Prevention of Hepatitis A

Hepatitis A is a virus which affects the liver. It is easily transmitted and may cause serious illness, particularly in carriers of hepatitis B or hepatitis C. Vaccination can prevent hepatitis A infection.

Hepatitis A occurs most commonly in:

• people travelling in developing countries,

• men who have sex with men,

• injecting drug users,

• people exposed to infected individuals.

If you are at risk of hepatitis A, you should be familiar with ways of reducing the risk, and vaccination is strongly recommended.

Hepatitis A virus is present in the faeces and blood of infected people and can be passed from person to person by touch. The virus enters the body through the mouth. It can survive on objects touched by infected people. Contaminated water and food (especially shellfish) are a common source of infection.

Those travelling to developing countries (for example in Asia, Africa or South America), or household contacts of people with hepatitis A are at increased risk of acquiring hepatitis A by touching infected people or objects, or ingesting contaminated food or water.

Sexual transmission can also occur — most commonly in men who have sex with men — usually as a result of:

• anal intercourse (Even with a condom. Handling used condoms after intercourse may transmit the infection)

• "rimming" (oral-anal contact).

Injecting drug users are at increased risk of hepatitis A if they have poor personal hygiene, are exposed to infected blood, or contaminated drugs that have been carried in the intestine or rectum.

To reduce the chance of transmission of hepatitis A, avoid exposure to potentially infected faeces.

In sexual contact, especially with a new partner, this means:

• ensure that the anal area is clean,

• wash your hands or any other part of your body that has been in contact with your partner's anus, as soon as possible after contact,

• use a barrier, such as a dental dam, for rimming.

To prevent household contact, always wash your hands thoroughly after going to the toilet and before eating or preparing food.

The other effective way of preventing transmission is vaccination.

Vaccination consists of two injections, six months apart. Vaccination against hepatitis A gives long term (possibly life-long) protection.

The most common side effect of vaccination is mild soreness and swelling at the injection site. Some people develop a headache and feel mildly unwell. These symptoms usually resolve within 24 hours. Less common side effects include fever, nausea and loss of appetite.

Clinic 275 is unable to provide free vaccination against hepatitis A. If you would like to be vaccinated, the doctor can give you a prescription and advise you where to buy obtain the vaccine. The recommended cost as at December 2000 is $70.39 for each dose plus a dispensing fee, which varies from one pharmacy to another. If you have private health insurance, you may be able to claim a rebate for part of this cost. You can return to Clinic 275 to have the vaccine administered without an appointment.

Because the vaccination is expensive, Clinic 275 will test your blood to discover whether you are already immune to hepatitis A before providing a prescription.

Blood tests are used to detect hepatitis A infection.

There are two tests available:

1. Testing for current infection (to find out if an illness or symptom is due to a current case of hepatitis A). A positive test means the person is infected with hepatitis A at the time of testing.

2. Testing for past infection. The result of this test is positive in people who are immune to hepatitis A, either through prior infection or vaccination. Some people are not aware they have had hepatitis A in the past.

Clinic 275 offers testing to people at higher risk (mostly men who have sex with men, injecting drug users or people who are carriers of hepatitis B, hepatitis C or HIV) to see if they are immune to hepatitis A. People who are not immune will be offered a prescription for vaccination.

Symptoms usually develop about four weeks after exposure to the virus. The most obvious symptom is jaundice (yellowing of the skin and eyes). Other symptoms may include aches and pains, nausea, loss of appetite, abdominal discomfort and darkening of the urine.

Recovery usually takes a few months, but some people remain unwell for longer than six months. The illness is likely to be more severe, and recovery takes longer, in people who are already carriers of hepatitis B or hepatitis C. Death from hepatitis A is rare, and usually occurs in older people, or those who have pre-existing liver damage.

Once you have recovered from hepatitis A, you have lifelong immunity to the virus, and there is no ongoing risk of liver damage. People with hepatitis A never become long term carriers of the virus — they are only infectious for a short time before and after the symptoms develop.