Hepatitis A

and Carola Felchner, science journalist

Dr. med. Mira Seidel is a freelance writer for the medical team.

More about the experts

Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

Hepatitis A is an acute inflammation of the liver caused by hepatitis A viruses. The pathogens are usually transmitted via contaminated water and contaminated food. Most patients can cure themselves at home if they are adequately cared for there. After surviving an infection, you are immune to hepatitis A viruses for life. Read more here about symptoms and treatment of the disease and in which cases a hepatitis A vaccination is advisable!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. B18B15

Hepatitis A: description

Hepatitis A is an acute form of inflammation of the liver, often referred to as travel hepatitis. This is because 40 to 50 percent of all those affected get the infection while traveling to countries with poor hygienic conditions. These include mainly subtropical and tropical regions such as South and Southeast Europe, Africa, Asia and South and Central America. Infection occurs mainly through contaminated water (including ice cubes) and contaminated food.

Around twenty percent of all hepatitis cases are due to an infection with the hepatitis A virus. These are so-called ribonucleic acid viruses (RNA viruses). They belong to the family of the non-enveloped, very resistant Picornaviridae - they are not affected by environmental influences.

For example, the hepatitis A virus can withstand disinfectants with 70 percent alcohol and mild soaps without any problems. The pathogen also doesn't mind heat up to a maximum of 85 ° Celsius or cold down to minus 15 ° Celsius. On top of that, the hepatitis A virus is very variable. Therefore, with small changes, it can easily escape the protective mechanisms of the human immune system.

Caution: The hepatitis A virus can also remain infectious on the hands for a few hours.

Hepatitis A: symptoms

In children in particular, hepatitis A infections are usually symptom-free. The disease is then usually not noticed at all and heals by itself. Experts suspect that around 30 percent of adults in western industrialized countries are immune to hepatitis A because they had an asymptomatic infection, i.e. an infection without symptoms, in childhood.

Hepatitis A infection is generally more severe in adults than in children. Very severe courses with acute liver failure or severely impaired liver function are rare. Such fulminant hepatitis usually affects older patients (from 50 years of age) with previously damaged liver or chronic hepatitis B or C.

Note: Hepatitis A always takes an acute course. Chronic cases are not known.

Initially, the symptoms of hepatitis A are usually unspecific, for example:

• slight rise in temperature to less than 38 ° Celsius
• Loss of appetite
• Nausea and vomiting
• Performance kink
• Pressure pain in the right upper abdomen

Doctors refer to this phase of early symptoms as the so-called prodromal phase. It lasts for about two weeks.

In about a third of patients, the prodromal phase is followed by the so-called icteric phase. The name is derived from the medical term for jaundice (icterus). In those affected, the skin and the white part of the eyes (sclera) turn yellow. This is because the liver damage releases bilirubin (breakdown product of the red blood pigment) and is deposited in the skin and sclera.

In addition, bilirubin is excreted by the kidneys, which makes the urine dark. In addition, intestinal bacteria can break down bilirubin, which discolors the stool (light-colored stool = clay stool).

Many patients also report itching of the skin.

Note: The jaundice phase can last from a few days to several weeks. It is significantly less common in children under the age of six than in adults.

Hepatitis A: transmission

Hepatitis A viruses are mainly transmitted by the fecal-oral route: Infected people largely excrete the virus in their stool, one to two weeks before the first symptoms appear. If patients do not wash their hands thoroughly after defecation, they can transmit the virus to door handles, cutlery or towels, for example. From there they can get on the skin of healthy people and - if they touch the mouth - penetrate the body through the mucous membrane.

Fecal waste can also end up in the groundwater under poor hygienic conditions. This is why hepatitis A is often transmitted via contaminated water (drinking water, ice cubes, bathing water) and contaminated food. This can be, for example, vegetables or fruits that have been poured or washed with the contaminated water. Seafood is also a common source of infection for hepatitis A, especially mussels and oysters.

Occasionally, hepatitis A is transmitted through blood and blood products. In this way, drug addicts can also infect each other if they use syringes (such as needles) together.

Pregnant women who become infected with hepatitis A can also infect their unborn child.

Duration of contagion

Anyone who has been infected with hepatitis A is contagious as long as he or she excretes the pathogen in their stool. The highest risk of infection for healthy people is one to two weeks before the patient shows the first symptoms. During this time, the virus multiplies very strongly in the infected person's body. Infectivity usually ends one to two weeks after the jaundice occurs.

Warning: Infected children excrete the hepatitis A virus in their stool for a much longer period than adults. From the end of the third week of illness, however, even the small patients are generally no longer considered to be contagious.

Hepatitis A: incubation period

The period of time between infection and the appearance of the first symptoms is called the incubation period. In hepatitis A it varies between 15 and 50 days. On average, the first symptoms appear thirty days after infection with the hepatitis A virus.

Hepatitis A: examinations and diagnosis

You cannot diagnose infection with hepatitis A yourself because it does not cause clear symptoms. Nonspecific complaints such as lack of appetite and tiredness as well as yellowing of the skin are clear indications of a liver disease such as hepatitis - especially after a stay in tropical-subtropical countries. Then you should definitely go to the doctor.

A blood test is necessary for a diagnosis of hepatitis A. Elevated liver values ​​such as GOT, GPT, Gamma-GT and AP indicate liver inflammation.

The body also produces specific antibodies against the hepatitis A virus, which can be detected in the blood. The exact nature of the antibodies shows how long ago the infection was. Anti-HAV IgM, for example, indicate a fresh infection - this type of antibody can be detected just two weeks after infection and for about three to four months. Anti-HAV IgG, on the other hand, only appear four to five weeks after infection. So they indicate that there was an infection, but it has already survived. This type of antibody circulates in the blood for life. After an infection, you are therefore immune to renewed infection with the hepatitis A virus.

Note: Anti-HAV-IgG can be detected in the blood even after a hepatitis A vaccination.

In addition to a blood sample, a stool sample from the patient is also examined if hepatitis A is suspected. In the case of an infection, characteristic components of the pathogen can be found in it.

Hepatitis A: treatment

There are no specific drugs for hepatitis A virus. Patients can therefore only be treated symptomatically. In this way, complaints such as nausea or fever can be alleviated with appropriate means if necessary. In addition, patients should take care of themselves physically and only eat light foods. High-carbohydrate, low-fat foods are particularly suitable to relieve the liver.

It is also important not to use alcohol. The luxury food also burdens and damages the liver - as a central metabolic organ, it has to break down alcohol. For the same reason, patients should only take drugs that are strictly necessary.

Hepatitis A therapy can generally be done at home. Up to two weeks after the onset of symptoms or one week after the onset of jaundice, patients should have little or no contact with healthy people. Consistent hand hygiene and a separate toilet for the patient help reduce the risk of infection for family members.

If necessary, relatives can get vaccinated against hepatitis A as a precaution. In certain cases it can be useful to administer finished antibodies against hepatitis A viruses (passive immunization) at the same time.

Reporting requirement

Hepatitis A is notifiable. This means that the attending physician must report all suspected cases and proven illnesses to the responsible health department. Deaths from hepatitis A must also be reported. The health department forwards the data to the Robert Koch Institute, where it is statistically recorded.

Hepatitis A: prognosis

Unlike other hepatitis infections, hepatitis A heals well. There is also no risk of developing chronic hepatitis from it.

After an infection, you are immune for life. Once infected, however, you need patience: it can take a few months for the disease to heal completely.

The disease is seldom severe and, when it is, it was usually promoted by alcohol consumption, previous or medication damage. One possible complication is the hepatic decay coma, which means that the patient loses consciousness in response to the toxic effects of the substances from decaying liver cells. Those affected must be treated as quickly as possible; a liver transplant may be necessary.

The older the patient, the higher the risk of complications. The mortality rate in patients over 50 years of age is around three percent. In general, the mortality rate from hepatitis A is one to two percent.

Hepatitis A: Prevention

In addition to good hygiene (especially when handling food), the best protection against hepatitis A is a vaccination.

A hepatitis A vaccination is possible for children from twelve months. It contains killed hepatitis A viruses (HAV vaccine) and is injected into the muscle. The vaccination is effective after two weeks, so that there is sufficient protection even for short-term trips abroad. After the first vaccination, you should vaccinate a second time every six to twelve months. This is important for a long-term effect.

How long the vaccination protection lasts after two hepatitis A vaccination doses has not yet been conclusively clarified. Studies have shown that no booster vaccination is necessary because almost all vaccinated people are protected from infection for 25 to 40 years, depending on the vaccine used.

Note: There are also vaccines that protect against hepatitis A and hepatitis B viruses at the same time. With such combination vaccines, three doses must be given.

The cost of the hepatitis A vaccination of 40 to 60 euros is sometimes covered by the statutory health insurance. If the vaccination is required for professional reasons, it is usually paid for by the employer. Inquire beforehand at your cash desk and / or company management.

In general, hepatitis A vaccination is recommended for the following groups of people:

• People with sexual behavior that carries a high risk of infection (e.g. with frequently changing sexual partners, homosexuality)
• People with certain medical conditions that are often given blood components (e.g. people with hemophilia)
• People in psychiatric facilities or comparable care facilities
• People with an increased occupational risk of infection in the health service
• Employees in the sewage system
• Food preparation employees
• People who have contact with hepatitis A sufferers, especially in community facilities
• Travelers to endemic areas with a high risk of infection
• People with chronic liver disease

The vaccination against hepatitis A is generally well tolerated. Possible side effects are, for example, tiredness, headache and body aches or redness. They usually disappear again quickly.

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