Hepatitis A

Question 1

What is the source and transmission of hepatitis A?

Answer 1

RNA virus which is normally contracted from contimated food or water

Spread via faeco-oral route mainly
Can also spread via close personal contact and rarely blood exposure

Question 2

Where is HAV most prevalent?

Who is most likely to have the virus in these populations?

Answer 2

It is the most common hepatitis worldwide with high prevlaence in Africa, Asia and South America

Peak age of infection is those in early childhood

Question 3

How many days post-infection is someone likely to present with symptoms?
What will someone with hepatitis A present with?

Answer 3

15-30 days post initial infection due to this being the length of the incubation period

Nausea 
Vomiting 
Anorexai 
Jaundice 
Dark urine and pale stools -> due to it causing cholestasis

Question 4

What investigations are done when hepatitis A suspected?

Answer 4

LFTs:

• early raised AST/ALT i.e. mainly ALT raised due to it being specific to the liver
• raised during the 1st month

Measure Ig:

• HAV-IgM= look for in acute infection
• HAV-IgG= look for in chronic infection

Question 5

How are the biggest spreader of the disease and what can this result in?
Which individuals are most at risk of infection?
What should be offered to these individuals?

Answer 5

Children= act as reservoir for infection due to being largely asymptomatic i.e. leads to community-wide outbreak

At risk:
-travelers 
-MSM
-IVDU 
Need to offer vaccine to these at risk people

Question 6

What can be done to prevent HAV infection?

When should the vaccine be given and who to?

Answer 6

HAV vaccine
3 types:
-monovalent 
-Combined HAV + HBV
-combined HAV + typhoid

Prexposure:

• travelling to areas of high prevalence
• chronic LD patients
• haemophilia patients
• MSM
• IVDU
• people with occupational risk i.e. health workeres, sewage workers, workers at large residential institutes

Post-expsore:

• given to contact cases i.e. might be asymptomatic for up to 30 days + vaccine takes 2 weeks to be effective
• in areas of outbreak

Question 7

What is the role of Immune globulin in preventing Heptatitis A infection?

Answer 7

In instances when cannot wait 2 weeks for vaccine to be fully effective

Pre-exposure:
-travelers to intermediate or high risk countries when travelling at short notice

Post-exposure
-w/i 14 days i.e. household/intimate contacts/day carers/infected food etc

Question 8

How is someone with HAV managed?

Answer 8

Supportive treatment because it will resolve w/i 1-3 months
I.e. analgesia

Trace contacts + info Publich Health i.e. notifiable disease

Monitor for complications:
-chronic hepatits