Hepatitis A is a prevalent concern, especially when traveling to regions with suboptimal sanitation or when consuming potentially contaminated food and water. While it may be less common in certain developed nations, its global prevalence necessitates awareness and preventative measures, especially for travellers. This article aims to shed light on the everything you need to knowabouthepatitis A - its transmission, associated risks, symptoms, and the importance of vaccinations.
Understandinghepatitis A
Hepatitis A, caused by the hepatitis A virus (HAV), is an inflammation of the liver. It primarily spreads when someone, who is uninfected and unvaccinated, consumes food or water contaminated with the faeces of an infected person.This disease is often linked to unsafe food and water sources, insufficient sanitation, lack of personal hygiene, and sexual transmission.
In nations with robust sanitary and hygiene systems, like many high-income countries, the incidence of hepatitis A is low. However, while hepatitis A is uncommon in Australia, many individuals contract the infection when traveling abroad.
How is hepatitis A transmitted?
Infected individuals have a high concentration of hepatitis A virus in their faeces. Under suitable conditions, this virus can endure in the environment for weeks.
The virus is primarily transmitted via the consumption of contaminated food items (such as raw shellfish or improperly cooked foods) or via direct person-to-person interactions, such as oral-anal sex. Another common transmission route is through food or water tainted by infected food handlers. In rare cases, the virus can also be transmitted via transfusion of contaminated blood.
Are you at risk of being infected?
Those unvaccinated or previously uninfected are vulnerable to the hepatitis A virus. In regions with high prevalence, most infections transpire during early childhood. Risk factors include:
- Subpar sanitation.
- Inaccessibility to clean water.
- Residing with an infected individual.
- Having sex with an infected person.
- Recreational drug use.
- Anal sex, especially among men.
- Travelling to high-risk regions without vaccination.
Travellers visiting developing nations or staying for extended periods in areas with medium to high transmission rates are especially at risk. This is especially true if they frequently consume food in unsanitary conditions, have close contact with locals, or engage in unsafe sex.
Regions at Risk
While hepatitis A infections are a global occurrence, developing nations with poor sanitation and limited clean water (notably in Africa, Asia, and Central and South America) see the most cases. Developed countries with good sanitation and hygiene practices generally report fewer infections. Yet, risks can still emerge due to the consumption of imported contaminated food.For instance, the first known Hepatitis A outbreak in Australia was linked to the consumption of imported Medjool dates (O’Neill et al., 2022).
Symptoms of hepatitis A
Hepatitis A symptoms can vary from mild to severe. These may encompass fever, malaise, appetite loss, diarrhea, nausea, abdominal pain, dark urine, and jaundice (yellowing of the skin and eyes). Not everyone with the virus will exhibit these symptoms.
Adult individuals tend to experience more pronounced symptoms than children. The likelihood of severe disease outcomes also rises with age. Notably, children below six often don't show symptoms, with a mere 10% developing jaundice. In some cases, hepatitis A may relapse, leading to another acute episode before eventual recovery.
Managing hepatitis A: Treatment, Prevention
There is no specific treatment for hepatitis A. Recovery can be a prolonged process lasting weeks or even months. It's essential to avoid medications that might further strain the liver, like acetaminophen and even paracetamol. Treatment for the virus generally involves rest and drinking fluids.
Reducing the spread involves:
- Ensuring safe drinking water.
- Proper sewage disposal.
- Adhering to personal hygiene practices like regular handwashing.
- Practicing safe sex
If you are planning to visit a region where the risk of hepatitis A is higher, it is recommended that you avoid food and drinks that may include or be washed in contaminated water.
Is there a vaccine for hepatitis A?
A reliable and effective vaccine against hepatitis A exists, offering the best protection against the virus.The vaccine is considered very safe with a low chance of minor side-effects, such as a headache and fatigue.
The vaccine can be taken from the age of 12 monthsand requires 2 doses taken 6 months apart to provide stronger long-term immunity.It takes 2 weeks before it comes into effect.
Under the National Immunisation Program, the hepatitis A vaccine is free for Aboriginal and Torres Strait Islander children in Australia. More information on the NSW Aboriginal Immunisation Health Worker Program can be found here.
Groups that are recommended to get vaccinated include:
- Travelers to high-risk countries.
- Visitors to indigenous communities.
- Certain health care workers.
- Sewage workers and plumbers
- Men engaged in sexual relationships with other men.
- Childcare workers.
- Those with intellectual disabilities and their caretakers.
- Drug users.
- Individuals with chronic liver conditions.
- Haemophilia patients requiring frequent blood transfusions
Vaccination against hepatitis A or recovering from the virus will provide long-term immunisation. However, this immunisation does not extend to hepatitis B or hepatitis C.
Conclusion
Hepatitis A, while preventable, remains a health concern, particularly in areas with poor sanitation and hygiene. Understanding its transmission, recognising its symptoms, and taking preventative measuresare vital steps to mitigate its spread. In particular, vaccination is a highly recommended preventative measure that provides safe, lasting protection against the virus. Even for those living in regions with low prevalence, travel or consumption of imported foods can still pose a risk. Therefore, awareness and vigilance are essential, ensuring not just personal safety but the safety of others.
References
O'Neill, C., Franklin, N., Edwards, A., Martin, T., O'Keefe, J., Jackson, K., Pingault, N., & Glasgow, K. (2022). Hepatitis A outbreak in Australia linked to imported Medjool dates, June-September 2021. Communicable diseases intelligence (2018), 46, 10.33321/cdi.2022.46.68. https://doi.org/10.33321/cdi.2022.46.68