Hepatitis A Disease and Immunization

Hepatitis A is a viral illness. It is especially important for expatriates to be aware of it because hepatitis A is seen commonly in Turkey although it is rare in most European countries and most parts of the US.

Hepatitis A is caused by a virus (a dna virus) It is very contagious. It involves the liver and typically causes jaundice thus given the name sarilik (yellow color) in Turkish.

It usually infects 1.4 million people in the world every year. And most probably even those numbers underestimate the burden of disease as well. The incubation period (the period when the virus multiplies in the body without causing symptoms) is 2-6 weeks.

HOW IS IT TRANSMITTED?
It is transmitted  by fecal-oral route, from person to person, by water or contaminated food.
It can also be transmitted by raw or improperly cooked food eg: Salad, unpeeled fruit or seafood.

THE SYMPTOMS
A lot of people have no symptoms at all. They do not know they have hepatitis A. Some people have a milder infection with some fatige and cold symptoms. Usually younger children have a milder infection.
Some of the possible symptoms include:
•Flu like symptoms;fever,chills,diarrhea,
•Decreased appetite
•Nausea
•Jaundice (yellow color in the skin and the eyes)
•Dark urine (tea color)
•Pale stool
•Belly pain
•Fatigue

The patient might present all or some of these symptoms or sometimes does not show any symptoms at all. The disease usually lasts 3-6 weeks. Sometimes the disease continues on and off for 6 months. Very rarely it progresses to severe liver disease.( fulminant hepatitis)

TREATMENT
There is no specific treatment however bedrest and good nutrition is important.

WHY IS IT IMPORTANT IN TURKEY?
In Turkey , like many other developing countries, Hepatitis A is endemic, in other words
it is pretty common. It is transmitted through contaminated food, human contact, fecal oral route and poor hand hygiene. Especially food purchased from street vendors or eaten
at places where hygienic standards are not optimal poses risk for Hepatitis A.

WHAT IS THE DIFFERENCE BETWEEN HEPATITIS A,HEPATITIS B AND OTHER HEPATITIS INFECTIONS?
They belong to the same family of viruses however Hepatitis B is transmitted by blood transfusion, blood or sexual route whereas Hepatitis A is transmitted through fecal oral route and casual human contact. Hepatitis C is mostly transmitted through blood transfusions.

Hepatitis B is a lot severer than Hepatitis A. It is much more likely to cause severe liver disease. It is also one of the causes of liver cancer and cirrhosis. Hepatitis C causes severe liver infection as well.

Hepatitis B immunization is within routine infant immunizations in many countries now where as Hepatitis A vaccine is only given in countries where it is common.

HOW TO PROTECT FROM HEPATITIS A?
Do not drink water unless you are sure it is clean!
It is much safer to peel off the skins of fruits and vegetables if they are going to be eaten raw. Also seafood should not be eaten raw in endemic areas.

VACCINATION IS VERY IMPORTANT.
If you do not come from an endemic area your kids and you should receive Hepatitis A vaccine before or ater coming to Turkey. Vaccine is recombinant. Three different brands are available. It is very safe, usually  very few side effects occur, if any.
It is a series of 2, 6 months apart. It can be given to children above 1 year of age (younger ones do not develop immunity with it) It is known to be protective for at least 20 years. Vaccine experts state that no booster is necessary for Hepatitis A vaccine.

Beril Bayrak Bulucu, MD FAAP
American Board Certified Pediatrician

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