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Hepatitis A

Hepatitis A is an infection of the liver caused by the hepatitis A virus that can cause severe illness. Hepatitis A occurs worldwide but is most commonly found in parts of Africa, Asia, Central and South America, in areas where there is a lack of safe water, inadequate sanitation and poor personal hygiene. Most cases imported into the UK have been contracted in the Indian sub-continent.

How is it contracted?
The virus is primarily spread when a person ingests food or water that is contaminated with the faeces of an infected person, or through close physical contact with an infectious person.  

Signs and symptoms
The incubation period of hepatitis A is usually 14–28 days [30]. Symptoms range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice. Children usually show less symptoms than adults, and the severity of disease and mortality increases in older age groups. Only 10% of children under 6 develop jaundice, compared to 70% of cases in older children and adults [30].

Recovery from symptoms following infection may be slow and may take several weeks or months. Hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and acute liver failure, which is associated with high mortality. Infection with hepatitis A results in lifelong immunity after recovery.

There is no specific treatment for hepatitis A, and care is supportive including replacement of fluids that are lost from vomiting and diarrhoea.

Recommendations for travellers
Prevention is focused on ensuring that food and water are safe. Good personal hygiene is also very important and individuals should ensure that they wash their hands prior to eating, and after using the bathroom.

Immunisation is recommended if you are visiting areas where drinking water may be unsafe, and where hygiene and sanitation is poor. There are two products for immunisation against hepatitis A. An immunoglobulin provides rapid but temporary immunity. The vaccine confers active immunity but response is not immediate. Vaccines are available as either monovalent, or combined with either typhoid or hepatitis B.

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Vaccination. Here’s the point...

While relatively uncommon in travellers and usually not fatal, recovery from symptoms following infection may be slow and may take several months. Immunisation is highly recommended for travellers visiting high risk areas, which for UK travellers is mainly the Indian subcontinent and the Far East, although the risk extends to Eastern Europe.