Content

Introduction

Hepatitis A is an inflammation of the liver caused by an infection due to a virus (HAV to RNA) belonging to the picornavirus family (Video). Still frequent in Africa, South America and South East Asia, the infection is present in those areas of the Mediterranean area where sanitation shortages persist.In Italy, the number of new cases (incidence) of hepatitis A has significantly reduced in the last twenty years.

The infection is generally transmitted through food but several cases are emerging, often in epidemic form, associated with sexual intercourse.

In the majority of children under six years of age it causes no detectable disturbances (symptoms) while in older children and adults it causes general disturbances (symptoms) (weakness, malaise, vomiting, low-grade fever) and, as in most of hepatitis, the appearance of a yellowish discoloration of the skin and eyes (jaundice).

Hepatitis A resolves in almost all cases within two to six weeks without serious complications and, rarely, tends to persist for the following six months or to cause severe liver damage.

Symptoms

Hepatitis A occurs suddenly (acute form) 15-50 days after infection of the virus. The first complaints (symptoms) are represented by malaise and weakness, low-grade fever, nausea, vomiting and abdominal pain. Generally, at a distance after a few days the skin and eyes take on a yellowish color (jaundice). At this stage the urine may appear darker than normal.The disorders (symptoms) caused by acute hepatitis can last for a period ranging from two to six weeks and, remaining at rest and following an adequate diet, tend to regress without causing consequences.

Causes

The HAV virus, coming from the feces of sick people, is very resistant in the air and in fresh or salt water. It can penetrate molluscs (for example, mussels, clams) which, by filtering the water, can concentrate it inside.

For this reason, the infection can be transmitted through:

  • contaminated water or food with feces of already infected people. In particular, molluscs eaten raw or undercooked and coming from highly populated areas where there is no adequate management of sewer discharges can pose a risk of infection. Eating fruits (including berries) and vegetables contaminated with fecal matter from washing or handling can also be risky. The infection can also be transmitted in the family through food preparation
  • sexual intercourse anal or oro-anal. The virus present in the faeces of people who have the infection can spread by direct contact with the mouth, in oral-anal intercourse, or with the glans penis in anal penetrative intercourse

Diagnosis

The ascertainment (diagnosis) of hepatitis A is based on clinical characteristics and on instrumental and laboratory evidence. Disturbances (symptoms) characteristic of acute hepatitis (yellowing of the skin and eyes, abdominal pain, nausea, vomiting and loss of appetite) they can provide the doctor with indications for the laboratory tests necessary to identify the cause of hepatitis.

An enlarged or "altered consistency of the liver, with or without pain, may be evidenced during the medical examination or by an" abdominal ultrasound.
The presence of high amounts of certain enzymatic proteins in the blood (transaminases GOT / AST and GPT / ALT, gamma-GT) suggests a state of inflammation of the liver. An increase in bilirubin may also be found in the blood and urine, which become darker than normal.
The "ascertainment (diagnosis) of hepatitis A requires the presence in the blood of antibodies against HAV. In particular, antibodies of the IgM class indicate an "infection in progress, while those of the IgG class can persist even years after healing.

Therapy

The disorders (symptoms) caused by hepatitis A generally last for a few weeks, tending to regress over time. There are no specific drugs for hepatitis A and the treatment consists of adequate rest and a specific diet based on light foods and fat-free until complete recovery.

Prevention

Infection can be avoided by:

  • adequate hygiene standards both collective (water control, sewer discharge management, food production and distribution control), and individual (hand and food washing, cooking food). It is advisable, especially in countries where the infection is common, to avoid drinking non-bottled water, ice, vegetables and fruit washed with running water. Instead, it is necessary to cook foods by bringing them to a boil, particularly seafood, which is at risk of contamination with the virus
  • use of a male condom or dental dam (latex membrane) in case of sexual intercourse at risk of transmission (anal, oral-anal)

An effective vaccine against hepatitis A is available that provides effective protection for several years, particularly in the case of booster vaccinations.It is generally recommended for those who intend to travel, for vacation or work, to countries where the spread (prevalence) of the infection is high (Africa, Southeast Asia or South America), to those with chronic hepatitis and in case of frequent sexual intercourse at risk. of infection.

Living with

Acute hepatitis A lasts for a few weeks and must be treated exclusively with rest and with a specific diet, based on light foods, low in fat, and rich in fiber and vegetables. In this period it is important to prevent the spread of the infection to relatives and cohabitants by washing their hands frequently and respecting the basic hygiene rules in the preparation of food.

Bibliography

World Health Organization (WHO). Fact sheet on Hepatitis A (English)

Ministry of Health. Hepatitis A

Higher Institute of Health (ISS). Integrated Epidemiological System of Acute Viral Hepatitis (SEIEVA). Epidemiological data

United Against AIDS (ISS). Sexually Transmitted Infections

EpiCentro (ISS). Viral hepatitis

Tosti ME, Mele A, Spada E, Marzolini F, Crateri S, Ferrigno L, Iantosca G, SEIEVA collaboration group (Ed.). X Workshop SEIEVA (Integrated Epidemiological System of Acute Viral Hepatitis). Bagno Vignoni (Siena) 13-15 December 2012. Proceedings. Rome: Istituto Superiore di Sanità, 2015. (ISTISAN Reports 15/29)

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