Charlotte, NC
Gauri Adhikari, MD
Hepatitis means inflammation of the liver. Although hepatitis can be caused due to heavy alcohol use, drugs, and toxins, it is most commonly caused by a virus. Viral hepatitis is caused by a group of viruses, namely hepatitis A, B, C, D, and E. Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are the most common causes of acute hepatitis worldwide.
Hepatitis A virus commonly spreads through contaminated food and water or direct contact with an infected person. Once inside the body, the virus attacks normal liver cells, causing inflammation and damage. Hepatitis A is generally acute or short-lived, though in rare cases, it can lead to severe infection or liver failure. The virus is highly contagious and can be transmitted in two main ways: person-to-person contact, such as through close physical contact like sexual activities or shared needles, and through the oral-fecal route, usually via contaminated food or water.
Hepatitis E, a member of the Hepeviridae family, spreads primarily through the fecal-oral route and is called enteric hepatitis. The infection usually resolves on its own within two to six weeks.
Like Hepatitis A, Hepatitis E can be contracted by consuming contaminated food or water. Eating undercooked pork or organ meats from infected animals increases your chances of getting the virus from animal sources. Though less common, transmission can occur through blood transfusions, organ transplants from infected donors, or an infected mother to her child.
Here are some groups of people who are at higher risk of getting Hepatitis A or Hepatitis E:
If you travel to countries where these viruses are common, especially in areas with poor sanitation, you are more likely to be exposed and contract any of these viruses.
Living in places without access to clean drinking water or proper waste management makes it easier for these viruses to spread.
Using drugs, whether injected or not, can increase your risk, especially if you’re in environments where hygiene and safety aren’t prioritized.
You are at increased risk of getting Hepatitis A if you are a man who has sex with men.
Living with or caring for someone who has Hepatitis A puts you at higher risk, even before they start showing any symptoms.
People who work with food are more likely to be exposed to Hepatitis A, especially if they come into contact with contaminated sources.
If you’re pregnant, there’s a higher risk of severe complications from Hepatitis E, particularly during the later stages of pregnancy.
Hepatitis A and Hepatitis E mostly present with similar symptoms; sometimes, the disease may develop without noticeable symptoms. The clinical presentation involves two phases: the prodromal phase followed by the icteric phase.
Prodromal phase: This phase lasts 3 to 10 days and is primarily characterized by malaise and myalgia. Other symptoms during this phase may include:
Icteric phase: The next phase is the icteric phase, which may last up to 3 weeks. Symptoms during the icteric phase include:
People who are more likely to experience severe disease from Hepatitis A and E include:
Initial Diagnostic Tests: Both Hepatitis A and E diagnoses involve blood tests to detect specific antibodies produced by your immune system in response to the viruses.
IgM antibodies are the first to emerge in response to Hepatitis A and E infections. They typically appear within the first week after infection, serving as an important marker for the body’s immune response. IgM antibodies indicate an acute infection and confirm recent exposure to either virus, helping healthcare providers diagnose the condition effectively.
IgG antibodies will develop as the infection progresses and your body starts to recover. These antibodies typically appear about 2 to 4 weeks after the onset of symptoms. IgG antibodies indicate that you have had a past infection or have developed immunity to the virus. This signifies that you are no longer infectious and have gained a certain level of protection against future infections.
Detection of viral RNA is an important diagnostic tool for both Hepatitis A and E, complementing antibody testing. In Hepatitis A, the presence of Hepatitis A virus RNA can be identified using nucleic acid testing (NAT), which is particularly useful during the early stages of infection, often before antibodies are produced. Similarly, Hepatitis E virus RNA can also be detected through NAT, allowing for early diagnosis of the infection. This detection typically occurs shortly after infection, usually within the first week or two, before the immune response generates significant levels of antibodies. Identifying viral RNA is essential for diagnosing acute infections and can help distinguish Hepatitis A and E from other liver diseases. Viral RNA is used to monitor the viral load in patients, assess the severity of the infection, and guide treatment decisions.
Both hepatitis A and E mostly resolve on their own within 4-8 weeks. Almost all cases of HAV and HEV are self-limiting in immunocompetent patients.
Supportive care rocks here. Both Hepatitis A and E typically require supportive care, as these infections are self-limiting and resolve on their own without specific antiviral medications. Adequate rest is crucial for helping your body recover from the infection. Drinking plenty of fluids can help prevent dehydration. Maintaining good hydration is essential, especially if symptoms like nausea and vomiting occur. You might need over-the-counter medications to alleviate specific symptoms, such as pain relievers for abdominal discomfort or fever reducers.
In most cases, both Hepatitis A and E do not lead to chronic infection, and patients can expect a full recovery. However, monitoring may be necessary for those with pre-existing liver conditions or weakened immune systems to manage any complications. Severe cases, including fulminant hepatitis, require hospitalization. Antiviral drugs like ribavirin and interferon may also be used in cases of chronic hepatitis E. Although very rare, more serious cases may also require liver transplantation.
Complications from hepatitis A and E are uncommon. Certain populations, such as individuals with pre-existing liver diseases like chronic hepatitis B or C, pregnant women, and those with weakened immune systems, are at higher risk for severe complications from Hepatitis A and E. Some of the possible complications include:
While most individuals recover fully, some people may experience prolonged symptoms such as fatigue, weakness, and jaundice that can last for weeks or even months after the initial infection. This post-viral fatigue can significantly impact daily life and requires time for recovery.
Although chronic infection is rare for both Hepatitis A and E, individuals with existing liver problems may experience worsening of their condition. This can lead to complications like cirrhosis or liver cancer over time.
In rare cases, both Hepatitis A and E can lead to acute liver failure, a severe condition where the liver suddenly loses its ability to function. This can result in symptoms such as jaundice, confusion, and bleeding tendencies. Acute liver failure requires immediate medical attention and often leads to hospitalization.
Pregnancy poses unique risks when it comes to Hepatitis E, as infected pregnant women are at a significantly higher risk of developing severe complications, including acute liver failure. This increased susceptibility is particularly concerning during the third trimester, with the greatest likelihood of severe outcomes. Infections during pregnancy can lead to adverse effects for both the mother and the fetus, including the risk of stillbirth, premature delivery, and maternal mortality. The transmission of the virus from the mother to the fetus can also occur, potentially resulting in neonatal infection.
Both Hepatitis A and E are transmitted through the fecal-oral route, making good hygiene practices crucial. Regular handwashing with soap and water, especially after using the bathroom and before preparing or consuming food, can significantly reduce the risk of infection.
Ensuring access to clean and safe drinking water is essential for preventing both Hepatitis A and E. Avoiding tap water in areas where the virus is common, drinking bottled or boiled water, and being cautious about ice made from unpurified water can help prevent infection. When eating, especially in areas where the viruses are endemic, opt for well-cooked foods and avoid raw or undercooked shellfish, fruits, and vegetables that cannot be peeled.
If you’re traveling to regions where Hepatitis A or E is common, take precautions by getting vaccinated ahead of time, practicing good hygiene, and being mindful of food and water safety. This is particularly important in developing countries where sanitation may be inadequate.
Reducing high-risk behaviors, such as sharing needles or engaging in unprotected sex with multiple partners, can help prevent Hepatitis A transmission, especially among men who have sex with men. Although Hepatitis E is less commonly transmitted through person-to-person contact, maintaining general safe practices is still advisable.
The most effective way to prevent Hepatitis A is through vaccination. The Hepatitis A vaccine is safe and effective and is recommended for all children aged 12-23 months. It is also recommended for individuals at higher risk, such as travelers to endemic areas, people with chronic liver diseases, and men who have sex with men. Although there is currently no vaccine for Hepatitis E, awareness of its prevention strategies remains important.
In the US, there are now two registered single-antigen vaccinations. One year or older is the recommended age for the first dose of all inactivated hepatitis A vaccinations, authorized for intramuscular injection into the deltoid muscle in a two-dose regimen.
A 6-to-18-month delay between dosages one and two is normally recommended, although this can be extended to 4 or 5 years. Over-18-year-olds can receive the combination vaccine containing both HAV and HBV antigens. Three doses are given during primary immunizations in the first, first, and sixth months. Common side effects of the vaccine include fever, headache, tiredness, and soreness at the injection site.
