Hepatitis A: Symptoms, Diagnosis, Therapy

Hepatitis A (synonyms: epidemic jaundice; HA virus infection; HAV; hepatitis A (hepatitis epidemica); hepatitis epidemica; viral hepatitis A; infectious hepatitis A; ICD-10-GM B15.-: Acute viral hepatitis A) is an inflammation of the liver transmitted by the hepatitis A virus. The hepatitis A virus is considered the most common trigger for acute hepatitis in Germany.

The hepatitis A virus belongs to the Picornaviridae family, genus Hepatovirus.

The pathogen is very resistant to temperature and drought. It can survive indefinitely in cold conditions and remains infective for 3 months in seawater and about 1 month in dry conditions. It is equally resistant to normal soaps.

Humans are currently the only relevant reservoir of the pathogen.

Occurrence: The virus is distributed worldwide. In developing countries, almost all people contract hepatitis A in childhood due to poor hygienic conditions. In Germany, hepatitis A occurs less frequently. 50% of cases are due to infection during travel to high-prevalence countries.The infection occurs in Southeast Asia, Russia, the Middle East, the Mediterranean region, Africa, and Central and South America.

Contagiousness (infectiousness or transmissibility of the pathogen) is medium.

Seasonal accumulation of the disease: Hepatitis A occurs more frequently between September and November.

Transmission of the pathogen (route of infection) occurs by contact or smear infection (fecal-oral: infections in which pathogens excreted with feces (fecal) are ingested by mouth (oral), e.g., through contaminated drinking water and/or contaminated foods such as raw seafood, vegetables and salads fertilized with feces). Parenteral infections through contaminated injection needles (intravenous drug abusers) or through anal-oral contacts are very rare.

The incubation period (time from infection to onset of disease) is 15-50 days (usually 25-30 days).

The incidence (frequency of new cases) is about 1 case per 100,000 inhabitants per year (in Germany).

The duration of infectivity (contagiousness) is 2 weeks before to 2 weeks after the onset of the disease or 1 week after the appearance of jaundice. The disease leaves a lifelong immunity.

Course and prognosis: Hepatitis A is asymptomatic (“without symptoms”) in 25% of cases, symptomatic in 74.8%, and fulminant (sudden, rapid, and severe) in 0.2%. It is never chronic and always resolves without sequelae (within 4 to 8 weeks). An icteric course (yellowing of the skin) occurs in 10% of children < 6 years of age, in about 45% of children 6-14 years of age, and in about 75% of ill adults. Hepatitis A leads to spontaneous (“on its own”) cure in 100% of cases.

The lethality (mortality in relation to the total number of patients with the disease) is 3 % in patients > 50 years of age.

Vaccination: A vaccination against hepatitis A (active immunization) is available. Vaccination is recommended especially when traveling to high-risk areas. Also employees of the food industry and catering, in nursing professions, of facilities for sewage disposal, educators as well as medical personnel have a higher risk of infection and should be vaccinated. An anti-HAV immunoglobulin is available for hepatitis A postexposure prophylaxis (passive immunization; to prevent disease in persons who are not protected against hepatitis A by vaccination but have been exposed to it).

In Germany, the disease is notifiable according to the Infection Protection Act (IfSG). Notification must be made by name in cases of suspected illness, illness, and death.