Vaccine

Hepatitis A

 
What is hepatitis A?

Hepatitis A is a liver disease caused by hepatitis A virus.. The liver becomes inflamed, tender, and swollen. Patches of liver tissue may be damaged.

How does it occur?

Hepatitis A is caused by infection with the hepatitis A virus. An infected person may pass hepatitis A to others by not washing his or her hands (especially after going to the bathroom) before handling food that others are going to eat. Hepatitis A can also be picked up from contaminated water or by eating shellfish taken from contaminated waters.

Hepatitis A virus is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A. This type of transmission is called "fecal-oral." For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed. Most infections result from contact with a household member or sex partner who has hepatitis A. Casual contact, as in the usual office, factory, or school setting, does not spread the virus.

Most infections result from contact with a household member or sex partner who has hepatitis A. Casual contact, as in the usual office, factory, or school setting, does not spread the virus.

What are the symptoms?

Symptoms generally appear 2 to 6 weeks after infection with the virus. Hepatitis A is often so mild that there are no obvious symptoms, especially in children. The disease usually begins with flulike symptoms: loss of appetite fever general achiness fatigue. Smokers may lose their taste for cigarettes. Other symptoms may follow after several days: nausea and vomiting foul breath and bitter taste in the mouth dark urine yellowish skin and eyes (jaundice) pain just below the ribs on the right side, especially when pressure is applied pale-colored bowel movements that may be looser than normal. How is it diagnosed? Your health care provider will talk to you about when and how your symptoms developed. He or she will examine your skin, eyes, and especially your abdomen to see if your liver is enlarged or tender. Your provider will use urine and blood tests to diagnose your condition.

Persons with hepatitis A virus infection may not have any signs or symptoms of the disease. Older persons are more likely to have symptoms than children. If symptoms are present, they usually occur abruptly and may include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and eyes). Symptoms usually last less than 2 months; a few persons are ill for as long as 6 months. The average incubation period for hepatitis A is 28 days (range: 15–50 days).

How is it diagnosed ?

A blood test (IgM anti-HAV) is needed to diagnose hepatitis A. Talk to your doctor or someone from your local health department if you suspect that you have been exposed to hepatitis A or any type of viral hepatitis.

How is it treated?

The usual treatment is bed rest, a balanced diet, and avoiding alcohol for at least 6 months. You will not have to stay in the hospital unless you have a very serious case. Antibiotics are not useful in treating hepatitis.

How long will the effects last?

Recovery from hepatitis A usually takes 4 to 8 weeks. The disease rarely has lasting effects such as permanent liver damage. Hepatitis that lasts more than 6 months usually isn't caused by hepatitis A infection.

How can I take care of myself?

Rest in bed until your fever is gone, urine color is normal, and jaundice lessens. Ask your health care provider how much bed rest you need. As your symptoms improve, you may gradually increase your level of activity. It is best to avoid too much physical exertion until your health care provider tells you it's OK. Eat small, balanced meals, even when you feel nauseous, but avoid foods that do not appeal to you. Soft drinks, juices, and hard candy may help reduce nausea. Follow your health care provider's instructions for taking medicine to relieve your symptoms. Avoid taking certain drugs that are processed in the liver. Ask your health care provider which drugs these are. Do not drink alcohol until your health care provider says it's safe.

What can be done to help prevent hepatitis A?

Hepatitis A can be spread only by people with active infections. It is usually contagious for 2 to 3 weeks before symptoms appear and for 2 to 3 weeks afterward. During this period, others can pick up the virus by touching anything contaminated with the blood, stool, saliva, and possibly other body fluids of an infected person. An injection of immune (gamma) globulin is usually given right after you have been exposed to contaminated food or have had contact with an infected person. Immune globulin may not always prevent hepatitis A, but it may make it milder. The protection begins almost immediately but it lasts for just 2 to 4 months. A vaccine specific for hepatitis A is also now available. The first shot should be given at least 2 weeks before a person plans to be in an area where the disease is common. For adults the first shot is usually followed by a booster shot 6 to 12 months later. This vaccine may protect against hepatitis A for many years.

What products are available to prevent hepatitis A virus infection?

Two products are used to prevent hepatitis A virus infection: immune globulin and hepatitis A vaccine. Immune globulin is a preparation of antibodies that can be given before exposure for short-term protection against hepatitis A and for persons who have already been exposed to hepatitis A virus. Immune globulin must be given within 2 weeks after exposure to hepatitis A virus for maximum protection. Hepatitis A vaccine has been licensed in the United States for use in persons 2 years of age and older. The vaccine is recommended (before exposure to hepatitis A virus) for persons who are more likely to get hepatitis A virus infection or are more likely to get seriously ill if they do get hepatitis A. The vaccines currently licensed in the United States are HAVRIX® (manufactured by GlaxoSmithKline) and VAQTA® (manufactured by Merck & Co., Inc).

Is hepatitis A vaccine safe?

Yes, hepatitis A vaccine has an excellent safety profile. No serious adverse events have been attributed definitively to hepatitis A vaccine. Soreness at the injection site is the most frequently reported side effect. Any adverse event suspected to be associated with hepatitis A vaccination should be reported to the Vaccine Adverse Events Reporting System (VAERS). VAERS forms can be obtained by calling 1-800-822-7967.

When are persons protected after receiving hepatitis A vaccine?

One month after receiving the first dose of hepatitis A vaccine, 94-100% of adults and children will have protective antibodies. Many persons will have protective antibodies by 2 weeks after the first vaccine dose. However, to receive optimal protection, the first dose of hepatitis A vaccine should be given 4 weeks prior to time of desired protection. Those who need optimal protection earlier than 4 weeks after the first dose of vaccine should also receive immune globulin. The second dose of vaccine in 6-18 months is necessary to assure long term protection. Check with your doctor for when the next dose is due. Can hepatitis A vaccine be given after exposure to hepatitis A virus? No, hepatitis A vaccine is not licensed for use after exposure to hepatitis A virus. In this situation, immune globulin should be used.

Should pre-vaccination testing be done?

Pre-vaccination testing is done only in specific instances to control cost (e.g., persons who were likely to have had hepatitis A in the past). This includes persons who were born in countries with high levels of hepatitis A virus infection, elderly persons, and persons who have clotting factor disorders and may have received factor concentrates in the past.

Should post-vaccination testing be done?

No. Can a patient receive the first dose of hepatitis A vaccine from one manufacturer and the second (last) dose from another manufacturer? Yes. Although studies have not been done to look at this issue, there is no reason to believe that this would be a problem.

What should be done if the second dose of hepatitis A vaccine is delayed?

The second dose should be administered as soon as possible. There is no need to repeat the first dose. Can hepatitis A vaccine be given during pregnancy or lactation? We don't know for sure, but because vaccine is produced from inactivated hepatitis A virus, the theoretical risk to the developing fetus is expected to be low. The risk associated with vaccination, however, should be weighed against the risk for hepatitis A in women who may be at high risk for exposure to hepatitis A virus.

Can hepatitis A vaccine be given to immunocompromised persons? (e.g., persons on hemodialysis or persons with AIDS)

Yes.

PERSONS WHO SHOULD RECEIVE HEPATITIS A VACCINE

Hepatitis A vaccination provides protection before one is exposed to hepatitis A virus. Hepatitis A vaccination is recommended for the following groups who are at increased risk for infection and for any person wishing to obtain immunity.

  • Persons traveling to or working in countries that have high or intermediate rates of hepatitis A.
  • All susceptible persons traveling to or working in countries that have high or intermediate rates of hepatitis A should be vaccinated or receive immune globulin before traveling. Persons from developed countries who travel to developing countries are at high risk for hepatitis A. Such persons include tourists, military personnel, missionaries, and others who work or study abroad in countries that have high or intermediate levels of of hepatitis A. The risk for hepatitis A exists even for travelers to urban areas, those who stay in luxury hotels, and those who report that they have good hygiene and that they are careful about what they drink and eat.
  • Children in states, counties, and communities that have consistently increased rates of hepatitis A and periodic hepatitis A outbreaks.
  • Children living in states, counties, and communities that have consistently increased rates of hepatitis A and periodic outbreaks should be routinely vaccinated beginning at 2 years of age. High rates of hepatitis A can be found in these populations, both in urban and rural settings. In addition, to effectively prevent epidemics of hepatitis A, vaccination of previously unvaccinated older children is recommended within 5 years of initiation of routine childhood vaccination programs. Although rates differ among areas, available data indicate that a reasonable cutoff age in many areas is 10-15 years of age because older persons have often already had hepatitis A. Vaccination of children before they enter school should receive highest priority, followed by vaccination of older children who have not been vaccinated.
  • Men who have sex with men
  • Sexually active men (both adolescents and adults) who have sex with men should be vaccinated. Hepatitis A outbreaks among men who have sex with men have been reported frequently. Recent outbreaks have occurred in urban areas in the United States, Canada, and Australia.
  • Illegal-drug users
  • Vaccination is recommended for injecting and non-injecting illegal-drug users if local health authorities have noted current or past outbreaks among such persons. During the past decade, outbreaks have been reported among injecting-drug users in the United States and in Europe.
  • Persons who have occupational risk for infection
  • Persons who work with hepatitis A virus-infected primates or with hepatitis A virus in a research laboratory setting should be vaccinated. No other groups have been shown to be at increased risk for hepatitis A virus infection because of occupational exposure.
  • Outbreaks of hepatitis A have been reported among persons working with non-human primates that are susceptible to hepatitis A virus infection, including several Old World and New World species. Primates that were infected were those that had been born in the wild, not those that had been born and raised in captivity.
  • Persons who have chronic liver disease
  • Persons with chronic liver disease who have never had hepatitis A should be vaccinated, as there is a higher rate of fulminant (rapid onset of liver failure, often leading to death) hepatitis A among persons with chronic liver disease. Persons who are either awaiting or have received liver transplants also should be vaccinated.
  • Persons who have clotting-factor disorders
  • Persons who have never had hepatitis A and who are administered clotting-factor concentrates, especially solvent detergent-treated preparations, should be given hepatitis A vaccine. All persons with hemophilia (Factor VIII, Factor IX) who receive replacement therapy should be vaccinated because there appears to be an increased risk of transmission from clotting-factor concentrates that are not heat inactivated.

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Tinplate Hospital
P.O.Golmuri, Jamshedpur - 831003, JHARKHAND
Phone: 0657-2342266/2342228
Email Contact :DMS Office (TCIL)