HEPATITIS A

From person to person

Hepatitis A viruses are excreted by infected persons (even before the onset of symptoms) in their stools. Transmission from one person to another is possible if they are in close contact, for example in a shared household or childcare facilities. In such cases, the pathogens are spread by smear infection through tiny traces of feces on hands or objects and are absorbed through the mouth.

Infection can also occur through sexual contact, usually in oral-anal practices or when fingers come into contact first with the anus and then with the mouth.

Transmission through blood and blood products is also possible.

Through food and water

Hepatitis A viruses are often transmitted by eating contaminated food. For example, salads and vegetables fertilized with feces, or seafood such as mussels or oysters may be contaminated with pathogens. Pathogens can also get into food through unwashed hands, for example during preparation.

In recent years, food imported into Germany, which is produced in areas where hepatitis A is widespread, has been increasingly identified as a trigger for increased hepatitis A diseases. Examples include frozen berries and smoothies, cakes or desserts made from them, as well as dried dates and tomatoes.

Contaminated drinking or bathing water can also be a source of infection.

Anybody who has not yet been infected or people who are not sufficiently protected by a full vaccination can contract hepatitis A. The risk of a hepatitis infection is particularly high amongst the following groups of people:

• Travelers staying in regions where hepatitis A is widespread,
• People in close contact with hepatitis A sufferers.

Older people and those with pre-existing liver conditions are at higher risk of contracting a severe case of the disease.

• There is no specific treatment for hepatitis A. It is only possible to alleviate symptoms such as vomiting or flu-like symptoms.
• In the acute phase of the illness, you should avoid physical exercise wherever possible. Depending on the severity of the symptoms, staying in bed may be useful.
• In the early stages of the illness, you should eat high-carb and low-fat foods.
• It is particularly important to avoid alcohol.
• Avoid taking any medicines that could place a strain on your liver unless advised to do so by a doctor.
• Wash your hands thoroughly on a regular basis, especially after going to the toilet, before preparing food and before eating. After washing, dry your hands with your own personal towel or disposable paper towels.
• If possible, use your own toilet.
• Keep as far away as possible from other people for up to two weeks after the first symptoms appear or for up to one week after the onset of jaundice.
• Do not prepare meals for others if you are infected yourself.
• The provisions of the German Protection against Infection Act apply for hepatitis A. People suffering from or thought to be suffering from hepatitis A must not visit or work in community institutions such as schools or nurseries. This also applies to anyone living in shared accommodation in which there is an actual or suspected case. Affected persons must inform the community facility of the infection. The doctor treating you or the responsible health authority will decide when you can return to work or resume visits to community institutions.
• Anybody who comes into contact with certain foods as part of their job within the scope of section 42 of the German Protection against Infection Act and who is ill with or suspected of having hepatitis A has to temporarily stop work. The exact time from which you are allowed to work is determined by the responsible health authority.

Vaccination

Vaccinations against hepatitis A are available. Primary immunisation consists of two doses of a hepatitis A vaccine administered at an interval of 6 to 12 months. A single dose of vaccine provides comprehensive protection for 6 to 12 months. Combination vaccines with hepatitis B are also available, for which different vaccination schemes are possible.

The Standing Committee on Vaccination (STIKO) recommends vaccination for people at risk, in particular for:

• People at a high risk of infection due to their sexual behavior (for example, men who have sex with other men),
• People suffering from liver disease or diseases that affect the liver,
• People who receive frequent transfusions of blood components (for example, in the case of haemophilia),
• Drug users who use syringes,
• People undergoing treatment in psychiatric or similar care facilities,
• People at a greater risk of infection as a result of their work or voluntary activities (for example, healthcare professionals, employees in community institutions and those in contact with wastewater, for example in sewage treatment facilities and wastewater treatment plants),
• Travelers in regions where hepatitis A is widespread.

A hepatitis A vaccine can effectively prevent disease if given early after exposure to the virus.

People in contact with hepatitis A sufferers who are not yet protected by a hepatitis A vaccine and have not had a hepatitis A infection should be vaccinated as early as possible within the next 14 days. People at particular risk can also be passively immunized (administration of antibodies).

People at particular risk can also be passively immunized (administration of antibodies).

Hygiene

Observe strict hygiene measures if you come into contact with sufferers:

• Wash your hands thoroughly on a regular basis.
• If caring for an infected person, you should wear disposable gloves.
• Pay attention to cleanliness, especially in the toilet area and kitchen.
• It may be wise to use special “virucidal” disinfectants, as long as they are recommended by your health authority or doctor.

When traveling in areas in which hepatitis A is widespread, you should observe thorough hand and sanitary hygiene and ensure good food hygiene:

• Drink bottled or boiled water.
• Eat only food that has been cooked thoroughly wherever possible.
• Raw fruits and vegetables should be freshly peeled.
• Avoid raw salads and juices.

Your health authority can provide you with further advice and information. Since hepatitis A must be reported to the health authority, they will also have the latest information and be very experienced in dealing with the disease.

More (specialist) information is available online from the Robert Koch Institute (www.rki.de/hav). Travelers should also pay attention to the advice of the Federal Foreign Office (www.auswaertiges-amt.de).

Further information on infection control through hygiene can be found on the website of the Federal Centre for Health Education (BZgA) (www.infektionsschutz.de).