HEPATITIS A

Submitted by: Janine Grace D. Ku

Submitted to: Ms. Quenie Mae Tiro

History

The first descriptions of hepatitis (epidemic jaundice) are generally attributed to

Hippocrates. Hepatitis A is referred to as one of the oldest diseases known to
humankind by the World Health Organization (WHO). HAV was first discovered in
1973 by Steven M. Feinstone as a nonenvoloped, spherical, positive stranded RNA
virus. HAV was an unidentified viral disease prior to this discovery. Hepatitis A is a
disease caused by infection from the hepatitis A virus (HAV). HAV has been called
epidemic hepatitis, epidemic jaundice, infectious hepatitis, catarrhal jaundice, HA
and type A hepatitis in the past according to the WHO. One of the more common
causes of acute hepatitis is hepatitis A virus (HAV), which was isolated by Purcell in
1973.

About Hepatitis A
HAV is a single-stranded, positive-sense, linear RNA enterovirus of the
Picornaviridae family. HAV is an icosahedral nonenveloped virus, measuring
approximately 28 nm in diameter .The virus can be inactivated by heating to
185F (85C) or higher for one minute, or disinfecting surfaces with a 1:100
dilution of sodium hypochlorite (household bleach) in tap water.

Pathogenesis
HAV infects the livers parenchymal cells (internal liver cells). Once a cell has
been penetrated by the viral particles, the hepatitis A virus releases its own
toxins that cause, in essence, a hostile takeover of the hosts cellular system.
The cell then produces new viral components that are released into the bile
capillaries or tubes that run between the livers parenchymal cells. This
process results in the death of liver cells, called hepatic necrosis.

Pathophysiology

Humans appear to be the only reservoir for the HAV.

The incubation period usually lasts 2-6 weeks. The time to onset of symptoms may be doserelated.

Viral replication depends on hepatocyte uptake.

After uptake, the viral RNA is uncoated, and host ribosomes bind to form polysomes.

Viral proteins can then be synthesised with the viral genome being copied by a viral RNA
polymerase.

Assembled virus particles are then shed through the biliary tree into the faeces.

Shedding of the HAV is greatest during the anicteric prodrome of infection (between 14 and
21 days after infection). This corresponds to the time when transmission is highest.

Incidence
Approximately 1.5 million clinical cases of hepatitis A occur each year worldwide,
and the prevalence of antibodies against hepatitis A in the general population can
vary from 15% to almost 100% in some countries. Nordic countries show the lowest
prevalence of infection, with an incidence of approximately 15%. In Australia, other
parts of Europe, Japan, and the United States, the seroprevalence of antibodies to
HAV is 40% to 70% in adults. In developing areas of the world, most adults show
serologic evidence of past infection

Transmission
Hepatitis A is a communicable (or contagious) disease that often spreads from
person to person. Person-to-person transmission occurs via the fecal-oral route,
while all other exposure is generally attributable to contaminated food or water.
Food-related outbreaks are usually associated with contamination of food during
preparation by a HAV-infected food handler. The food handler is generally not ill
because the peak time of infectivitythat is, when the most virus is present in the
stool of an infected individualoccurs two weeks before illness begins. HAV is
relatively stable and can survive for several hours on fingertips and hands and up to
two months on dry surfaces.

Symptoms
Seventy percent of hepatitis A infections in children younger than six years of age
are asymptomatic; in older children and adults, infection tends to be symptomatic
with more than 70% of those infected developing jaundice. Symptoms typically
begin about 28 days after contracting HAV, but can begin as early as 15 days or as
late as 50 days after exposure. The symptoms include muscle aches, headache,
anorexia (loss of appetite), abdominal discomfort, fever, and malaise. After a few
days of typical symptoms, jaundice sets in. Jaundice is a yellowing of the skin, eyes
and mucous membranes that occurs because bile flows poorly through the liver and
backs up into the blood. [17] The urine will also turn dark with bile and the stool
light or clay-colored from lack of bile. When jaundice sets in, initial symptoms such

as fever and headache begin to subside. Additionally, pruritus, or severe itchiness

of the skin, can persist for several months after the onset of symptoms. These
conditions are frequently accompanied by diarrhea, anorexia, and fatigue.

Complications
Fulminant hepatitis A, or acute liver failure, can be a complication of hepatitis A
infection. The fulminant form of hepatitis occurs when this necrotic process kills so
many liver cellsupwards of three-quarters of the livers total cell countthat the
liver can no longer perform its job. Fulminant hepatic failure can lead to
encephalopathy and cerebral edema.

Diagnosis
Hepatitis A infection is typically diagnosed through blood tests:

IgM negative / IgG negative: Most persons with these results have never contracted
hepatitis A. Antibodies of the IgM variety develop five to ten days prior to the onset of
symptoms.
IgM positive / IgG negative: This result indicates acute hepatitis A.
IgM positive / IgG positive: This result indicates that acute hepatitis A occurred within
the last six months. By six months, the IgM reverts to negative.
IgM negative / IgG positive: Persons with this result are immune to hepatitis A. They
have either been infected with the virus months or years in the past (with or without
symptoms), or they have been vaccinated for hepatitis A. However, if they are currently
ill, it is not likely to be due to hepatitis A.

Treatment
Once a clinical infection is established, there is no specific treatment for hepatitis A.
Affected individuals generally suffer from loss of appetite, so the main concern is
ensuring a patient receives adequate nutrition and avoids permanent liver damage.
An individuals perception of the severity of fatigue or malaise is the best
determinant of the need for rest. Treatment of those suffering from fulminant
hepatic failure depends largely on the affected persons status. But for those whose
liver failure is so complete that it has led to encephalopathy or cerebral edema,
timely liver transplantation is often the only option. Unfortunately, many individuals
with irreversible liver failure do not receive a transplant because of
contraindications or the unavailability of donor livers.

Prevention

Hepatitis A is totally and completely preventable. Food handlers must always wash
their hands with soap and water after using the bathroom, changing a diaper, and
certainly before preparing food.
Vaccination is also recommended. Hepatitis A is a liver disease caused by the
hepatitis A virus (HAV). Hepatitis A can affect anyone. Vaccines are available for
long-term prevention of HAV infection in persons 1 year of age and older. Good
personal hygiene and proper sanitation can also help prevent the spread of hepatitis
A. The hepatitis A vaccine is given as two shots, six months apart. The hepatitis A
vaccine also comes in a combination form, containing both hepatitis A and B
vaccine, that can be given to persons 18 years or older. This form is given as three
shots, over a period of six months or as three shots over one month and a booster
shot at 12 months. The first dose should be given at 12-23 months old. Children
who are not vaccinated by two years old can be vaccinated at later visits. The first
hepatitis A vaccine was approved in Europe in 1991 and the United States in 1995.

There are a lot of types of vaccines, here are some of Hepatitis A vaccine:

Avaxim: made by Sanofi Pasteur.

Epaxal: made by Crucell.
BIOVAC-A: made by Pukang
Combination vaccines
Twinrix is a vaccine against hepatitis A and hepatitis B.
Vivaxim is a vaccine against hepatitis A and typhoid