Friday, January 01, 2010

Hepatitis A - the common Jaundice

Most of us in India are aware of and have probably been vaccinated against hepatitis B. Given the fact that so many of us are protected from hepatitis B, have you ever wondered why we still have so many cases of jaundice especially in the months of summers and monsoons?
The reason is jaundice due to poor food, water and sanitation, meaning hepatitis A and hepatitis E virus.

The most important thing to realize that taking hepatitis B vaccination will not protect you against these forms of jaundice since they are caused by a different virus.

Today we are going to talk in some more details about Hepatitis A.
Hepatitis means inflammation (swelling) of the liver. While there are many infections that can cause this, in India the commonest cause in children and one of the most common causes in adults is Hepatitis A. 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. Casual contact, as in the usual office, factory, or school setting, does not spread the virus. Persons with hepatitis A virus infection may or 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 (i.e., time taken from transmission from one person to the other) for hepatitis A is 28 days (range: 15–50 days).
The diagnosis cannot be made without doing a blood test (IgM Hepatitis A antibody- cost approx. Rs. 600/-), since the symptoms of all types of hepatitis are the same. Other tests like the liver function tests are useful in finding out the extent of the disease. The good news is that once you have the disease, you develop antibodies that provide life-long protection from future infections. After recovering from hepatitis A, you will never get it again and you cannot transmit the virus to others.
Treatment is essentially supportive, and with adequate rest and minimum use of anti-fever and anti – vomiting medicines a patient should generally recover within 15- 30 days. However 15 % of patients (mostly adults) may have a prolonged course of illness lasting even as long as 6-9 months!
Prevention rests on maintaining a good personal hygiene. Always wash your hands after using the bathroom, changing a diaper, or before preparing or eating food. Avoid outside food and water especially food that is undercooked/ uncooked (like salad etc.). Since proper food and water in India is still a pipe-dream, a more feasible way is to take the Hepatitis A vaccine. This is a very safe and highly effective vaccine (more than 90 % effective) with no major side-effects. It can be given to anyone above 1 year of age. Two doses are needed for life long protection and these need to be given 6 months apart. The vaccine is effective a month after the first dose is given.
With proper cooking habits, care about water and outside food and proper vaccination at the right time, we can ensure that we do not have to suffer Hepatitis A disease.
Dr. Gaurav Gupta, Consultant Pediatrician, practicing in Charak Clinics, Phase 7, Mohali.