Hepatitis A

Hepatitis A is a viral infection of the liver.  It can cause fever, jaundice of the eyes and skin, swelling of the liver, nausea, vomiting, abdominal pain, and grey-colored stools.    Most people who get Hepatitis A get it through infected food or water or after an infected person uses the bathroom without washing his/her hands and then touches someone else or food that someone else then eats.  This is called “fecal-oral transmission” (yes, I know, yuck.)  The amount of feces that is needed to transmit Hepatitis A is tiny, even microscopic, so that one could get it after changing the diaper of an infected baby or adult without using proper hand hygiene.  Hepatitis A can also be spread through sex.  As it takes 2 to 7 weeks after infection to develop symptoms, most people never find out where or from whom they got the infection.  Some people become infected and have no symptoms at all but still can spread the infection to others.

There is currently an ongoing Hepatitis A outbreak in Michigan that started in August 2016.  As of May 2018 it has caused over 650 hospitalizations and 27 deaths.

How serious is Hepatitis A infection?

Most people who get Hepatitis A recover completely after several weeks.  Many children and some adults get no symptoms at all, and some people get sick enough to need hospitalization.  Death is uncommon but can result if liver failure develops.  Most people who die from Hepatitis A are older than 50 years or already have liver disease (or both).

Who is at risk of Hepatitis A?

Anyone can get it, which is why we routinely vaccinate against it.  However, certain people are at higher risk of contracting Hepatitis A (this list is from the CDC):

  • People with direct contact with someone who has hepatitis A
  • Travelers to countries where hepatitis A is common
  • Men who have sexual contact with men
  • People who use drugs, both injection and non-injection drugs
  • Household members or caregivers of a recent adoptee from countries where hepatitis A is common
  • People with clotting factor disorders, such as hemophilia
  • People working with nonhuman primates

 

Can I prevent Hepatitis A?

YES!!!  There is a vaccine that is very effective; it has been given routinely to children at 12 months and again at 18 months old since 2005.  Older children and adults can get vaccinated as well.  The full series is 2 doses at least 6 months apart.  Also, if you find out that you have been exposed to Hepatitis A, either getting the vaccine or a medication called Hepatitis A immune globulin may prevent the infection from developing.

 

Find out more at the CDC’s Hepatitis A website

 

June 14, 2018: Now even the Huffington Post is talking about Hep A!!


Usual Pediatric Schedule:

  • 1st dose age 12 months
  • 2nd dose age 18 months

Ebola is back, and we should be very scared

Ebola Vaccine

Ebola has resurfaced in the Democratic Republic of Congo.  For the past month, the World Health Organization has been monitoring multiple cases of hemorrhagic fever which were suspected of being caused by Ebola or a similar virus, but Ebola has now been confirmed in multiple patients.  The first cases were in isolated regions in the country’s interior but unfortunately, several of the most recent cases have been found in Mbandaka, a port city of over 1 million people, which makes spread outside of the DRC far more likely.  The WHO has supplied the region with several thousand doses of an experimental Ebola vaccine (made by Merck) which are being administered, but the vaccine is new and not yet licensed, although it performed well in trials in Europe and Africa last year.  The mainstay right now is attempting containment and isolation of patients and their contacts.  Until more doses of the vaccine are available, the vaccine will be used for healthcare workers, contacts of known patients and contacts of those contacts, in a strategy known as “ring vaccination”.  WHO considers the risk of spread outside the DRC “very serious” at this time.

During a prior outbreak of Ebola in Africa several years ago, over 11,000 people died and there was a worldwide effort at containment which proved to be extremely expensive but effective.  Hopes are that the experimental vaccine will work well and that as Merck increases vaccine supply, extensive vaccinations can help to contain the outbreak before it spreads outside of the DRC.

Read or listen to the story on NPR here:

The world is full of life-threatening viruses; we tend to forget about most of them quickly unless they are local or unless we get reminders.  Currently there are several cases of Nipah Virus in India, which is spread to people from bats and pigs, and is even more scary than Ebola, with up to a 75% fatality rate.  Mark my words, unless it spreads outside India, you’ll probably forget about it by next week.  As Americans we are inundated with news and very little stays with us – we tend to care about a lot of things but only for a moment.

 

Update 10/9/2018: Ebola Likely to Spread From Congo to Uganda

The New York Times recently reported that the Ebola outbreak in Congo is now “very likely” to spread to Uganda.  Spread outside of Congo was predicted by many, as containment efforts are hampered by civil war, poverty and decentralized healthcare provision.  Uganda has better tools to deal with Ebola but to to the speed with which the virus can spread this is a very serious development.  Here’s the link: