Hepatitis A Virus

Hepatitis A (HAV) is caused by an RNA virus of the enterovirus family. This form of hepatitis is transmitted primarily through the fecal-oral route, by the ingestion of food or liquids infected by the virus. The virus is found in the stool of infected patients before the onset of symptoms and during the first few days of illness. The incubation period is estimated to be 2 to 6 weeks, with a mean of approximately 4 weeks. The course of illness may last 4 to 8 weeks. The virus is present only briefly in the serum; by the time jaundice appears, the patient is likely to be noninfectious. A person who is immune to hepatitis A may contract other forms of hepatitis. Recovery from hepatitis A is usual; it rarely progresses to acute liver necrosis and fulminant hepatitis. No carrier state exists, and no chronic hepatitis is associated with hepatitis A.

• Many patients are anicteric (without jaundice) and symptomless.
• When symptoms appear, they are those of a mild, flulike, upper respiratory infection with low-grade fever.
• Anorexia is an early symptom and is often severe.
• Later, jaundice and dark urine may be apparent.
• Indigestion is present in varying degrees, marked by vague epigastric distress, nausea, heartburn, and flatulence.
• Liver and spleen are often moderately enlarged for a few days after onset.
• Patient may have a strong aversion to cigarette smoke and strong odors; symptoms tend to clear when jaundice reaches its peak.
• Symptoms may be mild in children; in adults, they may be more severe and the course of the disease prolonged.

• Stool analysis for hepatitis A antigen
• Serum hepatitis A virus antibodies; immunoglobulin

• Encourage a nutritious diet, as well as bed rest during the acute stage.
• Provide small, frequent feedings supplemented by IV glucose if necessary during period of anorexia.
• Promote gradual but progressive ambulation to hasten recovery. Patient is usually managed at home unless symptoms are severe.
• Assist patient and family to cope with temporary disability and fatigue, both common problems associated with hepatitis.
• Educate patient and family about seeking additional health care if the symptoms persist or worsen.
• Instruct patient and family regarding diet, rest, follow-up blood work, avoidance of alcohol, and sanitation and hygiene measures (hand washing) to prevent spread of disease.
• Educate patient and family about reducing risk for contracting hepatitis A: good personal hygiene with careful hand washing; environmental sanitation with safe food and water supply and sewage disposal.