Hepatitis A is a virus that causes inflammation in the liver. It is contracted by eating or drinking contaminated food or water, as well as close contact with someone who is infected with the Hepatitis A virus (including sexual contact and sharing needles/using drugs together). Symptoms include fever, abdominal pain (especially on the right upper side), nausea, vomiting, diarrhoea, decreased appetite, weakness, tiredness, pain in the joints, jaundice (yellowing of the skin and whites of the eyes), itchy skin, pale faeces, and dark urine. Hepatitis is an acute (short-term) infection, but its symptoms can last weeks to months, and symptoms usually do not occur for two or more weeks after exposure to the infection. It is possible for children younger than 6 years old to have no symptoms of infection, and someone who is infected can spread the virus for up to weeks before they start having symptoms. Most people who get sick with Hepatitis A will have a full recovery with no resulting health problems. However, illness may come and go (relapse) for up to 6 months. Rarely, Hepatitis A infection can cause acute liver failure, which may result in the need for a liver transplant, or even death.
Treatment for Hepatitis A infection involves rest, hydration, ensuring adequate nutrition, and symptom control. There is no antiviral medication that treats hepatitis A.
You must take medications with care and caution if you have hepatitis A because many are processed through the liver and can cause extra stress on your already inflamed liver. You will need to discuss any medications you are taking with your doctor and/or pharmacist, including OTC and herbal/dietary supplements. You may need to temporarily discontinue some medications or take a different dose to allow your liver time to rest and heal. You should also avoid drinking alcohol because it can damage the liver.
Rehydration is important to replace the loss of fluids/body water due to fever, vomiting, diarrhoea, and decreased oral intake in patients with hepatitis A. Oral rehydration solutions that contain electrolytes/salts (ex.-potassium, magnesium, sodium) are available. Water alone may not be the best method of rehydration, especially with diarrhoea, because it causes a loss of electrolytes, which are necessary for many body processes. Oral rehydration solutions are available in pre-mixed liquids or in powder form. It is important to use clean or bottled water and follow the instructions carefully when mixing powdered oral rehydration solutions. In severe cases of dehydration, intravenous (IV) fluids may be administered at a healthcare facility. These include 0.9% sodium chloride solution (normal saline/NS), 5% dextrose in water (D5W), and lactated ringers solution (LR). Electrolytes may be added to these IV solutions.
Pain/Fever Reducers, also called “analgesics” or “antipyretics,” can be used to help make patients with Hepatitis A more comfortable, treating symptoms such as fever and abdominal pain. Examples include acetaminophen, aspirin, and ibuprofen. Acetaminophen works by stopping pain signals and stimulating the brain to cause temperature regulation. Ibuprofen and aspirin are NSAIDs (non-steroidal anti-inflammatory drugs) that treat pain and fever by decreasing inflammation in the body. Aspirin should NOT be given to children under 16 years old due to a serious potential reaction called Reye’s Syndrome. It is important that these medications, especially acetaminophen, are taken at the lowest possible dose that brings symptom relief to minimize stress on the liver (recommended max daily dose of acetaminophen is 3-4 grams, or 3000-4000 mg, per day).
Antiemetics are only recommended in severe cases to help prevent dehydration in Hepatitis A patients with severe nausea and vomiting. Again, these should be used at the lowest possible dose that provides symptom relief. There are several classes of antiemetics. They generally work by inactivating receptors in the stomach or the brain that trigger vomiting, or by helping move food and drink downward through the digestive tract. Examples of antiemetics used in migraine symptom treatment include ondansetron, promethazine, prochlorperazine, metoclopramide, dimenhydrinate, and meclizine.
Hepatitis A Vaccine may be given to help prevent hepatitis A infection in someone who is exposed to the virus. The vaccine works by introducing an inactivated version of the virus into the body by injection (a shot), which stimulates the immune system to create antibodies to hepatitis A (proteins that recognize and fight the virus). The vaccine needs to be given within 2 weeks or less of exposure to be effective. Two to three doses of Hepatitis A vaccine are required to be fully protected, but one dose soon after exposure can be effective in preventing infection.
Hepatitis A Immune Globulin is an injection or infusion made from human blood that contains antibodies to the hepatitis A virus. This may be recommended for people who have known exposure to the virus and either cannot receive the vaccine or are at high risk of complications due to other health conditions.
Common side effects that you may experience while taking these medications include nausea, diarrhoea, constipation, dizziness, drowsiness, headache, fever, body aches, and irritation at the injection site. A reaction to the hepatitis A vaccine that includes aches, fever, or injection site reactions can be a sign that the vaccine has caused the desired immune response.
Rarely, an allergic reaction to a medication or vaccine can occur. If you experience a rash accompanied by swelling, hives, shortness of breath, and nausea/vomiting, you should seek medical attention.
There are important measures that can help prevent hepatitis A infection and the spread of the disease. It is important to wash your hands with warm, soapy water before eating, after you use the restroom, after changing dirty diapers, and before and after handling food. It is important that you have clean drinking water and wash fruits and vegetables appropriately before eating. If you have hepatitis A, you should avoid close contact with others, and take extra cleaning precautions when you use the restroom.
After recovering from hepatitis A, you are immune to the virus for life. However, due to the risks associated with infection, and because the infection can be spread when an infected person does not have any symptoms, you should talk to your doctor about whether receiving the hepatitis A vaccine is right for you.