Hepatitis A: Are you at risk?

An outbreak in Southeast Michigan raises questions about the viral liver disease and the vaccine to prevent it.
Get the facts on hepatitis A. (For Spectrum Health Beat)
Get the facts on hepatitis A. (For Spectrum Health Beat)

As a hepatitis A outbreak makes hundreds sick and kills at least 19 people in Southeast Michigan, it leaves Americans pondering two big questions.

What is my risk?

Should I get the vaccine to prevent it?

The odds of contracting the viral liver disease vary―by occupation, lifestyle and travel plans. But because the disease can be spread easily, it’s worth considering the vaccine, says Rosemary Olivero, MD, a pediatric infectious disease specialist at Spectrum Health Helen DeVos Children’s Hospital.

“It’s a safe vaccine and it’s well tolerated,” she said. “If you live in an area with an outbreak, to me it’s kind of a no-brainer.”

Dr. Olivero gave an overview of hepatitis A―how it’s transmitted, the risks it poses and how to avoid it.

Here are factors to consider:

The fecal connection

The hepatitis A virus spreads by the fecal-oral route. People who have the infection who use the bathroom and don’t wash their hands well enough can spread it to others by contaminating their food. This most commonly happens through food preparation.

Hepatitis A is rarely spread through contaminated water sources or produce. It is also rarely spread through sexual contact, Dr. Olivero said.

Recently, health officials warned the public of possible exposure to hepatitis A at a restaurant in the Detroit-area suburb Grosse Pointe Woods after an employee tested positive, according to The Detroit News.

How sick?

A person infected with hepatitis A might have a very mild illness, but certain people will get extremely sick from the virus, Dr. Olivero said. Some young children will show no signs of illness at all.

People can spread the infection to others one to two weeks before they show signs of the illness. Younger persons who get infected, especially infants and young children, can shed the virus for up to six months after infection.

“The vast majority of people are not going to know they have a viral infection,” Dr. Olivero said. “They might have mild nausea or mild gastrointestinal upset.”

Those at the other end of the spectrum may experience extremely high fever, abdominal pain, vomiting and diarrhea. As bilirubin levels become elevated, the skin and whites of their eyes may look yellow.

If you get the infection and prepare other people’s foods, you can really amplify the spread of the virus.

Dr. Rosemary Olivero
Pediatric infectious disease specialist

The vast majority of patients overcome the infection. But in some cases, the illness lasts several months and can lead to death from liver failure.

The outbreak in Southeast Michigan includes 486 reported cases, 409 hospitalizations and 19 deaths, according to the Michigan Department of Health and Human Services.

People with an underlying liver disease―such as hepatitis B or C―or an immune-compromising illness face a greater risk of developing the most severe form of hepatitis A. Highest-risk individuals include those with a history of substance abuse, homeless people and those incarcerated in correctional facilities.

Age also can affect how hard the disease hits a patient.

“The younger you are, the less likely you are to have symptoms of it,” Dr. Olivero said.

The overall fatality rate is only 0.3 percent. But the death rate is six times higher for those older than 60.

Evaluating risk

Infection rates for hepatitis A are relatively low in the U.S. and other countries with more sanitary food practices, according to the World Health Organization. But there are factors Americans should consider, particularly if they live in an area with an outbreak, Dr. Olivero said.

Infected people who have only a mild illness―or no symptoms at all―may not realize they have the disease. But they still shed the virus and can transmit it to others.

Health care workers and food handlers who contract the virus are considered high risk for spreading the disease.

“If you get the infection and prepare other people’s foods, you can really amplify the spread of the virus,” Dr. Olivero said. “How do you know you’re not going to encounter it? It’s not necessarily something you can see.”

Travel also can affect risk level. In developing countries, 90 percent of children have been infected by age 10, the World Health Organization reports. Areas with high to moderate risk include Mexico, Central America and most of South America.

“Whenever you travel out of the country, unless you are going to western Europe or certain resort areas in the Caribbean, we really recommend the hepatitis A vaccine,” Dr. Olivero said. “Hepatitis A is one of the most common infections picked up during international travel.”

About the vaccine

Most children and many young adults already are vaccinated against hepatitis A because the vaccine has been part of routine childhood immunizations since 1994. Children typically get immunized at 12 months of age and get a booster shot at 18 months.

Adults get a hepatitis A vaccine followed by a booster at least 6 months later. After those two doses, they have strong immunity to hepatitis A for the rest of their lives.

Michigan health officials encourage vaccination for those in the high-risk categories.

Dr. Olivero encouraged others to think about the vaccine, as well.

“For vaccine-preventable diseases, the question is, ‘Why not?’ We don’t always know what our health is going to be in the future,” she said. “And if you are in a high-risk group later on, you can already be vaccinated with a highly effective vaccine like we have for hepatitis A.

About hepatitis B and C

Although they sound similar, hepatitis A, B and C “are totally unrelated from each other,” Dr. Olivero said. “They are called (hepatitis) because they all affect your liver.”

Hepatitis B is transmitted by the exchange of blood and body fluids, such as in needle pokes and sex. A mother can pass the virus to her baby during pregnancy and delivery.

Those sharing a household with an infected person could acquire the virus through shared toothbrushes and razors.

Some infected individuals don’t realize they have the disease. But in some cases, they may become chronic carriers and be at risk for liver cancer later in life.

Children receive a three-dose vaccine series for hepatitis B through the routine immunization schedule. Health officials also recommend the vaccine for health care workers, international travelers and those with infections such as hepatitis C or HIV.

Hepatitis C also is transmitted through direct blood exchange, through shared needles and sex. Pregnant women also can transmit the infection to their child.

A vaccine does not exist for hepatitis C, but curative treatments became available in recent years.

Health officials encourage adults to get tested for it, particularly those born in the baby boomer years, 1945-65. The virus was not well recognized in their early risk years.

“The liver may slowly undergo damage and scarring,” Dr. Olivero said. “We want to recognize it before we get to that point so we can treat it and have better outcomes.”

Learn more about Infectious Disease Program for Children and the Travel Medicine Clinic at Spectrum Health Helen DeVos Children’s Hospital.

Call 616.774-2822 to contact infectious disease physicians with Spectrum Health Medical Group.

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