The hepatitis A virus is one of the most frequent causes of foodborne infection. The disease is closely associated with the lack of pure drinking water, poor sanitation and poor personal hygiene. Regions with high social inequity and poverty burden, where adequate hand washing was not performed; overcrowding, nutritional deficiencies and school level have been identified as variables with significant causal association.
The distribution is worldwide, and occurs sporadically and epidemically. In developing countries, adults tend to be immune, and epidemics are rare. In places where sanitation is deficient, infection is common and appears at an earlier age.
Improvements in sanitation, personal hygiene and the vaccine against Hepatitis A are the most effective measures to combat the disease. Hepatitis A viruses persist in the environment and can withstand the processes of food production.
It is important to highlight the fact that Argentina, Uruguay, Panama, the United States and some provinces of Canada have introduced the vaccine against the hepatitis A virus in the vaccination schemes.
It should be clarified that there is a high sub-registry of cases; for each case reported, a minimum of four cases not reported is expected. As for the new cases of infection, for each new case 2 to 4 new infections are expected.
How Is Hepatitis A Caused?
Hepatitis A virus is transmitted mainly via the fecal-oral route, that is, when an uninfected person ingests food or water contaminated by the stool of an infected person.
It is usually transmitted by contact from person to person or close family or institutional contacts, where children and young people have an important role in the dissemination; it is also transmitted through a common source by ingestion of water or any contaminated food.
Having suffered from Hepatitis A becomes cause of exclusion to be considered as a donor of blood and organs, which is an additional loss for society.
Infection with the hepatitis A virus has an incubation period of 15 to 50 days (average 30 days), a relatively long period, which makes control measures very difficult. In general, the onset of symptoms is acute and clinically the disease is usually divided into two periods:
Pre-icteric phase: it is characterized by a fever of 38 – 40.5º Celsius; in children it is moderate and often absent, but in adolescents and adults it can last up to five days. The fever may be accompanied by headache, asthenia (weakness), vomiting, abdominal pain and eventually diarrhea. In children, the symptomatology in this phase is less intense.
Icteric phase: Jaundice occurs (yellowish color of skin and mucous), the fever recedes and there may be coluria (urine of intense color) and acolia (white fecal matter). In adolescents and adults the symptoms of the pre-icteric phase, especially vomiting, are exacerbated.
There is no specific treatment for hepatitis A and its management is ambulatory support. The patient is recommended to be at rest during the acute phase of the disease, since inflammation of the liver can increase the severity of the disease. People with acute hepatitis should avoid alcohol and any substance that is toxic to the liver, including acetaminophen.
The hydroelectrolytic and nutritional balance must also be taken into account. Medical management is symptomatic for pain, fever and general discomfort.
Recurrent Hepatitis: occurs in 10% of cases, one to four months after the initial episode, rarely repeated more than once. The disease is completely resolved between 16 and 40 weeks, relapses depend on the immune status of the patient.
Fulminant hepatitis: The frequency described is 0.3 to 0.4%; the risk factor is the presence of hepatitis A at older ages.
The complications of fulminating hepatitis are cerebral edema, sepsis, gastrointestinal bleeding and hypoglycemia.
Hepatitis A virus can also spread through contaminated objects if they come into contact with the mouth. Another way of transmitting the disease is by ingesting contaminated food and water.
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