Ask the Doctors

Dear Doctor: I'm familiar with hepatitis C's connection to death, but hepatitis A? I had no idea that could be lethal, and now I'm reading about a number of deaths in San Diego. I thought anyone could get hepatitis A.

Dear Reader: You're right, anyone can get hepatitis A. That's what makes the current outbreak alarming, but only if you don't know how, or are unable, to protect yourself. First, some background: Hepatitis A occurs in about 1.4 million people worldwide each year; in the United States, only about 1,200 to 2,500 people are infected per year, primarily in sporadic outbreaks.

The virus is released in the stool of infected people, and from there it can move to their hands. It's resistant to detergents, high temperature and solvents. Frequent handwashing can reduce the risk of transmission, but some of the virus can linger. A significant factor in hepatitis A transmission is that a person can transfer the virus to others even before he or she shows symptoms. In areas of poor sanitation, hepatitis A can easily be transferred among the population. This is why the disease is so prevalent in developing countries. Hepatitis A also can be transferred via contaminated foods, like shellfish, that have come in contact with the virus.

San Diego's hepatitis A outbreak is blamed on poor sanitary conditions, with related contamination of food sources. This has led to more than 400 cases since November 2016; 16 have been fatal. Many of these cases have occurred in the homeless population, which lacks proper sanitation facilities, leading the city to clean many of the streets with bleach and to provide portable handwashing stations in areas frequented by the homeless.

Once ingested, the hepatitis A virus moves into the bloodstream and then into the liver. There, it replicates in the liver, causing the immune system to attack the infected cells. This, in turn, leads to massive liver inflammation. Shortly after infection, patients experience nausea, fever, fatigue, poor appetite and stomach pain. A few days later, 40 to 70 percent of patients will have a yellowish discoloration of the skin and severe itching. For the majority, this is as bad as it gets, and symptoms improve after two weeks. In fact, 85 percent of patients will have full recovery within two to three months, and nearly 100 percent have full recovery at six months.

In contrast, hepatitis C and sometimes hepatitis B cause a chronic low-grade infection that can lead to cirrhosis of the liver and liver cancer. For people who already have chronic hepatitis C or B, hepatitis A can more readily lead to liver failure and death. Also, people over the age of 50 have greater difficulty recovering from hepatitis A, leading to dehydration, other infections and death.

In short, good public sanitation, handwashing and vaccination for hepatitis A can prevent infection. Children now routinely get vaccinated for hepatitis A, which has decreased the incidence of hepatitis A not only in children, but also in the general population. People with chronic hepatitis B or C should also be vaccinated against hepatitis A to reduce their risk of death should they become infected, as should homosexual men and IV drug users.

So, while hepatitis A is rare in the United States, incidents such as the one in San Diego highlight the need to be vigilant against the disease.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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