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Is Hepatitis A and E Contagious?

Viral hepatitis is a frequent disease and its main cause is infection for the hepatitis A virus (HAV). It is common that the infection by this virus in children goes unnoticed and is not diagnosed, but in adults it can manifest clinically, often with jaundice (yellowish coloration of skin and mucous membranes), and reach an acute liver failure as a result of a severe hepatitis A. Hepatitis A is not associated with chronic liver disease and chronic carrier status is not present, as the case with other hepatitis viruses. No specific treatment against the virus is available.

Hepatitis A is one of the leading causes of jaundice in the world. Approximately 1.4 million annual cases of hepatitis A are estimated worldwide. The virus is transmitted by fecal-oral route when water or food contaminated with the fecal matter of an infected person is ingested; however, although scarce, cases of infection by sexual contact and through infected blood have also been reported. Worldwide hepatitis A is presented as epidemics that recur in a cyclical way. The disease is associated with poor hygiene conditions and has a close relationship with developing countries. It especially commits the children of these regions, susceptible adults, particularly those from developed countries who travel to endemic areas, and young adults from developing countries who do not have antibodies against the hepatitis A virus.

The disease has an incubation period ranging from 15 to 50 days, and at higher dose of virus, there is a shorter incubation time. Studies have shown that the hepatitis A virus is excreted in fecal matter for two weeks before jaundice appears. The prolonged excretion of the virus in fecal matter is responsible for the spread of the virus and outbreaks of hepatitis A, particularly in homes, in international travelers, in those who practice oral-anal sex, those who use parenteral drugs, and children and staff linked to child care centers; however, in almost 60% of hepatitis A cases the source of infection is unknown.

Hepatitis E

Hepatitis E is a viral infection of intestinal transmission (medically termed “enteric”), through waters contaminated by infected fecal remains. It’s clinical characteristics are those of acute hepatitis.

It’s transmission mechanism is very similar to that of hepatitis A and, like this one, hepatitis E does not become chronic. The virus reaches the liver through still unknown mechanisms and, replicating in this organ, it accumulates in the bile, from where it reaches the intestine through the bile duct, later; it is excreted in the feces. Although the disease usually presents a low mortality (0.2-0.3%), it can become extremely serious in pregnant women, in which the original frequency is a fulminant liver failure with mortality rates between 20 to 30%. On the other hand, in patients with chronic liver diseases, infection with HEV can trigger a severe hepatic decompensation.

The infection is transmitted mainly via “fecal-oral” through contaminated water and manifests itself in the form of isolated cases and epidemic outbreaks, especially in areas with inadequate sanitary conditions. HEV is endemic in many regions of Asia, the Middle East, North Africa and Central America. The optimal circumstances for the occurrence of epidemics of hepatitis E occur when the waste water is not connected in contact with drinking water during the periods of heavy rains, floods, monsoons, etc. Washing, watering and preparing the food with water contaminated with HEV can lead to outbreaks of hepatitis E, especially if the food is consumed without cooking or if the handlers of this are infected with the virus.

In addition, in areas considered as non-endemic, more and more autochthonous cases are found that are not related to trips to endemic areas.

Conclusion

Both Hepatitis A and E are very contagious, for that reason it is important to prevent this infectious disease, which can be passive or active. Passive immunization with hyperimmune gamma globulin is indicated in case of outbreaks of acute infection as observed in closed communities. The different types of vaccines for active immunization are indicated in travelers from developed countries who plan to travel to areas of high epidemiological risk.

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Is Hepatitis A and E Contagious?