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| Hepatitis A |
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The disease
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Hepatitis A (also known as Infectious Hepatitis and
epidemic jaundice) is an infectious disease caused by Hepatitis A virus (HAV). The disease
is heralded by fever, chills, headache, fatigue, generalized weakness, aches and pains
followed by anorexia, nausea, vomiting, dark urine and jaundice. The disease is benign
with complete recovery in few weeks.
Hepatitis A is endemic in most developing countries, with frequent outbursts of major and
minor outbreaks. The exact incidence of Hepatitis A in India is difficult to estimate,
however it has been estimated that approximately 4 million people in India suffer every
year from one or the other form of acute hepatitis. In children 50% of acute hepatitis are
due to HAV.
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| About
the virus |
HAV is an enterovirus and multiples exclusively in
the liver cells. It is fairly resistant to heat and chemicals and can survive upto 10
weeks in well water. It withstands heating upto 60 degree C for 1 hour and is not affected
by the usual dose of chlorination. The virus is inactivated by Ultra-Violet (UV) rays or boiling for 5
minutes. Man is the only reservoir of infection. Stools are the infective material, and
virus is excreted in the stools from 2 weeks before to one week after the development of
jaundice.
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| Modes of
transmission: |
- Fecal-oral: This is the major route of transmission. It may occur by direct (person to
person) contact or indirectly by way of contaminated water, food or milk. Direct contact
occurs readily under conditions of poor sanitation or overcrowding.
- Rarely hepatitis A may be transmitted by parenteral route i.e. through blood or blood
products or by contaminated needle pricks.
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| Clinical picture: |
Infection with HAV is more common among children
although it can affect people of all ages. In young children, infection tends to be mild
or subclinical; the clinical severity increases with age. In India by the age of 10 years,
90% of the population has evidence of past exposure to HAV.
The symptoms of acute hepatitis include anorexia, nausea, vomiting, fatigue, joint pains,
and muscle pains, headache and sometimes cough and pharyngitis. Within 1 to 2 weeks there
is development of jaundice. Low-grade fever may be present. Dark urine and clay colored
stools may occur 1 to 5 days prior to onset of jaundice. Patient may experience mild
weight loss and there may be enlargement of the liver. Recovery usually occurs within 2 to
12 weeks.
Immunity after an attack probably lasts for life; second attacks have been reported in
about 5% of patients.
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| Treatment
of acute Hepatitis: |
There is no specific treatment for typical acute
viral hepatitis. Most patients do not require hospitalization, although hospitalization
may be required for the clinically severely ill. Forced and prolonged bed rest is not
essential for full recovery, but many patients feel better with restricted activity. A
high calorie diet is desirable; the major caloric intake is best tolerated in the morning
because many patients may experience nausea late in the day. Physical isolation of
patients is usually not necessary.
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| Prevention
of Hepatitis A: |
- Prevention of transmission: The best method of reducing the spread of infection is by
promoting simple measures of personal and community hygiene, e.g. hand washing before
eating and after using the toilet. Prevention of contamination of water, food and milk by
practicing proper hygiene.
- Vaccines: A reliable vaccine for prevention of Hepatitis A is available.
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