surface antigen. Routine Follow-up of Hepatitis A
The education and public health aspects of managing Hepatitis A Household and sexual contacts should be screened for hepatitis A with anti HAV-total and IgG, with those seronegative persons offered hepatitis A vaccine. Those ill or in a household with hepatitis A illness are cautioned to maintain careful, vigorous handwashing techniques, especially after a bowel movement or changing a child's diaper and before cooking or eating. The practice barrier protection when having sexual intercourse is debatable, though worth consideration depending on practices. Education as to the means by which the virus is passed to others is advisable for close family members and all household contacts. Hepatitis A ill persons and their families/close household associations who wish more information can contact organizations such as the American Liver Foundation, Hepatitis Foundation International or CDC-Centers for Disease Control/Hepatitis Branch. |
