What is Hepatitis A?

Hepatitis A is an infection of the liver caused by a virus called Hepatitis A virus.

How does this disease spread?

Hepatitis A is an enterally transmitted disease that is it is food borne. It spreads from one to another through contaminated food or water.

What are the symptoms of this disease?

This disease is symptomatic in adolescents more than in younger children. In younger children, it is mostly a silent disease. This disease usually has two phases. In the first phase, there may be no jaundice. This is called the ‘anicteric’ phase of the disease which is self limiting and is easily passed off and a simple viral illness. Only symptoms of this phase are nausea, vomiting, abdominal pain, reduced appetite, loose stools,  malaise and general ill feeling. This may last for 2-3 days after which jaundice appears. Urine becomes dark coloured, and stools light coloured. This is called the icteric phase and lasts for about a week or 10 days. However, a minority have a prolonged cholestatic phase characterised by itching and jaundice which may last for 2-3 months

The anicteric phase can be easily passed off as an episode of general viral fever, gastroenteritis etc in small children

How dangerous is the disease?

In children Hepatitis A is a self limiting infection. It is known to cause fulminant hepatitis i.e. liver failure in a minority of children (<0.5%). We need to look for any bleeding, change in sleep habits and convulsions to suspect fulminant hepatitis

How do we diagnose acute hepatitis A?

We do liver function tests. These show a rise in transaminases- SGOT, SGPT- to be more than 400 IU/ml . Total bilirubin may be raised. Specific blood test for acute hepatitis A is Anti HAV IgM.

What are the other complications of the disease?

It may cause prolonged cholestasis i.e. prolonged jaundice and itching lasting more than 3-4 weeks. This is also self limiting and recovery is complete eventually. Sometimes children may develop relapses of the same disease though the percentage is low (8%).

Some children may develop fluid in the abdomen (ascites)  or chest cavity (pleural effusion). This fluid especially the one in the abdomen can get infected -  called as spontaneous bacterial peritonitis. It is treated with antibiotics.

Other rare complications include an enlarged spleen (splenomegaly), infection in the gall bladder (acute cholecyctitis); which are self limiting.

How do we treat this disease?

Treatment consists of bed rest, diet well tolerated and easily digested. Plenty of fluids need to be given to maintain good hydration and urine output. No drug has been shown to reduce the risk of development of complications such as acute liver failure

Acute fulminant hepatitis A requires ICU admission and close monitoring and aggressive treatment

Is there any vaccine available for preventing the disease?

Yes. Vaccine is available. However, this is not part of universal immunisation programme in India.  It should be given to children >1 year of age with a second dose  in 6-12 months to hgh risk children such as those suffering from chronic live disease. The routine use of this vaccine is debatable.

In children >10years of age, pre testing for IgG Anti HAV may be done as 70- 90% of children are immune to this disease by acquiring it naturally since hepatitis A is endemic in India. If the titers are low, single dose of Hepatitis A vaccine can be given. Also, if the individual is infected at an older age, the disease is likey to be more severe. Naturally acquired antibodies from exposure in childhood confer lifelong immunity against the virus as against the vaccine which may not confer lifelong immunity

How do we prevent this disease?

Since this disease spreads through food, it is important to maintain good food hygiene to prevent this disease. Use of boiled water for drinking and cooking is easy way to prevent this disease. Good sanitation and hand washing practises also play an important role in preventing this disease

Important articles on Hepatitis A in India

1. Epidemiological transition of hepatitis A in India: Issues for vaccination in developing countries.

http://www.ncbi.nlm.nih.gov/pubmed/19246792

P. Mathur & N.K. Arora*, Indian J Med Res 128, December 2008, pp 699-704.

PMID: 19246792 [PubMed - indexed for MEDLINE]

1. Prevalence of hepatitis A virus, hepatitis B virus, hepatitis C virus, hepatitis D virus and hepatitis E virus as causes of acute viral hepatitis in North India: A hospital based study.

http://www.ijmm.org/text.asp?2013/31/3/261/115631

Jain P, Prakash S, Gupta S, Singh K P, Shrivastava S, Singh D D, Singh J, Jain A. Indian J Med Microbiol 2013;31:261-5.

1. Changing spectrum of sporadic acute viral hepatitis in Indian children.

http://www.ncbi.nlm.nih.gov/pubmed/19246792

Mathur P, Arora NK. Indian J Med Res. 2008 Dec;128(6):699-704.

PMID: 19246792

1. Atypical presentations of acute viral hepatitis in children.

http://journals.lww.com/jpgn/Fulltext/2004/06001/P0044_PP_ATYPICAL_PRESENTATIONS_OF_ACUTE_VIRAL.168.aspx

Poddar, U.; Yachha, S.; Kumar, A.; Aggarwal, R. Journal of Pediatric Gastroenterology & Nutrition:June 2004 - Volume 39 - Issue - p S73.