Hepatitis A has been in the news recently.
This is an inflammatory disease of the liver that is caused by a virus. It is the most common vaccine-preventable illness that people get infected with when traveling.
Hepatitis A is certainly more common in countries with lower standards of sanitation, but this virus doesn’t care about borders. Even if you aren’t going anywhere, everyone over a year old should get the shot.
As the recent finding of contaminated strawberries illustrates, there are plenty of cases right here in this country.
There are several types of Hepatitis. The ones most of you have heard of are A, B, and C. There are big differences in how you get them, how long they last and how sick you can get.
Hepatitis A is usually not chronic like the other forms.
Transmission of Hepatitis A occurs through:
- Close direct person-to-person contact
- fecal-oral transmission (touching a contaminated surface and then putting your hand in your mouth)
- contaminated shellfish
- water (Hepatitis A can only be removed from drinking water by boiling or chemicals. Filters aren’t effective because the viral particles aretoo small)
- Raw food (including fruit and vegetables..organic doesn’t make a difference, alas)
- Any contaminated food (Cooking foods at 185 degrees F for at least one minute will kill the virus, but cooked food can still spread the disease if contamination happens after cooking) It is essential for anyone who is preparing food to thoroughly wash their hands.
- Ice cubes
I actually have a funny story about ice cubes. Sandy and I were in Cambodia several years ago. We had been scrupulously careful about where and what we ate. But there we were in a lovely bar on Pub street in Siem Reap. We ordered some drinks. They came with ice and we each took a sip before I put my glass down, “Oops, ice cubes are off limits' ' Here is the difference between us, I opted out. Sandy just decided to drink it quickly before the ice could melt.
Hepatitis A is hardy and can live outside the body for quite a while. It is important to note that it can survive being frozen. If you are in the habit of freezing berries and have some of the tainted ones in your freezer, get rid of them!
This is a nasty virus. Hand washing is important and can stop you from spreading it, but won't necessarily protect you from catching it. Poor hand washing, and then handling food, is a common mode of transmission, but so is changing a diaper. Thus diaper age children, infected with the virus, are a large reservoir for spreading it.
The incubation period averages 28 days (range 15–50 days). People are most infectious 1–2 weeks before the onset of clinical signs and symptoms, and can shed the virus in the stool for months and months.
Infection can be asymptomatic or range in severity from a mild illness lasting 1–2 weeks to a severely disabling disease lasting several months. Most common symptoms include:
- abrupt onset of fever,
- Malaise (you feel tired and generally crappy)
- poor appetite,
- nausea, and abdominal discomfort
- Joint pain
- Dark colored urine
- stool is often clay colored or freakishly light.
A few days after the first symptoms show up, many patients end up with jaundice (yellow skin and eyes). Although it is rarely fatal, adults with this can become very SICK!
The likelihood of having symptoms with a Hep-A infection is often related to the age of the infected person.
It is worth emphasizing: In children aged <6 years, most (70%) infections are asymptomatic.
Unless there was a known exposure, in an adult patient, jaundice is often the biggest clue that will lead a doctor to suspect Hepatitis. As I noted earlier, most of the time, young children don’t usually exhibit many symptoms at all. In the young children who are actually acting ill, jaundice is not a common symptom, so it might be a while until someone figures out what’s going on.
Unvaccinated caregivers are the ones who get walloped. I have seen it sweep through a daycare.
Here’s the thing. If you are vaccinated, you don’t need to worry! The shot is nearly 100% effective. It is also very safe.
The vaccination first became available in Europe back in 1993 and started getting phased into our vaccine schedule in 1996. It has been a routine childhood vaccine in the United States since 2005. Interestingly, although it is recommended, it is not one of the vaccines that are required for school entry.
It can be given as soon as a child reaches their first birthday and should be followed by a booster six to twelve months later.
If you are traveling, be aware that the protection isn’t instant. Protection against hepatitis A begins approximately two to four weeks after the initial vaccination. The recommendation for travelers is to get it at least 2 weeks before your trip, so plan accordingly.
The vaccine comes only in preservative free form (no thimerosal concerns). I rarely see any side effects at all. Once in a while a baby post vaccine might be extra fussy, but that is rare and not necessarily shot related.
This one requires little thought. You should make sure that Hepatitis A vaccine is included in your child’s immunization schedule. Parents, also please check your own health records and make sure that you are protected. Adults are often quite clueless about their own vaccination status!
If your child is between 6 months and a year you can get the shot early if you are traveling to a high risk area. This early dose won’t count towards the routine 2 dose series. High risk travel zones include everywhere except Canada, western Europe and Scandinavia, Japan, New Zealand, and Australia.
If you are interested in resources that will alert you to outbreaks and recalls:
This one has all sorts of education and activities for teaching your kids about safe food handling
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