Dr. Betsy: How we get, treat Hepatitis A
As I was celebrating Halloween this year, I noted that Oct. 31 was also the 500th anniversary of the Reformation, the day that Martin Luther split with the Catholic Church and Protestantism was born.
As a lifelong Lutheran, I raised a fun-sized Almond Joy in Martin Luther’s honor and reflected on some of his specific teachings in honor of my late mother. When I got a little fuzzy on a few of the details of his 95 Theses, I figured Mom wouldn’t mind if I googled a few of them to refresh my memory.
Mom was always quick to embrace new technology. Except the microwave oven. It took her a long time to trust the microwave.
While I was reading, I stumbled upon a fact I had never learned in church. Prior to the Reformation, the Catholic Church was responsible for the majority of beer production, but thanks to Luther, a beer drinker himself, the Protestants began adding hops to beer as an act of rebellion. I’m not a beer person, more of a fan of fruity umbrella drinks personally, but this is evidently a tasty improvement that has lasted 500 years. While he liked his beer, Luther did speak about the problems of excessive drinking as well. Today we know that too much beer is not good for your liver, and there are diseases that are not good for your liver either, such as hepatitis.
Hepatitis is a general term that means inflammation of the liver. There are several potential causes, ranging from infections to toxic substances (drugs, alcohol) to autoimmune diseases. Hepatitis is most often caused by a virus, and there is an alphabet soup of viral choices, including Hepatitis A, B and C and beyond. Each virus is slightly different in transmission and clinical course although they do share some similarities.
Hepatitis A, while not the most common of the hepatitis viruses, has been the one making all the news headlines lately. Caused by the Hepatitis A virus (HAV), it is typically transmitted person-to-person through the fecal-oral route. This sounds disgusting, because, of course, it is disgusting. Essentially, the virus can be passed on if someone does not wash his hands properly after using the toilet or changing a diaper or flinging poo at a wall (hopefully this applies to the toddler crowd only) and touches objects or food.
Food can become contaminated during any point in the growing or handling process and can transmit the virus as well. Contaminated water is another source of Hepatitis A, particularly in countries where the virus is commonly found.
While older children and adults usually develop symptoms about 2 to 6 weeks after infection with the Hepatitis A virus, over two-thirds of children under the age of six years old remain asymptomatic and many have mild symptoms only. Initial symptoms are often general and resemble the flu, with fatigue, nausea, vomiting, fever, abdominal pain, decreased appetite, clay-colored stools, joint pain and decreased appetite. Jaundice is seen frequently in affected adults and older children but not in younger children.
Since Hepatitis A is a self-limited disease, there is no specific treatment other than rest, adequate nutrition, fluids, observation and time. Most people infected with the virus feel sick for a few weeks to a few months, with no long-lasting liver damage and recover on their own. However, outbreaks recently in California (the largest U.S. outbreak to date) and Michigan have resulted in increased numbers of hospitalized patients and multiple deaths.
The best way to prevent Hepatitis A is by getting vaccinated. Complete protection requires two shots, given six months apart, and has been shown to be both very safe and highly effective. The hepatitis A vaccine was introduced in 1995 and became a recommended part of childhood immunization schedules in 2006. Many states, including Indiana, require the vaccine prior to enrollment in school and/or childcare programs.
In addition to all children over the age of one, the vaccine is recommended for adults who travel to areas of the world where hepatitis A is common, families of adopted children from certain countries, people with chronic liver disease and a few other high-risk groups. It has been proposed that starting with the 2018-19 school year, Indiana high school seniors will be required to have the Hepatitis A vaccine as well, so don’t wait until the next outbreak of bad tacos to get your child’s immunizations up to date.
Dr. Betsy Neahring practiced pediatrics in Evansville for 10 years before (mostly) retiring to become 'Daniel's Mom.' Write her at firstname.lastname@example.org.