Hepatitis A is the lesser-known cousin of B and C. But its obscurity makes it far more common a disease than it might be if we took simple preventive measures to keep it at bay.
One year ago, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) presented new recommendations as part of an ongoing campaign to stop the spread of hepatitis A in the United States. Their 1999 report called for routine vaccination of children living in areas with high rates of hepatitis A infection.
The Hepatitis Foundation International (HFI) recently issued a report card grading the progress of all 17 states named in the report. “We really need a plug for education about the need for vaccination,” says Thelma King Thiel, chairwoman and chief executive officer of the foundation. She notes three important preventive measures against hepatitis A infection: vaccination, good hygiene, and education about the dangers of intravenous drug use.
What Is Hepatitis A
Hepatitis A is an infection of the liver caused by the hepatitis A virus (HAV). Symptoms can include fever, fatigue, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and eyes.) The infection usually clears up in less than 2 months, but illness can last for up to 6 months.
According to Dr. Raymond Koff, hepatologist at MetroWest Medical Center in Framingham, Massachusetts, “The older you are, the more likely you are to get sick from hepatitis A infection.” He recommends vaccination for all chronic liver disease patients to protect against serious complications.
The Centers for Disease Control and Prevention (CDC) estimates that there are 125,000-200,000 infections per year in the United States. About one-third of all Americans show evidence of past infection and immunity. There are, on average, 100 hepatitis A deaths each year, mainly among older people.
Unlike hepatitis B and hepatitis C–two unrelated viral liver infections–hepatitis A does not become a long-term infection. Most people who get hepatitis A get rid of the virus without long-term complications, but it can keep you out of work for a long time. A recent report in the journal Hepatology estimates total lost work in 1997 caused by hepatitis A virus at 829,000 days. Total annual healthcare costs were estimated at $488.8 million.
How It Spreads
You can get hepatitis A by eating food or drinking water that has been exposed to fecal material from an infected individual. Most infections come from contact with household members or sexual partners. Casual contact in most work or school environments does not spread the virus. Foodborne outbreaks of hepatitis A are relatively uncommon in the United States.
Because the hepatitis A virus can survive on surfaces outside the body, infections are often passed between family members or sexual partners as a result of poor hygienic practices. Infected children rarely show symptoms of hepatitis A. Most children are at low risk for serious disease, but they can be a source of infection for other family members.
Hepatitis A is often common in communities that lack good sanitation facilities and a reliable source of clean drinking water. It is common in many developing countries. Americans who contract the virus often get it from traveling in countries with high rates of hepatitis A. If you are planning to travel outside the country, it is smart to ask your doctor about the need for hepatitis A immunization.
Where in the World . . .
Hepatitis A is especially common in the western United States. The 17 states identified in the ACIP report, in order of highest to lowest rates of hepatitis A, are Arizona, Alaska, Oregon, New Mexico, Utah, Washington, Oklahoma, South Dakota, Idaho, Nevada, California, Missouri, Texas, Colorado, Arkansas, Montana, and Wyoming.
Dr. Gary Simpson of the New Mexico Health Department explains some of the problems with trying to institute the ACIP recommendations. He says the department feared that New Mexico’s limited funds and resources would be spread too thin by a program designed to immunize all children in the state.
According to Dr. Simpson, most of the areas of high HAV incidence are located along the Mexican border or in Native American communities, and they tend to be geographically isolated. So, New Mexico’s Health Department has put together a very comprehensive strategy that targets vaccination in counties with high rates of hepatitis A. As a result, Dr. Simpson says there has been a “dramatic decrease in hepatitis A throughout the state since their immunization program was instituted in 1996.”
Pediatrician John Takayama of the University of California at San Francisco Medical School says he is concerned about universal vaccination. Because hepatitis A does not uniformly affect all communities, he argues for a targeted approach to immunization even in metropolitan areas like San Francisco.
“Just because we have a vaccine, we should not forget about other factors to control disease spread,” says Dr. Takayama. He points out the importance of education about basic hygiene, especially in day care settings, to prevent the spread of all types of childhood diarrheal diseases.
Preventing Hepatitis A Infection
- Ask your doctor about the need for vaccination, especially if you have any type of liver disease.
- Always wash your hands well after using the toilet or changing a baby diaper.
- Be careful about eating raw shellfish from potentially contaminated waters.
- If you are traveling outside the United States, check with your doctor about immunizations at least 1 month before departure.
For more information about hepatitis A and immunization, contact:
The Centers for Disease Control and Prevention, www.cdc.gov
Hepatitis Foundation International, 800-891-0707 or www.hepfi.org
Article By: Dorothy Fallows, Medical Writer