Get sick with hepatitis A. How is hepatitis A transmitted, symptoms and treatment. I. Signs and symptoms of hepatitis A in children: typical course

• Hepatitis A is a viral liver disease that can range from mild to severe.
• Transmission of hepatitis A virus (HAV) occurs through ingestion of contaminated food or water or direct contact with an infected person.
• Almost all patients with hepatitis A achieve a complete cure and develop lifelong immunity. However, in very rare cases, infection with the hepatitis A virus can lead to fulminant hepatitis, which can be fatal.
• WHO estimates that approximately 7,134 people died from hepatitis A in 2016 (representing 0.5% of deaths from viral hepatitis).
• The risk of contracting hepatitis A is associated with a lack of safe water, as well as poor sanitation and poor hygiene (such as hand hygiene).
• In countries with a low risk of acquiring hepatitis A through food and water, outbreaks have occurred among men who have sex with men (MSM) and people who inject drugs (PWID).
• Epidemics can be long-lasting and cause significant economic damage.
• A safe and effective vaccine is available to prevent hepatitis A.
• The most effective means of controlling this disease are a safe water supply, safe food, improved sanitation, hand washing and the hepatitis A vaccine. Members of high-risk groups, such as travelers to countries with high infection rates, men who have sex with men , and injection drug users can get vaccinated.

Hepatitis A is a liver disease caused by the hepatitis A virus (HAV). The virus spreads primarily when an uninfected (and unvaccinated) person consumes food or water contaminated with feces from an infected person. This disease is closely associated with contaminated water or food, poor sanitation, poor personal hygiene, and anal-oral sex.

Unlike hepatitis B and C Hepatitis A does not cause chronic liver disease and is rarely fatal, but it can cause severe symptoms and fulminant hepatitis (acute liver failure), which is often fatal. According to WHO estimates, in 2016, 134 people worldwide died from hepatitis A (representing 0.5% of deaths from viral hepatitis).

Throughout the world, hepatitis A occurs both in the form of isolated cases and in the form of epidemics, which tend to be cyclical. Hepatitis A virus is one of the most common causes of foodborne infection. Epidemics associated with contaminated food or water can be explosive, such as the 1988 Shanghai epidemic, which affected approximately 300,000 people 1 . They can also be long-lasting, affecting specific local communities over several months through person-to-person transmission. Hepatitis A virus survives in the environment and can remain viable even despite exposure to various food processing techniques commonly used to inactivate and/or control bacterial pathogens.

This disease can have serious socio-economic consequences for the population. Individuals recovering from an illness may take weeks or months to return to work, school, or daily life. Significant damage can be caused to public catering establishments, which in the opinion of the population could have caused the epidemic, and to labor productivity at the local level in general.

Epidemiological situation

Geographical distribution areas can be categorized as having high, moderate, or low levels of hepatitis A infection. However, infection does not mean illness because infected young children do not experience any significant symptoms.

Areas with high infection rates

In low- and middle-income countries where sanitation and hygiene standards are inadequate, infection is widespread and the majority of children (90%) become infected with hepatitis A virus before the age of 10 years, most often without symptoms. Areas with high level of infection omov2. Epidemics—This is not typical because older children and adults are generally immune. In these areas, rates of symptomatic illness are low and outbreaks are rare.

Areas with low infection rates

In high-income countries with good sanitation and hygiene, infection rates are low. The disease can occur among adolescents and adults from high-risk groups, such as injecting drug users, men who have sex with men, travelers to areas of high endemicity, and among isolated populations such as closed religious communities. In the United States, large outbreaks have been reported among homeless people.

Areas with medium infection rates

In middle-income countries and areas with varying health conditions, many individuals are not exposed to infection in early childhood and reach adulthood without immunity. Thus, improvements in economic and sanitary conditions sometimes lead to an increase in the number of adults who have never been infected and are not immune. Thus, in such areas, increased susceptibility in older age groups may lead to higher incidence rates and large outbreaks.

Virus transmission

The hepatitis A virus is transmitted primarily through the fecal-oral route; that is, when an uninfected person consumes food or water contaminated with the feces of an infected person. In families, this happens through dirty hands when an infected person prepares food for family members. Outbreaks of waterborne infections are infrequent and are usually associated with water contamination from sewage or inadequate water treatment.

The virus can also be transmitted through close physical contact (such as anal-oral sex) with an infected person, but household contact does not spread the virus.

Symptoms

The incubation period for hepatitis A is usually 14-18 days.

Symptoms of hepatitis A vary—from light to heavy—and may include fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and whites of the eyes). Not all infected individuals will exhibit all symptoms.

The risk of developing symptomatic infection as a result of HAV infection is directly related to age. Disease severity and mortality increase in older age groups. In children under 6 years of age, the infection is usually asymptomatic, and only 10% develop jaundice. In other children and adults, the infection usually occurs with the onset of clinical symptoms, with jaundice observed in more than 70% of cases. Hepatitis A sometimes recurs. Immediately after the illness, the patient becomes ill again and suffers another acute episode. However, recovery follows.

Who is at risk?

People who have not been vaccinated or have not previously been infected with HAV can become infected with the hepatitis A virus. In areas where the virus is widespread (high endemicity), most cases of hepatitis A infection occur in early childhood. Risk factors include:

• poor sanitation;
• lack of safe water supply;
• living in a family with an infected person;
• sexual partnership with a person infected with acute hepatitis A
• recreational use of psychoactive substances;
• sexual contacts between men;
• travel to areas of high endemicity without prior immunization.

Diagnostics

Cases of hepatitis A are clinically no different from other types of acute viral hepatitis. A specific diagnosis is made by detecting immunoglobulin G (IgM) antibodies specific for HAV in the blood. Additional testing includes reverse transcription-polymerase chain reaction (RT-PCR) to detect hepatitis A virus RNA and may require specialized laboratories.

Treatment

There is no specific treatment for hepatitis A. Recovery from infection symptoms may be slow and take several weeks or months. The main thing is to avoid unjustified prescription of medications. Acetaminophen/paracetamol and anti-vomiting medications are not indicated.

In the absence of acute liver failure, hospitalization is not required. Treatment is aimed at maintaining comfort and proper nutritional balance, including replacing fluid losses caused by vomiting and diarrhea.

Prevention

The most effective means of controlling hepatitis A are improving sanitation, improving food safety, and increasing vaccination coverage.

The spread of hepatitis A can be reduced by the following measures:

• ensuring an adequate supply of safe drinking water;
• proper disposal of wastewater within populated areas; And
• practicing good personal hygiene, such as regularly washing your hands before eating and after using the toilet.

There are several inactivated injectable hepatitis A vaccines available on the international market. They are all similar in terms of effectiveness and range of side effects. No vaccine has been licensed for use in children under one year of age. Live oral vaccine is also used in China.

Almost 100% of the population develops protective levels of antibodies within one month after one dose of the vaccine. Even after exposure to the virus, one dose of vaccine given within two weeks of exposure is protective. However, manufacturers recommend two doses to provide long-term protection for 5 to 8 years after vaccination.

To date, millions of people around the world have been vaccinated with inactivated hepatitis A vaccine without serious adverse events. The vaccine may be given as part of routine childhood immunization programs and with other vaccines recommended for travel.

Vaccination of the population

Hepatitis A vaccination should be part of a comprehensive plan to prevent and control viral hepatitis. When planning large-scale vaccination programs, careful cost-effectiveness assessments should be carried out and alternative or additional preventive measures, such as improved sanitation as well as health education to improve hygiene practices, should be considered.

The advisability of including the vaccine in the routine childhood vaccination program depends on local conditions. The proportion of people in the population susceptible to infection and the level of exposure to the virus should be taken into account. In general, universal childhood vaccination is most appropriate in countries with moderate levels of endemicity. Countries with low endemicity may consider vaccinating selected high-risk groups in the adult population. In countries with high endemicity, use of the vaccine is limited because most adults have natural immunity.

As of May 2019, 34 countries were using or planning to introduce hepatitis A vaccine as part of their routine vaccination of children at particular risk.

While many countries use a two-dose course of immunization with inactivated hepatitis A vaccine, other countries may consider including a single dose of inactivated hepatitis A vaccine in their vaccination schedules. In addition, some countries recommend vaccination for people at high risk of hepatitis A, including:

• recreational drug users;
• persons traveling to countries where the virus is endemic;
• men who have sex with men; And
• patients with chronic liver disease (due to an increased risk of serious complications from hepatitis A infection).

For outbreak response immunization, hepatitis A vaccination recommendations should also be tailored to local circumstances. The feasibility of rapidly implementing a large-scale immunization campaign also needs to be assessed.

Vaccination campaigns to control outbreaks in close-knit communities are most effective in small populations in the early stages of outbreaks, achieving high coverage across multiple age groups. Vaccination efforts must be accompanied by health education to improve sanitation, hygiene and food safety.

WHO activities

In May 2016, the World Health Assembly adopted the first Global Health Sector Strategy on Viral Hepatitis 2016–2021. It highlights the critical role of universal health coverage and sets targets that are consistent with the Sustainable Development Goals. The strategy contains the concept of eliminating viral hepatitis as a public health problem, which is reflected in the global goals of reducing the number of new cases of viral hepatitis infection by 90% and mortality from viral hepatitis by 65% ​​by 2030. The strategy sets out the measures that countries and the WHO Secretariat must take to achieve these goals.

To support countries in achieving global hepatitis targets under the 2030 Agenda for Sustainable Development, WHO is working in the following areas:

• raising awareness, facilitating partnerships and mobilizing resources;
• formulating evidence-based policy and generating evidence for action;
• prevention of transmission of infection; And
• expanding coverage of screening, care and treatment services.

WHO published the Progress Report on HIV, viral hepatitis and sexually transmitted infections 2019, which describes the progress made towards eliminating them. The report provides global statistics on viral hepatitis B and C, rates of new infections, chronic infections and deaths caused by these two common viruses, as well as information on key actions taken at the end of 2016 and 2017.

Since 2011, WHO, together with national governments, civil society and partners, has organized annual events to mark World Hepatitis Day (one of the nine major annual health campaigns) to raise awareness and understanding of viral hepatitis . The date of July 28 was chosen to honor the birthday of Nobel Prize-winning scientist Dr. Baruch Blumberg, who discovered the hepatitis B virus and developed a diagnostic test and vaccine against the virus.

Hepatitis A(or Botkin's disease). The causative agent is of viral etiology, which belongs to the Picornaviridae family. Main mode of spread: fecal-oral. In most cases, infection occurs through contact with infected liquids, food or personal hygiene items of hepatitis A virus carriers. It should be noted that the excrement and mucous secretions of patients during the incubation period are also dangerous for a healthy person.

The hepatitis A virus is very resistant to temperature changes (up to 20 C) for two years, remains virulent when the temperature rises to 60 C for four hours, and persists in the environment for a long time. But susceptible to disinfectants containing chlorine

Hepatitis A disease

The introduction of the hepatitis A virus into the human body occurs through the mucous membranes of the gastrointestinal tract. Hematogenously, it penetrates into the liver, where it finds the most favorable conditions for further reproduction and spread. As a result of damage to hepatocytes and deterioration of the permeability of membrane membranes, the activity of enzymes (aminotransferases, etc.) increases.

With severe liver failure, doctors often note a significant decrease in its size. Histologically, extensive necrotic changes in the parenchyma, cell proliferation, etc. are detected. However, such forms of GA are fortunately extremely rare.

The hepatitis A virus can be detected in the patient’s blood and feces by the end of the incubation period; it stops being generated in the body under the active influence of immune reactions during the acute cyclic course of the disease already in the first days of the icteric period

The incubation period for hepatitis A takes from 15 to 45 days, more often from 20 to 30. Viral hepatitis can take an icteric, anicteric and subclinical form. They also distinguish acute (up to 2 months), prolonged (up to 6 months). The chronic course of the disease for GA has not been proven. The onset is acute with a pre-icteric stage, which lasts, on average, from 2 days to a week.

This period is also characterized by prodromal phenomena: a short-term rise in body temperature, loss of appetite, nausea, vomiting, nagging pain in the liver, stool retention, enlargement of the liver and a slight enlargement of the spleen, darkening of the urine and lightening of the stool may appear.

In the icteric stage, jaundice appears and increases within 2-3 days, sometimes accompanied by itching of the skin, but intoxication phenomena in typical cases subside. Recovery is characterized by the gradual disappearance of jaundice and normalization of well-being, but an increase in the size of the liver and an increase in transaminase activity may persist up to 3-6 months, and only by this time should true recovery from this infection be attributed.

Treatment of hepatitis A

From the first days of illness, adherence to bed rest and a special gentle diet (table No. 5). Hepatoprotectors. The patient is recommended to drink plenty of fluids up to 3 liters per day in the form of glucose solutions, sweet tea or alkaline-containing mineral water.

Strict bed rest is extremely important for patients with severe hepatitis A at the first onset of symptoms. Physical activity should also be limited as much as possible; its resumption is possible only six months after discharge from the hospital and under the supervision of doctors based on the data of the patient’s biochemical parameters.

The diet should have a normal calorie content (2500 - 3000 kcal per day), be rich in proteins, complex carbohydrates and easily digestible fats (this does not apply to pork, beef or lamb fat).See calorie calculator.

To speed up the body's metabolic processes, balanced vitamin therapy is prescribed. In the first days of the disease, enterosorbents (enterodes, enterosgel, etc.) are advisable.

Therapy for diagnosing mild forms of the disease is limited to the above measures.

For hepatitis A of moderate and severe severity, it is additionally necessary to carry out anti-intoxication therapy: administration of 5% solutions of glucose, Ringer-Locke (5-10%), albumin, protein hydrolysates, hemodez, sorbitol, rheopolyglucin, etc. An enzyme-based drug, Cytochrome C, will have an effective therapeutic effect; it activates the body’s redox reactions. The dosage of the drug is calculated individually and can reach from 40 to 100 mg.

If the effectiveness of detoxification therapy for viral hepatitis A is low, doctors additionally prescribe the use of corticosteroids. This important decision is made in those rare cases in HA when the disease occurs with the threat of hepatic encephalopathy.

In even more rare cases of the development of encephalopathy in GA, it is necessary to increase the amount of administered medicinal corticosteroid substances from 100 to 250 mg per day (intramuscular or intravenous), additionally, inhibitors of proteolytic enzymes are prescribed, such as trasylol, contrical (10,000-30,000 units). It is also necessary to increase the volumes of solutions that are introduced into the patient’s body by infusion for detoxification.

Symptoms of overhydration require the use of diuretics in therapeutic measures: ethacrynic acid, veroshpiron, furosemide, etc.

A necessary measure in this case is the suppression of intestinal microflora with the help of substances taken orally: neomycin (1 g 4 times a day), kanamycin (0.5 g 4 times a day). Patients are also recommended to perform daily enemas with a weak solution of sodium bicarbonate (2%).

As mentioned above, recovery from hepatitis A occurs gradually; this process can be accelerated a little by undergoing a restorative course of procedures in a sanatorium; a prerequisite for this is the monitoring of the patient’s condition by the attending physician.

Regardless of severity, GA contributes to damage to the biliary tract (cholecystitis, etc.). To prevent them and improve liver recovery processes, it is advisable to use UDCA at a dose of 10-12 mg/kg per day, starting from the icteric period and the entire period of residual effects (3-6 months).

Prevention of hepatitis A

• Monitoring the source of the disease for 45 days, taking measures to disinfect it.
• Isolation under quarantine conditions of a patient diagnosed with hepatitis A.
• Urgent examination and, in the absence of immunity, vaccination against GA of all contact persons.
• After recovery, mandatory monitoring of the patient’s condition in a dispensary for 6 months.
• Implementation of measures to prevent the spread of the hepatitis A virus through the fecal-oral route through compliance with sanitary and epidemiological standards.
• Promoting a healthy lifestyle among the population, disseminating information about the characteristics of hepatitis A and ways to prevent it.

Botkin's disease, aka hepatitis A virus affects the liver, causing disruption of its normal functioning. A clear sign of hepatitis is jaundice. It appears as a result of the fact that the substance bilirubin produced by the liver, under the influence of the virus, begins to be released into the blood in large quantities. This is why the skin of patients with hepatitis acquires a yellow tint. The normal level of bilirubin in the blood of a healthy person is 0.6 mg%. In patients, this figure increases to 0.8 mg%. If you use the Hymansvan den Berg method, you can detect up to 20 mg% in the blood of patients, sometimes this figure reaches 30 mg%.

Classification of hepatitis A
1) the typical variant of the development of the disease includes all cases when the patient develops jaundice
2) with the atypical variant, the skin does not turn yellow, and the disease may not even be noticed. In children, for example, only one symptom may appear - temporary bowel dysfunction.

Three forms of the disease:
1) light (the most common);
2) moderate (affects 30% of patients);
3) severe form of hepatitis A (no more than 1-3% of patients).

Hepatitis usually results in complete recovery, with the liver beginning to function normally again. Less commonly, it may still remain enlarged for life, but other symptoms, as a rule, are absent in such patients.

Symptoms of the disease

Children usually tolerate hepatitis relatively easily. The disease is severe in children under one year of age, adults and the elderly. Their infection is characterized by severe jaundice and intoxication, the disease lasts about 3 months.

When should you get vaccinated against hepatitis A?

If there are no antibodies in the blood, there is a risk of disease, therefore, it is necessary to get vaccinated.

Prevention

A child sick with hepatitis A is immediately isolated, and all children who interact with him are examined every day for skin and eyes, and be sure to pay attention to the size of the liver.

Children who have been in contact with a sick child are given immunoprophylaxis (antibodies to the hepatitis A virus are administered). In regions where the incidence rate is high, prevention is carried out as planned: antibodies to the virus are administered in August or September.

For prevention, vaccines are used - preparations containing a weakened virus. Vaccination begins at 12 months of age, the vaccine is re-administered 6 months after the first administration, the third stage of vaccination is carried out a year after the first administration. Children usually tolerate the vaccine easily, although pain may occur at the injection site.

Treatment of hepatitis A

Usually liver function is completely restored.

Children with a mild form of the disease should be limited in their physical activity (exclude outdoor games). If the baby is seriously ill, bed rest is necessary. Children who have had hepatitis are exempt from physical education for 3-6 months; they should not engage in sports for 6-12 months.

The diet of patients should be balanced, nutritious and high-calorie.

Products with a high protein content include milk, cottage cheese, kefir, lean meat (chicken, beef, veal), lean fish (cod, pike perch, navaga, pike), low-fat cheese, and omelet. Fats are introduced into the diet in the form of butter and vegetable oil (sunflower, corn, olive). Various porridges contain carbohydrates: rice, semolina, oatmeal, buckwheat; pasta, potatoes, bread, sugar.

The diet must contain sufficient quantities of raw and boiled vegetables: tomatoes, cucumbers, cabbage, carrots, zucchini), herbs, fruits and juices.

It is necessary to exclude from the diet: refractory fats (margarine, lard, shortening), fatty sausages, canned meat, pork, fatty poultry, ham, fatty fish; spicy food, marinades, smoked meats; legumes, radishes, garlic, radishes; cakes, pastries, chocolate, sweets; mushrooms, nuts, horseradish, products containing extractives, etc.

Among sweets, it is allowed to eat jam, honey, savory cookies, marshmallows, prunes, dried apricots, raisins, jelly, mousses, and jelly. You can eat vinaigrettes, salads, jellied fish, soaked herring.

If you have had Botkin's disease (hepatitis A) write your review about treatment and recovery.

Comments

They admitted me to the hospital and gave me a drip of Glucose and Sodium Chloride for two weeks. There were also two injections a day, I don’t remember their name. And three weeks later I’m already home, only now I can’t leave the house for 10 days and I need to drink oat tea 2 times a day.

Alexander 12 April 2013 15:59

I spent 15 days in the hospital and was ill at home for a week, the most difficult period. The first two weeks were just terrible, I ate almost nothing, during the first week a banana and a couple of sandwiches, when I turned yellow it seemed to get better. Thanks doctors. True, when they filled the first dropper, 1.5 liters, I thought the sides would burst, the doctor lowered the norm to a liter, then raised it to 1.2. We were treated with phosphoglyph, injections in a dropper for a week, then pills. Now the diet.
Wash your hands and bananas and oranges, and tell your children not to eat bananas on the street.

I got over it very easily. Difficult period at home. First, nausea and heaviness in the stomach appeared, this lasted for 5-7 days, then it turned yellow, and my health improved a lot. I was immediately admitted to the hospital for 5 days, put on a glucose drip and given enterosgel. For the rest of the week I drank Essliver Forte and continued to eat Enterosgel. Overall, I got over the illness very easily. Don't hurt anyone!

She was seriously ill, with cholestasis. 3 months have passed, I’m still treating the gastrointestinal tract. There were a lot of medications and IVs. Perhaps because there was a duodenal ulcer. It’s terrible that it’s also reflected on the skin now: dryness, rashes. Now I take Nolpaza, phosphogliv, bifiform. My muscle tone is very weak, I used to do oriental dancing, but now I can’t. I went to yoga once and my stomach hurt. When will it be possible to do fitness and dance, who knows?

Oi August 17, 2015 00:50

I noticed that I was disgusted by the fried onions. I went to the toilet, and when I saw the picture “they have sailed” there, for some reason, out of fear, I took a bucket of cosmetics with me and rushed to the hospital. I got over the illness easily, no IVs were given, only hepatoprotectors and vitamins. I drank a large amount of rosehip brew or immortelle (a weak brew). She stayed there for 21 days (that’s how it was supposed to be). Afterwards I led a normal lifestyle and got one plus - I lost 10 kg. Well, what does cosmetics have to do with it? - you thought. Yes, despite the fact that I didn’t take anything into my head! She started the morning with makeup, which lasted for hours, leaving no shadow of illness! People who wanted to hang themselves were brought to me on an excursion.... 20 years have passed. Sometimes I undergo an ultrasound, you know, age.

I was sick when I was in the 8th grade, my nephew brought it from kindergarten, just when I was going to the sanatorium, I didn’t notice right away, they told me to eat and I had no appetite, as soon as I ate it all came back, already in the sanatorium we noticed yellowing of the sclera, after admitted to the hospital, 2 weeks on drips of glucose and sodium chloride, then 11 days of injections 3 times a day, a total of 25 days, soon they said no alcohol and sweets for about 6 months, but I ate what I wanted, in general this was the experience , after that, after strong alcoholic drinks, there is always vomiting. Now I’m 22 years old, I’m looking at the recent results of a blood test and noticed that direct bilirubin is 3.0 µmol/l, I wondered if the disease had an effect.

Botkin's disease occurred at the age of 4 years. She became infected in kindergarten. She was admitted to the Morozov hospital in serious condition because the local pediatrician was unable to diagnose the disease in time. The consequences, of course, were unpleasant and took a long time to make themselves felt. Fatigue, of course, but it was still impossible to understand what and in what combination could be eaten. Constant nausea, or even vomiting, weakness, fever. Only one thing saved me: I stopped eating all meat. Became a different person. Now I eat sour, fried, and spicy, but nothing meat, not even chicken, especially no sausages. I eat legumes, a lot of dairy products, fruits, nuts, cereals, soy products... Now I’m 58 years old, I haven’t eaten meat for almost 18 years. I'm not advocating anything, I'm just sharing my experience.

Veronica P July 15, 2017 00:14

I was ill almost a year ago, in a severe form. She was in the hospital for 1.5 months and received drops all this time, but the liver tests never decreased. They were discharged with indicators 5 times higher than normal, they say, then everything will go away, it just takes time and diet. After 2 weeks, I repeated the tests, they were growing, they prescribed IVs again 5 days after them, nothing much changed; on the contrary, only the numbers grew; they were unrealistically high and the doctors were surprised, like this virus does not give such high figures. They sent me to the region to the hepatocenter for stationary treatment and re-tested for all possible viral hepatitis and various viruses such as herpes, etc. nothing, just hep A antibodies and that’s it. They put me in static and then again 5 days of IVs, but in the end everything was again to no avail. Then they prescribed retoxil, atoxil and bicyclol, a drug to lower alt/ast, but that really helped. After 7 months, the pain is again in the right hypochondrium and the same as it was then, I don’t know what it is and why this is happening, I went off the diet after two months and you’re screwed again

I got sick in July '17. It started with a high temperature of up to 39.5 for several days. And there was no appetite. Doctors made all sorts of diagnoses and nearly performed surgery. On the 6th day, the analysis showed antibodies to Hepatitis A. But it didn’t get better, I lost consciousness, at some point I thought I was going to die. They also put in intravenous drips, 3 liters per day. Then it turned yellow, the urine darkened and the stool came out white. I stayed there for about 20 days and was discharged with ALT and AST above 200. I stayed at home for a couple more months; I had very strong weakness, dizziness and periodic fever. Heptor started drinking again. The enzymes dropped and then suddenly rose again. In short, I more or less came to my senses only 4-5 months after discharge. I didn’t really like fatty and fried foods before, so it wasn’t difficult to follow the diet. I lost 8 kg, mostly in muscle mass. That is, he returned to his youthful clothing size “S”. True, lately I’ve become addicted to sweets and cookies. I'll be back to the doctor soon for tests. In general, you wouldn’t wish it on your enemy. And for some, the skin color just changed and that’s it. In general, depending on your luck, it’s better not to get sick, of course.

Viral hepatitis A (or Botkin's disease)– a special type of viral hepatitis; it does not have chronic forms and has a fecal-oral transmission mechanism. A less common type of viral hepatitis has the same properties - hepatitis E.

Hepatitis viruses A and E do not have a direct damaging effect on the liver. Hepatitis - inflammation of the liver - occurs when viruses penetrate liver cells, thereby causing a reaction of protective blood cells against the altered liver tissue.

Hepatitis A is one of the most common infections in the world. Many people get this disease in childhood, which is associated with the greater prevalence of hepatitis A in children's institutions, in closed groups. Children tolerate the infection much more easily than adults; many suffer an asymptomatic form of hepatitis A and acquire lifelong immunity. In adults, severe forms of hepatitis requiring hospitalization are more common, most likely due to various concomitant diseases.

Viral hepatitis A is most widespread in countries with warm climates and poor sanitary conditions. Therefore, the likelihood of catching hepatitis A increases when traveling to hot countries: Egypt, Tunisia, Turkey, Central Asia, India, etc.

Hepatitis E distributed in the countries of Southeast Asia, Africa, and Central America. In our latitudes, hepatitis E is much less common.

Hepatitis A virus

The hepatitis A virus is extremely resistant to external influences and can persist in the environment for a long time.

• Withstands boiling for 5 minutes.
• Chlorination - 30 minutes.
• Formaldehyde treatment - 3 hours.
• Withstands treatment with 20% ethyl alcohol.
• Withstands acidic environments (pH 3.0).
• It lives in water at a temperature of 20ºC for 3 days.
• In meat and shellfish dishes at a temperature of 80 ºС it is active for 20 minutes.

How can you become infected with hepatitis A?

The source of infection is a sick person who releases viruses into the environment with feces. Viruses entering water and food penetrate the body of a healthy person and can cause disease. Especially dangerous are dishes prepared from insufficiently heat-treated seafood. In addition, infection often occurs by eating vegetables and fruits, which may themselves contain hepatitis A viruses or may be washed with contaminated water.

A less common mechanism of transmission is through contaminated blood. This occurs during blood transfusions, drug addicts using shared syringes, and also during homosexual contacts.

Development of hepatitis A and E virus

Hepatitis viruses penetrate the intestines through the mouth, from there, being absorbed into the blood, they penetrate the liver cells, causing their inflammation through an attack by the body's own immune cells. The viruses then enter the bile ducts, and from there into the intestines and the environment.

A sick person is dangerous to others in the last week of the incubation period and in the first week of the disease. The incubation period is the period from infection to the first manifestations of the disease. In the case of hepatitis A, it is 14-28 days. And in case hepatitis E can reach 60 days (average 40 days).

While the virus is in the blood, there is no jaundice, there are general signs of intoxication, and the infection occurs under the guise of an acute respiratory viral infection.

The appearance of jaundice means that there are no more viruses in the blood and the immune response is fully formed. However viral hepatitis A often occurs without jaundice.

The appearance of jaundice indicates damage to 70% of the liver, so all patients with jaundice are advised to undergo hospital treatment. However, in most cases, with adherence to the regimen and adequate treatment, the structure and function of the liver is completely restored.

Symptoms of hepatitis A and E

Anicteric period with hepatitis A and E virus

The anicteric period can last for 1-2 weeks. In this case, general symptoms are observed that are very similar to the symptoms of flu and colds.

• Decreased appetite.
• Fatigue.
• Malaise.
• Fever (usually 38-39ºС, rarely the temperature rises to 40 ºС).
• Pain in muscles and joints.
• Headache.
• Cough.
• Runny nose.
• Sore throat.
• Nausea and vomiting.
• Abdominal pain.

Jaundice period with hepatitis A and E virus

The first symptom that makes you wary is darkening of urine. The urine turns dark brown, “the color of dark beer.” Then the eye sclera and mucous membranes of the eyes and mouth turn yellow, which can be determined by raising the tongue to the upper palate; The yellowing is also more noticeable on the palms. Later the skin turns yellow.

With the onset of the icteric period, general symptoms decrease and the patient usually feels better. However, in addition to yellowing of the skin and mucous membranes, heaviness and pain appear in the right hypochondrium. Sometimes there is discoloration of stool, which is associated with blockage of the bile ducts.

Full recovery occurs in 1-2 months.

Severe forms of hepatitis A and E virus

Severe forms of the disease include the so-called cholestatic forms when bile stagnation occurs, which is caused by inflammation of the walls of the bile ducts. In this case, the stool becomes lighter and skin itching occurs, which is caused by irritation of the skin by bile components.

Fulminant hepatitis is especially dangerous, in which massive liver necrosis develops, acute liver failure and often the death of the patient. At hepatitis A the fulminant form occurs extremely rarely, and when hepatitis E– its frequency is 1-2%. However, there is a particular danger hepatitis E represents for pregnant women - the frequency of the fulminant form is 25%

Mortality at hepatitis A ranges from 1 to 30%. Mortality increases with age, as well as in chronic carriers of other viral hepatitis.

Who is more likely to get hepatitis A and E virus?

• People traveling to countries where the incidence is higher (endemic regions)
• Children attending preschool institutions
• Workers of preschool institutions
• Food service workers
• Sewage and water workers
• People whose family members have hepatitis A
• Homosexuals
• Drug addicts

It should be noted that in countries with a high prevalence hepatitis A, as well as in rural areas, many people contract hepatitis A in childhood, often in mild or asymptomatic forms, thereby acquiring lifelong immunity. Whereas people living in cities suffer from hepatitis A much less frequently, and therefore have a greater risk of becoming infected through contact with a sick person, as well as when traveling to endemic areas.

Prevention of hepatitis A and E virus

General preventive measures come down to the basic principles of general hygiene. It is necessary to wash your hands before eating, wash fruits and vegetables with water, the purity of which is beyond doubt. Do not eat under-processed meat, fish, especially seafood.

Immunoglobulin

With the help of normal human immunoglobulin, so-called passive immunization is achieved, i.e. a person is injected with ready-made antibodies (protective proteins) against hepatitis A viruses. The duration of action of these antibodies is 2 months. When the drug is administered at the beginning of the incubation period, it prevents the development of the disease.

Immunoglobulin can be used in people who have been in close contact with the sick person no later than 2 weeks after the suspected infection; as well as in people located in an endemic region.

Immunoglobulin is safe and well tolerated; HIV infection cannot be transmitted through it, since the virus is inactivated during the manufacture of the drug.

Vaccination

Vaccines are available in Russia, which are viruses grown in cell culture and inactivated by formaldehyde. There are several vaccines of this type: Hep-A-in-vac (Russia), Avaxim (France), Havrix (Belgium), Vakta (USA).

Vaccination can be given to children starting from 2 years of age. After a single vaccination, immunity is formed in 1-4 weeks (depending on the type of vaccine), so it can be used 1-4 weeks or more before traveling to countries with a high prevalence of hepatitis A. After a single immunization, immunity is formed for 2 years; after two times – for more than 20 years.

For adults, the vaccine is administered intramuscularly - 2 doses with an interval of 6-12 months. Children aged 2-18 years are administered intramuscularly with 2 half doses at monthly intervals and a third dose after 6-12 months.

Complications of hepatitis A and E

Hepatitis A, which arises against the background of complete health, almost always ends in recovery. In elderly patients with concomitant diseases, especially with chronic carriage of other viral hepatitis, the prognosis worsens, and a protracted course of the disease is more often observed.

In a small number of patients, weeks and months after the illness, a relapse may occur, i.e. return of all symptoms of the disease: intoxication, jaundice. But even in these cases, hepatitis does not become chronic.

Besides, viral hepatitis E can cause hemolysis - destruction of blood cells - red blood cells, which can lead to kidney damage and acute renal failure.

Liver dysfunction after surgery hepatitis A are extremely rare, mainly in older patients. However, there are cases when hepatitis A occurs in an anicteric form, under the guise of ARVI, when the patient does not comply with bed rest; this can lead to the formation of scar tissue in the liver - hepatic fibrosis, which is dangerous due to the development of bile duct dyskinesia - disruption of the normal passage of bile.

With hepatitis E, liver cirrhosis occurs in 5% of cases.

Diagnosis of hepatitis A

Diagnosis is primarily based on clinical data - i.e. manifestations of the disease.

To confirm the diagnosis of viral hepatitis, a number of laboratory tests are performed. Biochemical blood tests may reveal significant increases in bilirubin and liver enzymes, confirming liver damage.

Then a differential diagnosis of viral hepatitis is carried out. Specific diagnosis of hepatitis A is based on the determination of antibodies in the virus in the blood, and specific antibodies characteristic of acute hepatitis are determined.

Regimen and diet for acute hepatitis

During acute hepatitis, it is better to stay in bed. Lying down improves blood supply to internal organs, including the liver, which helps normal restoration of liver cells.

For acute hepatitis, a special type of diet is indicated - diet No. 5.

Food should be consumed 5-6 times a day, warm.

Allowed:

• Dried bread or day-old bread.
• Soups made from vegetables, cereals, pasta with vegetable broth, as well as milk soups.
• Dishes made from lean beef, poultry, boiled or baked after boiling.
• Low-fat varieties of fish (cod, pike perch, navaga, pike, carp, silver hake) boiled or steamed.
• Various types of vegetables and herbs, sour sauerkraut, ripe tomatoes.
• Crumbly semi-viscous porridges, puddings, casseroles, dishes made from oatmeal and buckwheat porridge are especially recommended.
• Eggs - no more than one per day in the form of adding to dishes, egg white omelet.
• Fruits and berries except very sour ones, compotes, jelly, lemon (with tea).
• Sugar, jam, honey.
• milk with tea, condensed, dry, low-fat cottage cheese, small amounts of sour cream, mild cheeses (Dutch, etc.). Cottage cheese and curd products are especially recommended.
• Butter, vegetable oil (up to 50 g per day).
• Tea and weak coffee with milk, non-acidic fruit and berry juices, tomato juice, rose hip decoction.

Forbidden:

• All alcoholic drinks.
• Fresh bakery products, pastry products.
• Soups with meat, fish, and mushroom broths.
• Fatty varieties of meat, poultry, fish (stellate sturgeon, sturgeon, beluga, catfish).
• Mushrooms, spinach, sorrel, radishes, radishes, green onions, pickled vegetables.
• Canned food, smoked meats, caviar.
• Ice cream, cream products, chocolate.
• Legumes, mustard, pepper, horseradish.
• Black coffee, cocoa, cold drinks.
• Cooking fats, lard.
• Cranberries, sour fruits and berries.
• Hard-boiled and fried eggs.

In case of severe vomiting, parenteral nutrition is administered, i.e. nutrients are administered intravenously. A nutritious, high-calorie diet is an important factor in the treatment of these patients.

Treatment of viral hepatitis A and E

As a rule, hepatitis A and E do not require treatment, except for severe forms of the disease. In these cases, drug treatment consists of detoxification therapy, i.e. reducing the level of toxins that accumulate in the blood due to liver damage. Usually this is the intravenous administration of various detoxification solutions.

When a hepatovirus enters the human body, hepatitis A or Botkin's disease develops. The disease is accompanied by fever, stool instability, and jaundice of the skin. The condition has 3 degrees of severity and is dangerous with complications in the form of cholangitis, cholecystitis,. The disease is also dangerous during pregnancy. At the first symptoms, you should consult a doctor who will diagnose and diagnose, prescribe drug therapy and give preventive recommendations.

Causes, pathogenesis and routes of infection

Viral hepatitis A or has ICD code 10 B15. The causative agent is a virus of the Picornaviridae family. Virology studies the distribution of hepatovirus genotypes and the causes of their occurrence. The pathogenesis is as follows: the microorganism spreads through the bloodstream throughout the body and settles in the liver, affecting hepatocytes - the main structures of the parenchyma. This provokes an inflammatory process. The disease is characterized by seasonality. In the summer, the microbe experiences an active reproduction phase, therefore, given the long incubation period, the peak incidence occurs in autumn and early winter.

Hepatitis A and B viruses are very stable in the external environment and remain infectious at low and high temperatures, and are also resistant to exposure to alcohol or formaldehyde.

The epidemiology of distribution includes countries with warm climates - the disease occurs on the African continent, Eurasia, South and North America. Another cause of the disease is infectious diseases, such as chickenpox, which can cause complications on the liver. The routes of transmission of the hepatitis virus are as follows:

Hepatitis A and B of non-viral etiology in men and women are caused by the following factors:

• poisoning with pesticides;
• uncontrolled use of medications;
• radioactive exposure.

Symptoms and course: how does the disease develop?

There are 3 stages of viral hepatitis A - mild, moderate and therefore the clinical picture is different. The first signs of hepatitis appear 1-1.5 months after infection. When people get sick, skin rashes due to hepatitis in the form of age spots due to intoxication are often observed. Jaundice begins acutely and is manifested by the symptoms shown in the table:

Features during pregnancy

The source of infection and symptoms of hepatitis A in women during pregnancy do not differ from those observed in people in general. However, the disease can cause complications in the health of both the expectant mother and the child. For women, this is dangerous due to termination of pregnancy, placental abruption and severe bleeding, which can lead to death. The disease threatens babies with intrauterine hypoxia. However, with timely treatment, complications can be avoided, and the child is born healthy.

How is diagnosis carried out?

Infectious hepatitis can be determined by an infectious disease specialist or hepatologist. The doctor examines the medical history, listens to complaints, conducts a visual examination and prescribes diagnostic procedures to determine whether the disease is caused by a pathogen or non-viral hepatitis. The studies are as follows:

• general and biochemical blood test (genotypes 1 are present);
• polymerase chain reaction;
• linked immunosorbent assay.

Treatment: which methods are effective?

Drug therapy

Any form of the disease requires hospital treatment. Basic therapy for hepatitis A in adults and treatment principles include standards developed by WHO. Depending on how the severity of the disease is expressed, the medications shown in the table are used to treat hepatitis in the hospital: