Hepatitis A

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Hepatitis A
Hepatitis A

Video: Hepatitis A

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Video: Hepatitis A and B 2023, January
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Hepatitis A

Hepatitis A viruses (HAV) cause acute inflammation of the liver tissue. Hepatitis A is a serious disease, but is generally quite harmless. It usually heals completely and leaves a lifelong immunity. Hepatitis A is one of the most important food infections and is native to all tropical and subtropical regions. Infected travelers can infect other people after returning home, causing local outbreaks. The number of people infected with hepatitis A has been falling in Europe for years.

In Austria, however, the number of food-borne HAV infections has risen again in recent years. The disease often goes unnoticed in children. Contact persons can still be infected. This is why minor epidemics occur time and again in Austria, for example in schools or kindergartens.

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What is the cause of hepatitis A?

The hepatitis A virus is transmitted via a so-called faeco-oral (ingestion of stool through the mouth) smear infection or via unclean tap water or ice cubes. Food contaminated with the hepatitis A virus, such as ice cream, fresh milk, salads, raw meat, fish, mussels, oysters and crustaceans, can also be a source of infection. In the hepatitis A endemic areas (regions with many sick people), the infection is primarily acquired in childhood.

What are the symptoms?

In comparison to other viral hepatitis diseases, the incubation period is short at around two to seven weeks (usually 25 to 30 days). People who have become infected are contagious seven to 14 days before the onset of the disease.

The illness usually lasts a few weeks. It begins with uncharacteristic general complaints such as fever, tiredness, loss of appetite, nausea and vomiting. After a few days, in most cases, the urine will turn dark and the stool pale. Finally, jaundice will develop (recognizable by the yellowing of the whites of the eyes and the skin). Itching may occur, and dull pain in the area of ​​the right upper abdomen (liver area) may persist. The liver is enlarged (hepatomegaly), and the spleen may be larger too (splenomegaly). In addition, a rash can sometimes occur.

In children, the disease usually has no major symptoms.

Especially in older people and in patients with previous liver damage (fatty liver, liver cirrhosis, hepatitis B or C or other chronic liver diseases) and pregnant women, it can lead to severe or protracted courses. In around ten percent of those affected, the disease lasts a few months. Fulminant forms are observed in less than 0.1 percent of the sick. Among other things, this can lead to blood clotting disorders and functional disorders of the central nervous system (hepatic encephalopathy) and digestive organs. The frequency of deaths increases with the age of the sick. However, even in old age, fatal courses only occur in isolated cases.

How is the diagnosis made?

The doctor makes a suspected diagnosis based on the patient's information (e.g. stay abroad before the illness and typical complaints). During the physical examination, she / he checks, among other things, the tenderness of the right upper abdomen with an enlarged liver. Sometimes she / he can also feel an enlarged spleen. This is followed by a blood test. A stool exam is also rarely done.

Laboratory tests

The diagnosis of hepatitis A is made by the detection of certain serum antibodies (anti-HAV-IgM) in the blood using ELISA. HAV virus detection in the blood or in the stool by means of PCR (HAV-RNA) and in the stool by means of ELISA (HAV antigen) is also possible. However, these tests are very rarely carried out. Laboratory tests (in the blood) usually show a sharp increase in liver values ​​(primarily the transaminases GOT and GPT as signs of inflammation and destruction of liver cells). The yellow blood pigment (bilirubin) can also rise sharply. An increase in the urobilinogen concentration (breakdown product of bilirubin) can be measured in the urine. In addition, blood clotting (e.g. the Quick value) can be checked.

If necessary, an ultrasound examination can also be carried out.

Reporting requirement

Hepatitis A is a reportable infectious disease. If a doctor diagnoses hepatitis A, people in the immediate vicinity of the sick person are informed, examined and treated if necessary. Sick people and contact persons without antibodies against the hepatitis A virus are isolated. In particular, you are not allowed to go to community facilities (e.g. kindergarten, nursing home or school) until you can no longer transmit the virus. They are also not allowed to work in food production or distribution companies. Contact persons who have adequate vaccination protection or who have previously suffered from hepatitis A are not affected. In the case of an endemic, a possible source (e.g. contaminated drinking water) is sought.

How to prevent hepatitis A

Hepatitis A is an unpleasant disease, but it can be prevented very easily.

The most important measures for effective prevention (prophylaxis) are:

  • Vaccination,
  • Hygiene measures (e.g. thorough hand hygiene),
  • no consumption of uncooked food or uncooked water or ice in endemic areas (areas with many sick people),
  • Peeling fruits.

The risk of travel hepatitis depends on the general hygienic conditions of the region being visited and on the personal travel style (backpacker, guest in a five-star hotel). For more information, see Travel Medicine.

Vaccination

The conventional vaccination is an active vaccination (dead vaccine) and has a long-term effect. It is possible from the age of two.

  • Type of vaccination: Two stab vaccinations at least six months apart.
  • Start of vaccination protection: As early as two to four weeks after the first dose, up to 95 percent of patients are reliably protected.
  • Duration of protection: a few decades after the second vaccination.
  • Protection rate: after complete basic immunization over 98 percent.
  • Booster: After the second vaccination, it can be assumed that the protection will last for life in healthy people. An antibody titer can be determined by a (blood sample) for safety, for example after 20 years.

The vaccination against hepatitis A is available from the age of one as a combination vaccination with hepatitis B. Vaccination is carried out according to the following scheme:

  • The first dose is on day X,
  • the second dose after a month at the earliest and
  • the third dose after six to twelve months.

If a quick onset of action is needed (e.g., before a trip), a faster-acting regimen can be used in adults. A total of four vaccinations are given. One vaccine dose is given on day X, seven days, 21 days and one year after.

The combination with a typhoid vaccination is also possible after the age of 15. This is done six to twelve months after the combination vaccination with a hepatitis A vaccine.

Note Anyone who has ever suffered from hepatitis A does not need a vaccination. People born before 1950 or who have been in high-risk areas have often had hepatitis A infection. It is therefore recommended that you check whether you are immune to hepatitis A virus before vaccination. Evidence can be established through a blood test.

Vaccination recommendations

The hepatitis A vaccination is a particularly important travel vaccination and is recommended for all travelers. Active immunization should be carried out in good time, ie preferably three weeks before departure.

In addition, according to the Austrian vaccination plan, it is recommended for the following people:

  • Small children before entering a community facility;
  • Hepatitis A virus (HAV) personnel of medical facilities at risk, including schoolchildren and students, e.g. pediatrics, infection medicine, laboratory (stool examinations), including kitchen and cleaning staff;
  • other people with a job-related increased risk of hepatitis A, such as the judiciary / prison guard, sex workers, care staff for refugees and asylum seekers, funeral services;
  • all persons working in food businesses and restaurants;
  • Staff of large kitchens, large catering facilities, hospital kitchens and comparable facilities for communal catering;
  • agricultural personnel;
  • Staff of childcare facilities and facilities for people with intellectual disabilities;
  • Sewerage and sewage works personnel; Staff who come into frequent contact with feces;
  • Employees of companies that process blood or blood products;
  • First aiders, military personnel in the event of possible exposure, especially under field or training conditions;
  • People with frequent need for blood products (eg: "hemophiliacs" / haemophiles);
  • non-immune individuals with chronic liver disease such as: hepatitis B and C;
  • Contact persons for people with hepatitis A or who have eliminated HAV;
  • People with sexual behavior which can be risky with regard to faecal-oral transmission of hepatitis A viruses; especially MSM ("men who have sex with men").

Passive immunization

  • The passive vaccination against hepatitis A has a short-term effect and consists of specific antibodies (immunoglobulins - HAV-Ig). It is often not available in Austria. This vaccination should be given a maximum of 14 days after risk exposure. People who receive a passive vaccination (immunoglobulins) should also receive an active hepatitis A vaccination. Type of vaccination: one-time stab vaccination,
  • Start of vaccination protection: immediately,
  • Duration of protection: a few months,
  • Protection rate: approximately 95 percent.

Passive vaccination is recommended in the following situations:

  • as a quick protective measure in the event of contact with infected people, e.g. in the event of epidemic outbreaks (especially in people for whom hepatitis A would pose a high health risk),
  • in the event of less than 14 days before the start of the trip in exceptional cases if active immunization cannot be carried out.

Note The active vaccination can also be used shortly before starting a trip or after a risky contact. The vaccination usually starts before an infection or during the incubation period, i.e. before the disease breaks out.

Possible side effects: Hepatitis A vaccinations are usually well tolerated. Information on side effects can be found in the package insert. A pharmacist or your doctor can also provide you with information on this.

How is therapy and aftercare for hepatitis A carried out?

Since there is no specific treatment for hepatitis A, the main focus is on measures that improve the general condition of the patients and do not additionally damage the liver. This includes physical rest and avoidance of alcohol and medication, which can additionally burden the liver function. The recommended abstinence from alcohol should definitely be observed for a few months. In rare cases, hospitalization is required. Dietary measures have no significant influence on the course of the disease.

The follow-up checks include regular general medical examinations and the control of laboratory values, especially the so-called "liver values" (GOT, GPT, bilirubin, alkaline phosphatase, GGT, cholinesterase and INR, Quick-Wert / PTZ).

As a rule, the increased laboratory values ​​normalize over the course of several weeks. In exceptional cases, convalescence can take several months.

You can find detailed information on GOT, GPT, bilirubin etc. in the laboratory values ​​table.

Whom can I ask?

The diagnosis and treatment of hepatitis A is possible in the following facilities:

  • In the private practice area: Specialist in internal medicine, family doctor,
  • special hospital outpatient department: e.g. hepatological outpatient department,
  • Cash outpatient clinics,
  • if you are seriously ill at a department for internal medicine (gastroenterology and hepatology) in a hospital.

Note A hepatitis A vaccination can be given by your family doctor, by various specialists or at a travel medical center.

How will the costs be reimbursed?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. You can find more information under What does a hospital stay cost? Your resident doctor or outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (treatment contribution) (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For more information, see What does a hospital stay cost, a doctor's visit: Costs and deductibles.

For certain non-drug treatments (e.g. physical therapy) - in some cases only when a certain level has been reached - approval from the health insurance provider may be required.

For certain services (e.g. medical aids and medical aids) - depending on the health insurance provider - patient co-payments are provided. Most health insurance providers provide for a permit, sometimes depending on the type of medical aid. The prescription fee has to be paid for medication on a “prescription”. For more information about the respective provisions, please contact your health insurance provider, which you can find on the social security website, for example.

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