Hepatitis A

It is an acute viral illness.
Stages of Hepatitis A:
a) incubation;
b) prodromal or pre-jaundice – with an average duration of 7 days, characterized
by malaise, headache, low fever, anorexia, weakness, intense fatigue,
arthralgia, nausea, vomiting, abdominal discomfort in the hypochondrium region
right, aversion to certain foods and cigarette smoke;
c) jaundice – with varying intensity and duration usually 4-6 weeks.
It is preceded by two to three days of dark urine. There may hipocholia fecal
pruritus, hepatomegaly or hepatosplenomegaly. Fever, arthralgia and headache will
disappearing at this stage;
d) convalescence – return a sense of well-being, gradually
jaundice subsides, faeces and urine returned to normal color.
Etiologic agent: Hepatitis A virus (HAV). It is an RNA virus, family Picornaviridae.
Reservoir: The man. Also primates such as chimpanzees and marmosets.
Mode of transmission: Fecal-oral, waterborne, person to person (contact intrafamilial and institutional), water and contaminated food and inanimate objects. Transmission of the virus is facilitated because it stable in the environment and each infected individual releases large quantities of virus in feces. Percutaneous transmission (inoculation injury) and parenteral (transfusion) are very rare due to the short period of viremia
-People who have had hepatitis A have immunity to this type of injury, but remain susceptible to other hepatitis.
Incubation period: From 15 to 45 days, averaging 30 days.
Period of communicability: From two weeks before the onset of symptoms until the end of the second week of illness.
-Prolonged or recurrent forms are rare and characterized by maintaining high levels of transaminases in for months or even a year.
-A fulminant form presents high mortality (above 80%).
-It occurs massive or submassive necrosis of the liver, leading to acute liver failure rapidly (10 to 30 days). 2
-A toxemia, drowsiness and mental confusion (hepatic coma) may be accompanied by hemorrhagic manifestations. Sepsis is rare.
-There is no specific treatment for the acute form.
-If necessary, only symptomatic for nausea, vomiting and rash.
-As a general rule, we recommend relative rest until practically the normalization of aminotransferases.
Diet-low in fat and high in carbohydrates is in popular use, but its greatest benefit is to be more pleasant for the patient anorexic.
-As a practical matter, be advised that the patient set its own diet according to your appetite and food intake.
-The only restriction is related to alcohol intake, which should be suspended for at least six months and preferably for a year.
Medicines should not be administered without medical recommendation that does not worsen hepatic damage.
The drugs considered hepato-associated or not with vitamin complexes, has no therapeutic value.
Epidemiological characteristics:
-Hepatitis A has a worldwide distribution and is presented as sporadic or outbreak.
-You have a higher prevalence in areas with poor sanitation and hygiene.
It’s common in closed institutions.
-In developing countries, most often affects children and young adults, in developed adults.
-The mortality and mortality are low and the latter tends to increase with patient age.
Control Measures
-Control measures include notification of outbreaks and patient care.
-The notification is important to help initiate the investigation of the common sources and transmission control through preventive measures.
-The patient care include the removal of even the normal activities (if child, isolation and remoteness of the nursery, preschool or school) during the first two weeks of disease and maximum hygiene with disinfection of objects, cleaning countertops, floors , etc., using chlorine bleach or
Preventive measures include:
-Education of the population regarding good hygiene practices, with emphasis on hand washing after using the toilet, preparing food, before eating, the sanitary disposal of feces, etc.;
-Measures of sanitation with safe water and sewage guidance of daycare centers, preschools and closed institutions for adoption of strict measures of hygiene with hand washing to make diaper changing, when preparing food and before eating, and disinfection objects, countertops, floors, etc.;
Cooking-suited to seafood, seafood and disinfection (chlorine use) to raw foods.
-A vaccine against hepatitis A is available in the Reference Center for Immunobiology Special (CREATE), indicated for people with chronic liver disease susceptible to hepatitis A, allogeneic transplant recipients, or autologous bone marrow after transplantation in transplant recipients allogeneic or autologous, before collection of candidates to receive autologous bone marrow transplantation and donor allogeneic bone marrow transplantation.