Hepatitis A is a viral infection that primarily affects the liver. While hepatitis A itself does not directly cause cancer, chronic inflammation and damage to the liver caused by the virus can increase the risk of developing liver cancer in the long term.

Chronic liver inflammation, also known as hepatitis, is a known risk factor for the development of liver cancer. Chronic hepatitis B and hepatitis C infections are the leading causes of liver cancer worldwide. However, hepatitis A is generally an acute infection and does not typically progress to chronic hepatitis.

In rare cases, hepatitis A infection can cause a severe form of liver inflammation called fulminant hepatitis, which can lead to liver failure. While fulminant hepatitis can be life-threatening, it does not necessarily increase the risk of liver cancer.

It's important to note that hepatitis A can be prevented through vaccination, good hygiene practices, and avoiding contaminated food and water. Vaccination against hepatitis A is recommended for individuals at risk, such as those travelling to regions with a high prevalence of the virus or individuals with chronic liver disease.

Hepatitis

Liver inflammation is referred to as hepatitis. The function of the liver might be harmed when it is inflamed or damaged. Hepatitis can be caused by heavy alcohol use, pollutants, certain medicines, and certain medical conditions, although it is most commonly caused by a virus. Hepatitis A (H-A) virus, hepatitis B virus, and hepatitis C virus are the most prevalent hepatitis viruses in the United States.[1]

Hepatitis A

The hepatitis A virus causes hepatitis A, a highly infectious, short-term liver illness. [2]

Is hepatitis A a severe illness?

People who have hepatitis A may become ill for a few weeks to several months, but they generally recover entirely and have no long-term effects on their liver. Hepatitis A can cause liver failure and even death in rare circumstances; this is more prevalent in the elderly and in those who have other significant health problems, such as chronic liver disease.[3]

Prevalence of Hepatitis A:

In the United States, there were 12,474 cases of hepatitis A recorded in 2018. Because some patients are never diagnosed, the real number of cases recorded in that year is likely to be closer to 24,900. Over 32,000 cases of hepatitis A have been reported in the United States since 2016, primarily among persons who use injectable drugs or are homeless.

H-A incidence has decreased substantially in the United States since the hepatitis A vaccination was first suggested in 1996. Unfortunately, the number of persons infected has been rising in recent years as a result of several hepatitis A epidemics in the United States caused by person-to-person contact, particularly among drug users, homeless people, and men who have sex with other males.

Hepatitis A is spread in several different ways.

Infected persons have the hepatitis A virus in their faeces and blood. When someone ingests the (H-A) virus (even in trace levels), it spreads through the following mechanisms:

Person-to-person contact is a type of communication that occurs when two or more people come into contact with one another.

Hepatitis A is transferred by intimate physical contact with an infected person, such as some forms of sexual contact (such as oral-anal sex), caring for someone unwell, or sharing medications. (H-A) is highly infectious, and infected individuals can transmit the virus even before becoming ill.

Consumption of tainted food or beverages

Hepatitis A virus contamination of food can occur at any time during the planting, harvesting, processing, handling, or cooking process. In areas where (H-A) is widespread, contamination of food and water is more prevalent. People eating tainted fresh and frozen imported food goods have caused foodborne outbreaks in the United States, albeit they are rare.

(H-A) may affect anyone.

Although anybody can contract hepatitis A, specific groups of people in the United States are more likely to become infected and develop severe illness if they do.

Even though many people, particularly youngsters, show no symptoms, the illness can still spread. Furthermore, up to 2 weeks before symptoms show, a person might transmit the hepatitis A virus to others.[3]

Hepatitis A patients who are at a higher risk

Travelers from abroad

1. Males who have intercourse with other men are known as heterosexuals.
2. Individuals who use or inject drugs are referred to as drug users or injectors (all those who use illegal drugs)
3. Those who are in danger of being exposed because of their job.
4. Those who are looking forward to having a close personal touch with an overseas adoptee.
5. Homeless people
6. People who are at a higher risk of contracting (H-A).
7. Chronic liver disease patients that include hepatitis B and C
8. HIV infected people[3]

Symptoms:

(H-A) has a variety of symptoms.

Hepatitis A does not affect everyone equally. Mostly symptomatic in adults than in children. Symptoms emerge 2 to 7 weeks after infection, on average. Symptoms generally continue for less than two months, although some patients may remain sick for up to six months.

Symptoms that may appear as your condition worsens include:

Skin or eyes that are yellow, I'm not hungry, Stomach cramps, a stomachache, Indigestion, Fever, Light-colored stools or dark urine, Diarrhea, achy joints Tiredness [3]

How to diagnose (H-A):

The finding of specific anti-HAV IgM is required for serological diagnosis of acute viral hepatitis A. The presence of HAV in the patient's serum suggests that he or she has been exposed to the virus recently. By 4 weeks after infection, the HAV-specific IgM antibody level in the blood is detectable, remaining high for around 2 months before decreasing to undetectable levels by 6 months. They usually don't last more than a year after being infected.

IgM and IgG antibodies to hepatitis A are the two types of antibodies that may be examined. When someone is infected with (H-A), their bodies develop (H-A) IgM antibodies initially. Antibodies form 2 to 3 weeks after infection (and can be detected before symptoms appear) and last 3 to 6 months. IgG antibodies to (H-A) are generated within one to two weeks following IgM antibodies and generally last a lifetime.[4]

Result:

The presence of hepatitis A virus (HAV)-specific IgM antibodies in serum may be detected with this test. Negative findings suggest either: 1) an insufficient or delayed anti-HAV IgM response following known HAV exposure, or 2) the lack of acute or recent (H-A) infection.

Early acute (HA) with rising anti-HAV IgM levels or recent hepatitis A infection with falling anti-HAV IgM levels can also provide ambiguous findings.

To confirm the ultimate HAV infection status, repeat anti-HAV IgM (HAIGM / Hepatitis A IgM Antibody, Serum) and anti-HAV IgG (HAIGG / (H-A) IgG Antibody, Serum) tests in 2 to 4 weeks.

Positive tests suggest a hepatitis A infection that is acute or recent (less than 6 months). Positive anti-HAV IgM test findings must be reported to state health agencies as soon as feasible, as required by law in virtually every state, to conduct epidemiologic investigations into probable epidemic transmission.

Testing too soon after exposure to the (HAV) (less than 2 weeks) might result in negative anti-HAV IgM findings.

Cross-reactive antibodies from other viral infections or underlying diseases may cause false-positive findings (such as non-Hodgkin lymphoma). Positive results should be compared to the patient's clinical history as well as epidemiologic exposure.

The presence of heterophilic antibodies and human antimouse antibodies in serum (in patients who have received mouse monoclonal antibody preparations for diagnosis or therapy) might interfere with the test and lead to inaccurate findings (false-positive or false-negative). [5]

For the following specimen characteristics, performance characteristics have yet to be determined:

-Total bilirubin level >20 mg/dL - Grossly icteric

-Hemoglobin level >500 mg/dL (grossly hemolyzed)

-Extremely lipemic (triolein levels >3,000 mg/dL)

-Has particulate particles in it

-Heat-inactivated

-Samples from the cadaveric era[5]

Treatment:

Doctors often prescribe rest, proper diet, and water to treat the symptoms of hepatitis A. Some persons with severe symptoms will require hospitalization.[6]

Prevention:

Vaccination is the most suitable approach for (HAV). Multiple shots are required to receive the full effect of the hepatitis A vaccination. The quantity and timing of these injections are determined by the vaccination. Hand hygiene is crucial in avoiding the transmission of (H-A). This includes washing hands thoroughly after using the restroom, changing diapers, and before preparing or eating food[3].

Hepatitis A vaccination can be preferred by the following people:

Children

All 12- to 23-month-old youngsters

All children and adolescents aged 2 to 18 who have never had hepatitis A immunization (often known as "catch up" vaccination) are eligible.

Hepatitis A patients who are at a higher risk

People who are at a higher risk of contracting hepatitis A.

Vaccination was suggested by others.

Pregnant women who are at risk of contracting hepatitis A or who are at risk of having a serious (H-A) infection.

Those who make a vaccine request

Who should not be vaccinated against (H-A)?

People who have ever had a life-threatening allergic response to the hepatitis A vaccination or who are known to be allergic to any element of the vaccine should not have it. If you have serious allergies, tell your doctor. The vaccination should be avoided for children under the age of one year.[3]

Other preventions:

The following advice will help you avoid transmitting or contracting the virus:

After using the toilet and coming into touch with an infected person's blood, faeces, or other body fluids, always wash your hands thoroughly.

Food and water that have been contaminated should be avoided.

The virus might spread faster in daycare centres and other locations where people are in close quarters. Hand washing should be done before and after each diaper change, before giving meals, and after using the restroom to help avoid breakouts.

If you haven't had (H-A) or the (H-A) vaccination, talk to your doctor about obtaining immune globulin or the hepatitis A vaccine if you've been exposed to the disease.

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Reference:

1. Castaneda D, Gonzalez AJ, Alomari M, Tandon K, Zervos XB. From hepatitis A to E: A critical review of viral hepatitis. World J Gastroenterol. 2021 Apr 28;27(16):1691-1715. doi: 10.3748/wjg.v27.i16.1691. PMID: 33967551; PMCID: PMC8072198.