Viral Hepatitis A - Symptoms, Prevention, Treatment, How Is Hepatitis A Transmitted?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Symptoms, causes of infection, prevention and treatment of hepatitis A

Content:

• What is Hepatitis A?
• How is hepatitis A spread?
• Hepatitis A symptoms
• Consequences of hepatitis A
• Diagnosis of hepatitis A
• Hepatitis A vaccine
• Hepatitis A treatment
• Diet for hepatitis A
• Prevention of hepatitis A

Acute viral liver damage - Botkin's disease. Currently, the disease is identified as hepatitis A. The main symptoms of the disease: weakness, high fever, chills, profuse sweating, icteric coloration of the skin and visible mucous membranes, urine of dark beer color, colorless feces.

What is Hepatitis A?

Hepatitis A is an RNA virus, belongs to the Picornovirida family, the Enterovirus genus. Its size is 27-30 nm. The virus has no shell. Typing was carried out in 1973. Further, four more genotypes of the human virus and three genotypes of monkeys were identified.

It was found that regardless of genotypes, all type A viruses have similar antigenic, immunogenic and protective properties. That is, one serotype, a virus, is determined by the same standard sets of reagents, and can be prevented with the same vaccines.

Virus resistance in a humid environment, at a temperature:

• from 20 to 22 ⁰ С - 3-4 weeks;
• from 4 to 6 ° C - 3-4 months;
• up to 60 ⁰ С - up to 12 hours;
• 100 ⁰ С - up to 5 minutes.

Active chlorine at a concentration of up to 2.0 mg / ml and higher inactivates the virus within 15 minutes. The concentration of active chlorine below 2.0 mg / ml suppresses the virus after 30 minutes. The pathogen is resistant to drying acids and alkalis, ether.

The spread of the virus occurs mainly during the warm season. However, due to the long incubation and subclinical stage, it is characterized by outbreaks of infections in spring and autumn. Peaks during long-term observations are characteristic. About once every three to five years, hepatitis A is diagnosed more often than in other years.

Only people are susceptible to the virus, regardless of age. Animals, including laboratory ones, are not susceptible to the virus.

Children can get sick from the moment they are born. The following patterns of epidemiology of this form of hepatitis related to newborns have been established:

• If a child is born by a mother who has not previously been ill and has not been vaccinated against hepatitis A, then there is a possibility of contracting one of the possible ways of transmitting the virus.
• If a child was born by a mother who had previously had hepatitis A or vaccinated against this pathogen, then he is considered immune to the hepatitis A virus. Immunity is transmitted to the child from the mother and lasts up to one year of his life.

Up to 80% of all cases of diseases are diagnosed in groups of children from three to fifteen years old. Scientists explain this phenomenon:

• close contacts of kids and schoolchildren in kindergartens and schools;
• not developed sanitary and hygienic skills in children.

The pathogenesis of hepatitis in them is characterized by a latent (latent) course. Clinically, the disease is subtle due to symptoms that are nonspecific for hepatitis.

Another epidemic phenomenon is the incidence of people aged 15 to 30 years. A sharp increase in the disease in this age group is associated, oddly enough, with the improvement in living conditions of the population of the last two to three decades. Thus, conditions are created for the delay in the initial contact of people with the pathogen and a decrease in the body's immunity at this age.

Clinically characterized by classic symptoms. Epidemic risk groups, regardless of age, include:

• persons for various reasons who traveled to countries with a high incidence of diseases of the indigenous population;
• residents of small towns with irrational sewerage and water supply systems.

Up to 70% of the adult population of our country are carriers of factors of resistance to this form of infection. Refractoriness factors are protective antibodies formed as a result of a person's illness or vaccination. Immunity to hepatitis in the body lasts for life or for a long time.

• Hepatitis A is characterized by an acute course of pathogenesis - this is an epidemic feature of hepatitis A.
• The chronic form of the disease is rare, usually caused by a mixture of viruses, layered on the main pathogen.

The incubation period of hepatitis A

People are contagious to others:

• carriers of the virus in the subclinical stage or anicteric form of the disease;
• patients in the early stages of the disease (incubation and the first stage of the acute course to jaundice).

The stage from the moment of infection to the first clinical manifestations is called the incubation period, it lasts about 35 days, intervals from 15 to 50 days are possible.

During the incubation period, the virus penetrates and spreads along the bloodstream in parallel with the accumulation of viruses.

During this period, a person feels healthy. Outwardly vigorous, he is contagious to others. The disease in the subclinical stage proceeds with minimal symptoms, imperceptible to the patient and others.

Periods of pathogenesis of hepatitis A

Classic pathogenesis proceeds according to the following algorithm:

• incubation period (about 35 days, see intervals above);
• prodromal period or primary symptoms (5-7 days, intervals from 1 to 21 days);
• icteric period or the height of the disease (2-3 weeks, intervals from 7 days to 2 months);
• recovery period (up to 12 months, sometimes up to two years).

How is hepatitis A spread?

The source of infection is sick people at the stages of the subclinical course and the initial manifestations of the disease, including those with anicteric form.

After staining the sclera and skin, the contagiousness is significantly reduced. In the third week of pathogenesis, a dangerous virus is released only in 5% of patients.

The period of infectiousness, taking into account the incubation period, lasts about a month, less often up to one and a half months.

Proven sources of the spread of the virus, in descending order:

• Feces, urine, nasopharyngeal discharge. This method of transmission is called fecal-oral. The main proven factors in the transmission of hepatitis A virus include direct contact between healthy and sick. The virus can also be transmitted through food, water, airborne droplets (some authors exclude), through sexual contact, with non-sterile intravenous administration, through flies - mechanical carriers of the virus.
• Direct contact with the patient. It is characteristic of people with undeveloped hygiene skills and people who are in professional contact with them. This is how the pathogen is transmitted in preschool and school groups, boarding schools for people with disabilities.
• Seeded food. This method of transmission is of great epidemic significance. However, it is almost impossible to establish the type of dangerous food due to the long incubation period.

Meanwhile, the following products have been identified that are more often factors in the transmission of the virus:

• products prepared without heat treatment or consumed after storage (salads, vinaigrettes, cold snacks, dried fruits and berries, especially from Kazakhstan and Central Asia);
• garden berries in fresh and frozen (after thawing) form, especially if mollusks, slugs are found in the beds, next to berry plants, which can accumulate the virus if the beds are watered with fertilizer from human feces.
• Water. Typical for areas with undeveloped communal infrastructure, poor organization of water supply, sewerage and wastewater disposal. The risks of infection during accidents and natural disasters increase significantly.
• Aerosol. It is hypothetically possible in children's groups when outbreaks of respiratory diseases are layered in groups with low resistance. The virus is transmitted by coughing, sneezing with secretions from the nasopharynx of a sick person.
• Sexual. In the literature, it is indicated as a possible factor of transmission in homosexuals, while the causal relationship of homosexuality and hepatitis A is not deciphered.
• Transmissible (transmission of the virus through flies). Researchers do not exclude the possibility of transmission of infection through flies, but the prevalence of this factor has not been studied.
• Parenteral Transmission of the virus through blood transfusions, intravenous administration of solutions is not excluded, especially in an environment that excludes compliance with sterility (drug addicts).

Hepatitis A symptoms

The symptoms of hepatitis A can vary significantly depending on the circumstances, for example:

• the massiveness of the virus attack;
• the state of immunity of the organism attacked by the virus;
• the age of the person and others.

Depending on the combination of these circumstances, the disease can manifest itself in the form of typical (classical) and atypical manifestations of pathogenesis.

The typical course of hepatitis A. It has three variants of symptoms and manifests itself in the form of symptoms:

• mild illness;
• medium form of the disease;
• severe form of the disease.

Atypical course of hepatitis A. It has two main variants of symptoms. Atypical course proceeds exclusively as a slight malaise and manifests itself in the form of:

• anicteric disease (there is no yellow staining of the sclera and skin);
• subclinical disease (there are no visible symptoms, diagnosis is carried out on the basis of laboratory tests).

All types of hepatitis are more common in school-age children. But the greatest concern is caused by hepatitis in preschoolers. More details below.

I. Signs and symptoms of hepatitis A in children: typical course

In view of the underdevelopment of the skills of observing the rules of personal hygiene, close collective communication, preschoolers and younger students are the most vulnerable groups for infection with hepatitis A.

Signs of mild hepatitis A in children

The reasons for contacting a pediatrician or infectious disease specialist are:

• lethargy, sweating;
• an increase in body temperature (up to 37 ⁰ С, maybe slightly higher);
• signs of intestinal pathology (vomiting, diarrhea, signs of liver damage may be absent);
• dark urine, colorless feces;
• jaundice develops after about seven days from infection (options are possible).

Symptoms of mild hepatitis A in children

In about half of children who have had type A hepatitis, a mild form of the disease is identified. The study is being conducted by a pediatric infectious disease specialist. The doctor's task is to determine the severity of symptoms, the likelihood of complications, to determine methods of treatment, to isolate the patient from susceptible people.

Clinically, the symptoms are manifested by a cyclical course (periods of exacerbation and attenuation), moderate fever, and intoxication. On palpation, percussion, the liver is slightly enlarged. (Methods for determining the topographic boundaries of an organ in children are known to specialists; they are not indicated in this text). Icterus (yellowness) disappears by about 30 days. The disease often ends with complete restoration of the lost liver functions. The duration of the complete recovery of the body is about one year.

Signs and symptoms of moderate hepatitis A in children

The child should be considered ill based on the above signs of liver or gastrointestinal tract damage.

The task of the child's parents is to go to an ambulance as soon as possible, to isolate the patient from susceptible people, not to wait for the appearance of dark coloration of urine, colorless feces and yellowness.

The severity of pathogenesis correlates with the results of laboratory tests of blood, urine, and feces. The doctor describes the general intoxication of the child's body as moderate, ranking the symptoms of intoxication according to a special method.

The liver is examined by physical methods in the place of its localization, in the right hypochondrium. The organ is filled with blood (when probing the edges are dull), not always enlarged (topographic landmarks may not go beyond the normal range), the surface is smooth, dense. The spleen is slightly enlarged.

The amount of urine decreases, the color is dark, the feces, on the contrary, are light. The main symptom is jaundice. It develops by 7-10 days after the first signs of the disease. The duration of staining of the integument is two to three weeks.

It may take about two years to completely restore the morphological structure of the liver parenchyma. The transition from acute to chronic inflammation is observed in about 3% of patients.

Signs and symptoms of severe hepatitis A in children

It is extremely rare. However, this is not a reason for parents to be optimistic. It can proceed without development and with the development of a hepatic coma.

Call an ambulance immediately if a child is lethargic, sweating, repeatedly vomiting with bile, or discolored.

Additional signs are lethargy, apathy, dizziness, nosebleeds, and a rash on the body. Icteric coloration appears much later (after 5-7 days) signs of urine staining (the color of dark beer or dark blood) and discoloration of feces (like white clay).

The body temperature rises to 40 ⁰ С, periods of temperature decrease are possible. The liver is enlarged, which is manifested not only by the blunting of its edges, but also by an increase in the boundaries of the organ. When pressed, it is moderately painful. The spleen is enlarged. The severity is specified by laboratory methods according to the content of liver damage markers in the blood, urine, feces. Auscultation of the heart reveals a decrease in the heart rate - this is one of the characteristic, additional symptoms.

II. Signs and symptoms of hepatitis A in children: atypical course

Always mild pain relief. In epidemic terms, the atypical course of hepatitis A is the most dangerous. The fact is that a child who does not feel like an infectious patient continues to communicate in a team, spreading the virus in the environment (water, food, household items), infecting other people (children and adults) through personal contact.

The atypical form does not mean transmission to another person of the same mild form of hepatitis A. It is likely that an infected person develops one of the classic forms of the disease (see above).

But back to the description of the atypical pathogenesis. Atypical forms can occur in two main forms.

Signs and symptoms of anicteric hepatitis A in a child

They resemble mild damage to the gastrointestinal tract and liver. A slight increase in body temperature is possible. The main difference from the typical course is no yellowness of the sclera, visible mucous membranes and colorless coloration of urine.

Involvement in the pathogenesis of the liver and the type of virus is determined on the basis of laboratory tests of blood, urine, and feces. Confirmation of hepatitis A is the detection of specific IgM in the child's blood. The main symptom of hepatitis in the absence of staining is an increase in volume (dullness of the borders) and expansion (increase in topographic landmarks) of the liver.

Signs and symptoms of subclinical hepatitis A in a child

The peculiarity of inapparent (subclinical) infections is the absence of signs and symptoms. More precisely, they are available, but they are not obvious. From this, the disease only becomes more dangerous in an epidemic respect. The patient remains a hidden carrier of the disease.

The task of parents is to closely monitor the health of a child attending a preschool or school institution.

With some degree of probability, an asymptomatic disease can be guessed by poor digestion of food (diarrhea, constipation), increased gas production in a child, a slight change in the color of urine and feces, causeless lethargy or a short-term rise in temperature.

The main diagnostic method is the determination of specific immunoglobulins for hepatitis A. Blood tests to determine the level of digestive enzymes in the blood are of great importance. Other methods for examining feces and urine are also used, which have good diagnostic value.

Cholestatic hepatitis A syndrome in a child

Hepatitis in which bile does not enter the duodenum as a result of a decrease in its production or as a result of a mechanical obstruction in the duct.

A syndrome is a complex of symptoms. In children, the most common cause of the syndrome is viral liver damage. The syndrome includes the following symptoms:

• icterus (yellowness) of the sclera, other visible mucous membranes and skin due to the soaking of bile pigments of the integument;
• acholia (white feces) due to the absence of bile pigments in the gastrointestinal tract, bile is involved in the breakdown of intestinal contents, mainly fats;
• dark urine due to the increased excretion of under-oxidized products by the kidneys, which the liver cannot cope with its function as a biological filter;
• enlargement of the liver due to the increased load on the organ with increased blood flow and weakening of the outflow;
• itching due to irritation of the nerve endings with under-oxidized metabolic products, skin itching often ends in rashes on the skin, at first it is a consequence of internal pathology, and then a consequence of scratching.

Laboratory markers of cholestasis are associated with increased levels of:

• some enzymes (alkaline phosphatase, gamma glutamyl transpeptidase, leucinoaminopeptidase, nucleosidase);
• bile components (cholesterol, bile pigments, including urobilinogen, bilirubin);
• trace elements (copper).

Symptoms of Hepatitis A in Pregnant Women

It is believed that infection in the first half of pregnancy is not dangerous to the health of the child.

No infection detected:

• fetus during pregnancy;
• newborn during breastfeeding.

Meanwhile, predicting viral hepatitis in pregnant women is the prerogative of gynecologists and infectious disease specialists based on the results of careful observation.

Signs of hepatitis A, according to many clinicians, resemble the manifestations of acute respiratory infections (fever, chills, sweating, lethargy). Discoloration of feces, darkening of urine to the color of dark beer indicates involvement in the pathogenesis of the liver. Seek medical attention immediately. There are hepatitis (for example, hepatitis A, non-B), which is extremely dangerous for pregnant women.

Consequences of hepatitis A

Damage to the liver parenchyma is always bad for the body in the short term. Researchers associate the most dangerous viral hepatitis causing death of people or severe long-term consequences with parenteral infection.

As for hepatitis A, which spreads mainly by the oral-fecal route, deaths in clinical practice are observed no more than 1% of all cases of this form of infection, with fulminant pathogenesis.

Long-term consequences of hepatitis A. The most famous limitation is a lifetime ban on donation. The reason for the ban is not commented on, probably due to insufficient knowledge of the ability of the pathogen to persist (asymptomatic persistence of the virus in the body) and its reactivation in the long term.

Subject to diet and exercise restrictions, for up to two years after illness, no consequences for the body should be expected.

In case of forced or voluntary violations of the treatment regimen or the recovery period, the development of liver cirrhosis, less often liver cancer, is possible.

Employment after recovering from hepatitis A

After discharge from the hospital, an exemption from work is granted for a period of two weeks, sometimes more, depending on the health of the convalescent.

After closing the certificate of incapacity for work, a recovered employee (student, student), within three to six months, is exempt from:

• business trips on a business trip, internship;
• heavy physical exertion at work and physical education in the main group of students;
• work with substances that affect liver function;
• vaccinations with the exception (vaccinations against hydrophobia or rabies, as well as tetanus);
• planned surgical interventions;
• the use of drugs toxic to the liver.

Diagnosis of hepatitis A

The acute form of the disease is almost unmistakably identified. It is another matter if the patient's disease proceeds without a clear clinical picture.

In any case, to detect pathology, a traditional research algorithm is used, including physical, laboratory, instrumental methods:

• Clinical (anamnesis and physical studies of the patient. During the same period, epidemiological studies are carried out).
• Laboratory tests of blood, urine, feces.
• Instrumental research.

Methods of instrumental diagnosis of hepatitis A are not essential. In addition to clinical trials, the decisive factor is associated with laboratory testing of biological environments of patients.

Laboratory tests are classified as specific and non-specific.

• Specific, aimed at identifying the causative agent of hepatitis A directly, usually (PCR), or identifying traces of the virus, its specific antibodies (Ig) to the virus (ELISA);
• Non-specific (aimed at identifying markers of liver damage), including:
• Complete blood count (leukocytes, erythrocytes, platelets, ESR);
• general urine analysis (urobilin, bile pigments);
• biochemical blood test (using a biochemical analyzer) - total protein and fractions, as well as AST, ALAT, blood bilirubin, prothrombin index, fibrinogen, cholesterol, alkaline phosphatase;
• Instrumental methods, most often ultrasound.

Hepatitis A vaccine

For prophylactic immunization of the population of our country, several vaccines registered in the territory of the Russian Federation are used, including:

• Havrix or Havrix (720 units / dose for children from 12 months) and (1440 units / dose for adults), manufacturer: GlaxoSmithKline Biologicals SA, Belgium. The vaccine is administered intramuscularly, twice. Provides protective immunity for at least 15-20 years (according to other sources, no more than 8 years). Reg. in the RF P No. 013236/2001.
• Vacta or Vakta (25 units for children over 2 years old) and (50 units for adults), manufacturer: Merck Sharp & Dohme BV (Netherlands). The vaccine is administered intramuscularly, twice. Provides protective immunity for at least 6 years. Reg. in the RF P # 012585 / 01-2001.
• Avaxim 80 or Avaxim (80 units of antigen for children from 12 months to 15 years inclusive), manufactured by Sanofi Pasteur (France). The vaccine is administered intramuscularly with an interval of 6-18 months.
• Twinrix or Twinrix. The vaccine against hepatitis A and B. Produced in two dosages, including: (360 units of antigen A and 10 units of antigen B); (720 units of antigen A and 20 units of antigen B), administered intramuscularly to children from 12 months to 15 years old, as well as adults from 16 years old, manufacturer: GlaxoSmithKline Biologicals SA, Belgium. Registration in the Russian Federation No. ЛС-001928.
• Hep-A-in-Vac or Hep-A-in-Vac (50 units / ml of hepatitis A antigen). Appointment for children over 3 years old, adolescents and adults, manufacturer: CJSC Vector-BiAlgam (Russia). A single intramuscular injection provides protection against hepatitis A for 12 months, a double injection is intended for long-term protection, the duration of protective immunity is not indicated in the instructions. Registration in the Russian Federation No. R No. 000461 / 01-2007. Two modifications of this vaccine are used. One of the modifications with polyoxidonium is added to the indicated marking with the abbreviation (LPO).

Details of application can be obtained in the instructions for the vaccine. All vaccines should be transported in compliance with the temperature chain and stored in compliance with the temperature regime in accordance with the instructions for the drug.

Any biological products, including hepatitis vaccines, may have side effects, such as:

• general malaise;
• headache;
• slight increase in temperature;
• hot flushes;
• edema at the injection site;
• the appearance of proteins in the urine (in the form of cloudy urine, also determined by laboratory tests).

With the development of an allergy to an antigen or vaccine components, re-administration is not carried out, or is administered after establishing the causes of the allergy not related to the vaccine.

Do not vaccinate during the period of acute inflammation or exacerbation of the chronic course. Pregnant women are vaccinated in accordance with the instructions for the drug (vaccine).

For passive immunoprophylaxis, an immunoglobulin specific against hepatitis A is used. The application is carried out in accordance with the instructions for the drug.

On the subject: List of the best hepatoprotectors for liver restoration

Hepatitis A treatment

Treatment of mild to moderate forms of hepatitis A is based on basic therapy. It includes: using a diet, maintaining intestinal microflora and liver function, the careful use of medications that affect the affected organ.

The therapeutic strategy and tactics should be based on the individuality of the pathogenesis, taking into account the etiology of the pathogen, the characteristics of the patient's body, his age, habit, living conditions of life and work.

Treating mild hepatitis A

Based on the preservation and maintenance of the functions of the affected organ through a therapeutic diet. The patient must comply with a half-bed mode of life, give up physical activity. Medicines are used with caution.

Treatment of moderate hepatitis A

It is treated similarly (diet, regimen, limited use of pharmacological agents). In case of vomiting in the patient, which is a consequence of the accumulation of under-oxidized products (ammonia) in the blood. Vomiting, provokes dehydration. Therefore, the efforts of doctors are aimed at overcoming the violation of the antitoxic function of the organ.

Treating severe hepatitis A

The danger is the development of hepatic coma (impaired motor skills and consciousness).

Diet and bed rest are the basis for the prevention of precoma. In addition, antitoxic therapy is performed. In some cases, hormones (corticosteroids) are indicated.

In the case of the development of hepatic coma, therapeutic measures are carried out in the intensive care unit (department).

The treatment of critically ill patients is based on pathogenetic therapy:

• Corticosteroids (hydrocortisone, prednisolone, dexamethasone) in an extremely short course. Without discussion, they are shown only in the case of the development of cerebral edema syndrome.
• Detoxification solutions are prescribed intravenously, drip in order to replenish the energy of the brain tissue, with a decrease in blood glucose.
• Hemorrhagic syndrome - a frequent companion of severe liver damage is manifested by profuse gastrointestinal bleeding. The patient is shown the introduction through a tube into the stomach solutions of hemostatic agents (solution of 5% aminocaproic acid), parenteral administration of drugs that enhance blood clotting.
• H-2 receptor blockers. To suppress excessive secretory activity of the stomach and intestines.
• Deficiency of blood clotting factors. Transfusion of plasma, blood albumin is shown.
• Dehydration. Shown 10% solution of mannitol, intravenous drip. Lasix is controlled by the level of potassium in the blood. With the development of metabolic acidosis, bicarbonate is indicated, with alkalosis, potassium preparations are indicated.
• Antibiotic therapy is prescribed only in case of bacterial complications.

The following indicators are the basis for the discharge of a convalescent:

• state of health equal to that of healthy people of the corresponding age;
• lack of yellow staining of integuments and bilirubin in the blood.
• restoration of liver size to normal.
• lack of staining of urine and lack of pigments in laboratory tests.

Diet for hepatitis A

At the heart of the treatment of hepatic pathologies, any etiology and severity, strict adherence to the diet. Its value is higher than pharmacological therapy. The fifth table is the name of the diet common in our country for this disease. Recommended cooking methods are steam cooking or boiling.

The goal of the diet is to naturally reduce the burden on the liver, which is the body's main biological filter.

See the list of recommended foods for this diet here

The diet is strictly observed at any stage of pathogenesis, including during the period of the developed coma. The maximum allowable period of refusal to eat food naturally (by mouth) does not exceed five days.

In a state of precoma and coma, the energy needs of the body are replenished by intravenous administration of glucose solutions. After the indicated terms, liquid food in a volume of up to 50 g is introduced into the stomach through a tube. The energy requirement (about 2400 kcal / day) is replenished with liquid meals (semolina, mashed potatoes, jelly, etc.), as well as intravenous glucose.

For patients in a hepatic coma, liquid food is replaced with nutrient mixtures. To prevent the absorption of toxins into the bloodstream, primarily ammonia, patients are prescribed lactulose and similar drugs along with a diet.

Prevention of hepatitis A

Prevention of any infections is based on interrupting the transmission of the pathogen by any available means.

The spread of the hepatitis A virus is ensured by suppressing the fecal-oral mechanism of infection by:

• the creation of favorable living and working conditions for a person;
• sanitary improvement of settlements, provision of the population with high-quality drinking water and reliable sewerage;
• safe food at the stages of procurement, processing, storage and sale;
• improving sanitation

Author of the article: Kletkin Maxim Evgenievich | Hepatologist

Education: Diploma in the specialty "General Medicine" received at the Military Medical Academy. S. M. Kirov (2007). At the Voronezh Medical Academy. NN Burdenko graduated from residency in the specialty "Hepatologist" (2012).