Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ.
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source WHO World Health
Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses, referred to as types A, B, C, D and E. These five types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.
Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.
Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
There are many forms of Hepatitis A,B,C,and E, we will cover each separately.
We will cover hepatitis A first
What is hepatitis A?
Hepatitis A is a liver disease spread by contaminated food and water. It can also be spread from the hands of a person with hepatitis A. It is rarely spread through sexual contact.
Symptoms include a sudden onset of fever, tiredness, loss of appetite, nausea, vomiting, stomach pain, and jaundice (yellowing of the skin and eyes). Some people have no symptoms, while others have symptoms that last 1-6 months. Most people recover with no lasting liver damage.
Who is at risk?
Hepatitis A is a common infection among travelers to developing countries. Travelers going to rural areas in developing countries have a higher risk of getting hepatitis A infections than other travelers. However, hepatitis A infections can happen in urban areas with “standard” tourist accommodations as well.
People 1 year of age and older who are traveling to or working in countries where they would have a high or intermediate risk of hepatitis A virus, should strongly consider the Hepatitis A vaccine. These areas include all parts of the world except Canada, western Europe and Scandinavia, Japan, New Zealand, and Australia.
What can travelers do to prevent disease?
Get a hepatitis A vaccine:
- Ask your doctor or nurse about hepatitis A vaccine.
- The hepatitis A vaccine is given in 2 doses, 6 months apart. The vaccine is nearly 100% effective and has been a routine childhood vaccine in the United States since 2005.
Eat safe foods:
- Food that is cooked and served hot
- Hard-cooked eggs
- Fruits and vegetables you have washed in clean water or peeled yourself
- Pasteurized dairy products
- Food served at room temperature
- Food from street vendors
- Raw or soft-cooked (runny) eggs
- Raw or undercooked (rare) meat or fish
- Unwashed or unpeeled raw fruits and vegetables
- Peelings from fruit or vegetables
- Condiments (such as salsa) made with fresh ingredients
- Unpasteurized dairy products
- ”Bushmeat” (monkeys, bats, or other wild game)
Drink safe beverages:
- Bottled water that is sealed (carbonated is safer)
- Water that has been disinfected (boiled, filtered, treated)
- Ice made with bottled or disinfected water
- Carbonated drinks
- Hot coffee or tea
- Pasteurized milk
- Tap or well water
- Ice made with tap or well water
- Drinks made with tap or well water (such as reconstituted juice)
- Flavored ice and popsicles
- Unpasteurized milk
For more information see Food and Water Safety.
Practice hygiene and cleanliness:
- Wash your hands often.
- If soap and water aren’t available, clean your hands with hand sanitizer (containing at least 60% alcohol).
- Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
- Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.
Who should get hepatitis A vaccine and when?
Some people should be routinely vaccinated with hepatitis A vaccine:
- All children between their first and second birthdays (12 through 23 months of age).
- Anyone 1 year of age and older traveling to or working in countries with high or intermediate prevalence of hepatitis A, such as those located in Central or South America, Mexico, Asia (except Japan), Africa, and eastern Europe. For more information see www.cdc.gov/travel.
- Children and adolescents 2 through 18 years of age who live in states or communities where routine vaccination has been implemented because of high disease incidence.
- Men who have sex with men.
- People who use street drugs.
- People with chronic liver disease.
- People who are treated with clotting factor concentrates.
- People who work with HAV-infected primates or who work with HAV in research laboratories.
- Members of households planning to adopt a child, or care for a newly arriving adopted child, from a country where hepatitis A is common.
Other people might get hepatitis A vaccine in certain situations (ask your doctor for more details):
- Unvaccinated children or adolescents in communities where outbreaks of hepatitis A are occurring.
- Unvaccinated people who have been exposed to hepatitis A virus.
- Anyone 1 year of age or older who wants protection from hepatitis A.
Hepatitis A vaccine is not licensed for children younger than 1 year of age.
For children, the first dose should be given at 12 through 23 months of age. Children who are not vaccinated by 2 years of age can be vaccinated at later visits.
For others at risk, the hepatitis A vaccine series may be started whenever a person wishes to be protected or is at risk of infection.
For travelers, it is best to start the vaccine series at least one month before traveling. (Some protection may still result if the vaccine is given on or closer to the travel date.)
Some people who cannot get the vaccine before traveling, or for whom the vaccine might not be effective, can get a shot called immune globulin (IG). IG gives immediate, temporary protection.
Two doses of the vaccine are needed for lasting protection. These doses should be given at least 6 months apart.
Hepatitis A vaccine may be given at the same time as other vaccines.
- Anyone who has ever had a severe (life threatening) allergic reaction to a previous dose of hepatitis A vaccine should not get another dose.
- Anyone who has a severe (life threatening) allergy to any vaccine component should not get the vaccine. Tell your doctor if you have any severe allergies, including a severe allergy to latex. All hepatitis A vaccines contain alum, and some hepatitis A vaccines contain 2-phenoxyethanol.
- Anyone who is moderately or severely ill at the time the shot is scheduled should probably wait until they recover. Ask your doctor. People with a mild illness can usually get the vaccine.
- Tell your doctor if you are pregnant. Because hepatitis A vaccine is inactivated (killed), the risk to a pregnant woman or her unborn baby is believed to be very low. But your doctor can weigh any theoretical risk from the vaccine against the need for protection.
A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of hepatitis A vaccine causing serious harm, or death, is extremely small.
Getting hepatitis A vaccine is much safer than getting the disease.
- soreness where the shot was given (about 1 out of 2 adults, and up to 1 out of 6 children)
- headache (about 1 out of 6 adults and 1 out of 25 children)
- loss of appetite (about 1 out of 12 children)
- tiredness (about 1 out of 14 adults)
If these problems occur, they usually last 1 or 2 days.
- serious allergic reaction, within a few minutes to a few hours after the shot (very rare).
What should I look for?
- Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, or behavior changes.Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination.
What should I do?
- If you think it is a severe allergic reaction or other emergency that can’t wait, call 9-1-1 or get the person to the nearest hospital. Otherwise, call your doctor.
- Afterward, the reaction should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your doctor might file this report, or you can do it yourself through the VAERS website, or by calling 1-800-822-7967.
VAERS is only for reporting reactions. They do not give medical advice.