All you need to know about Hepatitis A – A Sexually Transmitted Disease
What Hepatitis A is
Hepatitis A, like other types of hepatitis is a viral infection affecting the liver. It is worth mentioning that Hepatitis A does not cause chronic infection and the immunity after infection lasts forever. Australia does not belong to the countries with high prevalence of Hepatitis A. Hepatitis A can affect people at any age (1). Between the years 1997 and 2016, hepatitis A had resulted in 35 deaths in Australia.
During the last years, hepatitis A notifications and hospitalisations have a decreasing tendency. On the other hand, there is an increasing rate of cases that relate to travelling abroad in countries where hepatitis A is endemic (2).
Ways of infection with Hepatitis A
The incubation period varies from 15 to 50 days, with an average incubation period of 4 weeks. Infected people excrete the Hepatitis A virus in faeces for up to 14 days before the onset of illness and at least 7 days after the onset of the illness.
Hepatitis A is usually transmitted by the faecal–oral route and infection occurs when you consume contaminated food or water. Hepatitis A can survive well in the environment conditions out of the human body and it persists on hands for several hours and in food kept at room temperature for even longer. In case of an infected person who prepares food without having properly washed his hands, hepatitis A can easily be transmitted. Moreover, Hepatitis A is quite resistant to conditions of heat and freezing. Another way of being infected with Hepatitis A is by consuming raw shellfish from water polluted with sewage (2).
An additional way of transmission of Hepatitis A is via sexual contact particularly oral-anal sex with an infected person (3).
Are you at risk for Hepatitis A?
If you have been vaccinated against Hepatitis A or have been infected in the past, then you have immunity against the virus. Therefore, those who have not had hepatitis A in the past and who have not been vaccinated against the virus, belong to the group of people who are at risk of infection (4).
People from areas or those visiting areas that have less access to clean water are more at risk of getting hepatitis A. According to the National data, Aboriginal and Torres Strait Islander children have higher risk of infection with Hepatitis A (5).
Symptoms of Hepatitis A infection
Many people with hepatitis A, especially young children, do not experience any symptoms. Otherwise, if you are infected with hepatitis A, you may experience symptoms like nausea, fever, loss of appetite, joint pain, stomachache, dark urine, or jaundice (yellow eyes and skin). Although symptoms might last for several weeks, it is more likely that most people will fully recover (3).
Complications of untreated Hepatitis A
Unlike other types of hepatitis, patients with hepatitis A recover without complications. It is very rare for a patient with hepatitis A to end up with a liver failure and these few cases are limited to people over their 50s or patients who have other liver-related diseases (6).
Hepatitis A test
According to the clinical examination and the patient’s travel history and symptoms, your doctor will ask some blood tests which is the standard way to confirm infection by hepatitis A. In some cases, hepatitis A can be diagnosed by a DNA testing done on blood or faeces samples (7).
The blood test may detect antibodies to the hepatitis A virus which are called immunoglobulin M (IgM) antibodies. If the results of the blood test indicate the presence of antibodies to the hepatitis A virus different to the IgM antibodies, this means that you have immunity to hepatitis A, because you had a vaccination or a previous infection in the past (6).
Management of Hepatitis A
In case of symptomatic infection, guidelines suggest supportive care. Hospitalisation is only recommended in rare cases of severe illness or symptoms deterioration. The patient with hepatitis A is advised to avoid any sexual contact during the acute illness and for at least 7 days after the onset of jaundice (1).
Since Hepatitis A is very contagious, in case of infection you should avoid involvement or working in childcare, school, or preparing foods-drinks for others. Furthermore, you should not share linen and towels with others.
Ways to reduce the chance of infection
One of the most important actions to avoid hepatitis A infection is by washing all the surfaces of your hands and fingers thoroughly with soap and warm water whenever there is a possibility of getting in contact with faeces, i.e. after using the toilet, after changing diapers and before and after handling or preparing food. Additionally, it is a good strategy to drink only bottled water when you travel in a developing country that you are unsure about the quality of the water. Using bottled water for your ice cubes, to brush your teeth, and wash your fruits and vegies can limit even more the chances of hepatitis A infection in such countries.
Hepatitis A vaccination
Hepatitis A vaccines protect you from getting infected and prevent serious disease. According to studies, the vaccines have protective efficacy of nearly 100%. In addition, no booster doses are required. You should only keep in mind that it may require a period of two weeks or more to provide protection. The importance of vaccination should be highlighted by the fact that before the vaccination program, the rates of hepatitis A in Aboriginal and Torres Strait Islander communities were very high, while after the hepatitis A vaccination program for Aboriginal and Torres Strait Islander, the rates dropped significantly (2).
Take away message
Hepatitis A is the less health damaging among the types of hepatitis infections. The rates of hepatitis A in Australia are dropping after the introduction of Australian National Immunisation Program against hepatitis A. Following the hygiene standards in our daily life and working environment can limit the spread of hepatitis A.
User, S., 2018. Hepatitis A – Australian STI Management Guidelines. [online] Sti.guidelines.org.au. Available at: <http://www.sti.guidelines.org.au/sexually-transmissible-infections/hepatitis-a> [Accessed 20 August 2020].
2020. [online] Available at: <https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/hepatitis-a> [Accessed 20 August 2020].
Hepatitis Australia. 2020. Hepatitis A. [online] Available at: <https://www.hepatitisaustralia.com/hepatitis-a> [Accessed 20 August 2020].
Health.nsw.gov.au. 2019. [online] Available at: <https://www.health.nsw.gov.au/Infectious/factsheets/Factsheets/hepatitis-a.pdf> [Accessed 20 August 2020].
2020. [online] Available at: <https://www.health.gov.au/health-topics/hepatitis-a> [Accessed 20 August 2020].
Information, H., Disease, L., (Viral), H., A, H., A, H., Center, T. and Health, N., 2019. Hepatitis A | NIDDK. [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available at: <https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-a#complications> [Accessed 20 August 2020].
Health.nsw.gov.au. 2019. Hepatitis A Fact Sheet – Fact Sheets. [online] Available at: <https://www.health.nsw.gov.au/Infectious/factsheets/Pages/hepatitis_a.aspx> [Accessed 20 August 2020].
Hepatitis C FAQs
Hepatitis A is another infection of the liver, but unlike Hep B and Hep C most people recover completely. This one is usually transferred from person to person through contact with an infected person’s faecal matter (yes poo) and like Hep B it is still quite common in several popular tourist destinations due to poor sanitation and the way food may be fertilised/prepared…sorry if we just turned you off that next holiday! The good news is that there is a vaccine and once you have had it, you can’t get it again either.
Even though Hepatitis A is not a long-term condition the symptoms can still be very debilitating and whilst you have it you can pass it along to others! Not to mention if you do already have liver damage it can be particularly dangerous. Whilst it is less likely you’ll have contracted this one there are times when our doctors will recommend you are tested for Hepatitis A just to be on the safe side particularly since up to 40% of people with Hepatitis A have no identifiable risk factors for infection.
Hepatitis A is again detected via blood test. We’ll be looking for IgM Hepatitis A antibodies, sounds fancy right? The presence of these antibodies tells us that you’ve recently contracted the infection because they’re present for 3-6 months after. We’ll also look for IgG Hepatitis A antibodies, the presence of these guys tells us you’ve had Hepatitis A in the past and now have immunity.
Hepatitis A is not usually treated, it will clear up all on its own, just like a nasty dose of the flu, but as we said the symptoms can be quite uncomfortable so being tested means a doctor will be able to give you some relief and most importantly knowing you have it means you won’t pass it along to anyone else!