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Hepatitis A

Hepatitis A is a disease that is infectious, affects the liver, and is caused by hepatitis A virus (HAV). Although the disease started long ago during the World War II, it was not until in 1973 that the illness was discovered. The incubation period of the virus is six weeks and the symptoms last for another eight weeks and recurs after six months. The disease may result in damage to the liver, especially in older patients or even no damage at all. Sometimes, infection by this virus may lead to death (Sharapov et al., 2009). Hepatitis A has many modes of transmission including eating or drinking contaminated water, and close contact with an infected person. Given that there is no apparent treatment for this disease, there are various measures that can be taken to prevent it’s spread, including providing vaccines. Hepatitis A is prevalent in areas with poor sanitation, especially in developing countries. This paper discusses the causative agent of HAV, the history, and epidemiology of the disease, the pathology, response and treatment of HAV, and the social, political and economic factors that can help hinder or reduce the spread of the virus.

Hepatitis A is caused by hepatitis A virus, which is a positive-strand RNA virus and lacks a lipid envelope. The RNA genome has a length of about 7500 nucleotides and has an open reading frame, with a VPg protein attached to the 5’ end, for the virus replication. The virus multiplication has various unique characteristics that distinguish it from other picornaviruses. Some of these unique features include its slow and prolonged time course, its ability to manifest in low virus loads and its tendency to establish recurrent infections in cell culture (Martin & Lemon, 2006).

Although HAV came into existence during the World War II, its discovery was not until 1978 when the virus was first seen under an electron microscope. Several years later, with intense research of the disease, its clinical features were identified including modes of transmission, and its distinction from hepatitis B. In 1784, cultured mammalian cells proved to allow the replication of HAV. Shortly after this, the virus RNA genome was reverse-transcribed followed by the molecular cloning of the cDNA copy that resulted (Martin & Lemon, 2006). Three years later, the RNA transcripts from the molecular cloning proved to be infectious when transfected into cell culture. The continuous cell culture of the disease and development of inactivation methods of the virus led to the development of an effective vaccine in the early 1990s. Even though cases of hepatitis A have reduced drastically since the invention of a vaccine, the disease remains prevalent in most developing countries.

HAV infections are believed to affect approximately 101 million people per year with 1.5 million of these people showing symptoms of the disease. Acute hepatitis resulted in 103,000 deaths in 2010, which is an increase from the 99,000 deaths caused by the same disease in 1990. Developing countries are the most affected with the HAV. However, in these developing countries, most adolescents and adults are immune to the disease due to prior exposure during childhood. CDC received more than 30,000 cases of hepatitis A in 1997 in the US, but these cases have reduced drastically to less than 2,000 cases per year. In 2003, the U.S experienced the most widespread outbreak of hepatitis A with at least 650 people killed from the disease (Sharapov et al., 2009). In 2013, 158 people in the US got infected from eating frozen berries, of whom 69 got hospitalized. The frozen berries incident was again witnessed in 2016 in Canada in which 13 people got infected with HAV, 3 of whom were hospitalized after eating the product (Fiore, 2004). Humans are the only known natural reservoir for the virus. The primary route of transmission of hepatitis A is the fecal-oral route, either through person-person contact or through ingestion of contaminated food or water. In some rare occasions, HAV has been transmitted through blood transfusion. The outbreak of this disease resulting from contaminated water is linked to sewage contamination or inadequately treated water.              

Various features of hepatitis A highly contribute to its pathology. Some of these features include the primary route of infection, the stability of the virus at low pH and ambient temperature, and the ability to resist acid pH and detergent. Significant amounts of the virus are present in feces during the first weeks of the infection, with most of the virus being produced in the liver, secreted by the infected hepatocytes into the intestines and excretion through the biliary tract (Taylor et al., 2006). Just before the beginning of hepatocellular injury, fecal shedding of the virus reaches its maximum and at this point, the patient is highly infectious. With this comes the liver injury and high levels of aminotransferase activities. After enzyme boost, the viral antigen continues to be shed for another three weeks or more. Hepatitis A is highly attributed to the immunologic response to the manifestation of the disease, which results in the inflammation of the liver. The signs and symptom of hepatitis A occur within six weeks of infection and can last for two to six months. These signs and symptoms include fatigue, fever, nausea, loss of appetite, diarrhea, jaundice, abdominal discomfort, and light-colored feces.

No specific treatment for the HAV has been invented although the patients can manage the virus until they get well. The body’s immune system can respond to the disease. After infection, replication of this virus occurs quietly in the liver during the incubation period. After incubation, the virus expresses itself in higher viral loads in the liver, bile, stool and less on blood. With the clinical manifestation of the disease after six weeks of infection, comes the immune response. The prolonged period of immune response clearly shows that the virus can disrupt cellular mechanisms where the mammalian cells recognize a virus as soon as it enters the body and initiates the synthesis of interferon-25, which would otherwise help fight the disease. The adaptive immune system of humans is very effective in eliminating HAV. The first antibodies to respond to this disease is IgM followed by IgG shortly after the onset of the symptoms (Taylor et al., 2006). The IgG antibodies result in immunity to the disease since they are long living. Even when administered after exposure to HAV, neutralizing antibodies have been known to protect against infection of HAV. Viral- specific HLA-restricted cytotoxic T-cells present within the liver during hepatitis A infection have been associated with the viral clearance as well as the resulting liver injury.

The spread of hepatitis A can be prevented using various ways including staying off work until the symptoms of the disease clear. In addition, the patient should avoid handling other people’s food until he gets well and should wash his hand regularly with soap and water (Franco, 2012). It is mandatory for such individuals to ensure that they clean the toilet frequently and avoid sex while they have the infection. Lastly, if the patients should avoid any close contact with others because they can infect them as well. Various steps can be taken to curb the risk of hepatitis A transmission. Socially, it is advisable that every person gets a hepatitis A vaccine. In addition, it is desirable to wash hands regularly since hepatitis A is transmitted person to person. Thirdly, the infected individual should not handle other people’s food and should also avoid having sex until the symptoms clear out. Politically and economically the government can promote public awareness of the disease through events such as seminars. In addition, the government should put more effort towards funding research on hepatitis A as well as ensuring the citizens get shots of hepatitis A vaccine. 

In conclusion, various policies should be implemented to ensure that the spread of Hepatitis Aid contained. Firstly, a hand washing policy should be implemented such that everyone even kids take regular hand washing seriously. To accomplish this, everyone has to take hand washing as their responsibility and should not wait to be told when to wash hands. Secondly, the policy of vaccination for every newborn baby would help eradicate hepatitis A in future. To attain this, the government should ensure all its citizens can afford healthcare to ensure all the children are born in hospitals and the doctors should make it mandatory for every newborn to be vaccinated. This way, hepatitis A will be eradicated and will no longer cause damage to many people especially in developing countries.

References

Fiore, A. (2004). Hepatitis A Transmitted by Food. Clinical Infectious Diseases, 38(5), 705-715.

Franco, E. (2012). Hepatitis A: Epidemiology and prevention in developing countries. World Journal of Hepatology, 4(3), 68.

Martin, A. & Lemon, S. (2006). Hepatitis A Virus: From Discovery to Vaccines. Hepatology, 43(1), 164-169.

Sharapov, M., Favorov, M., Yashina, T., Brown, M., Onischenko, G., Margolis, H., & Chorba, T. (2009). Acute viral hepatitis morbidity and mortality associated with hepatitis E virus infection: Uzbekistan surveillance data. BMC Infect Dis, 9(1).

Taylor, R., Davern, T., Munoz, S., Han, S., McGuire, B., & Larson, A. et al. (2006). Fulminant hepatitis A virus infection in the United States: Incidence, prognosis, and outcomes. Hepatology, 44(6), 1589-1597.

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