SYNOPSIS of "Hepatitis A", by Samuel Mattheny MD in AFP

This is a review of the article " Hepatitis A, SAMUEL C. MATHENY, MD, MPH, and JOE E. KINGERY, DO, University of Kentucky College of Medicine, Lexington, Kentucky"

Am Fam Physician. 2012 Dec 1;86(11):1027-1034.

     Hepatitis A is an RNA virus, specifically the picornavirus. It is transmitted through the fecal-oral route. It is spread through contaminated water, in day care centers, on raw vegetables, and through "sexual contact that promotes fecal-oral transmission".  The incubation period is about 28 days, at which time onset is abrupt. Signs and symptoms include jaundice, nausea, vomiting, diarrhea, dark urine, fever,  hepato/splenomegaly, headache, and abdominal pain.
     Laboratory tests will show elevated serum transaminase, bilirubin (total and direct) AP, ALT and AST (ALT will be higher). Diagnosis can be made through detection of IgM anti-HAV antibodies. It will become positive within 5-10 days, but will no longer be detectable after 4-6 months. IgG anti-HAV will increase at this time. The virus is shed in the stool during the time after the increase in ALT and before Igm is detectable (pearl or the day!)
     Hepatitis A is self limiting. There is a small chance of relapse, but it wont become chronic. Treatment consists of bed rest, not going to school or work until the fever and jaundice has resolved and avoiding alcohol.
     All children should be immunized between 1 and 2 years old. Immunoglobulin can be used as pre or post-exposure prophylaxis.  High risk populations (illicit drug users, men who have sex with men, health care workers, those with adopted children from endemic areas, with liver disease or clotting factor disorders) should also be vaccinated. Vaccination should be given to travelers going to countries other than Australia, New Zealand, Canada, Europe, or Japan at least 2 weeks prior. If the patient is over 40 years old, immunocompromised, or is leaving before 2 weeks, you can also give immunoglobulin. If the patient does not want the vaccine,  you can give them the Ig, but you would triple the dose to 0.06mL/Kg if they are going to travel for more than two months.
    For post exposure prophylaxis, you can give the patient the vaccine (or Ig) within two weeks of exposure.