Review Question - QID 104807

This patient is experiencing an active Heptatitis A infection. Hepatitis A virus (HAV) is transmitted via the fecal-oral route and is commonly seen in unvaccinated international travelers.

HAV is a picoranavirus that is transmitted via the fecal oral route. It is very commonly transmitted as a food-borne illness and is commonly seen in countries with poor sanitation. It has a short incubation period of 2 to 6 weeks, and symptoms typically resolve in less than 2 months. Infection leads to an acute viral hepatitis, with symptoms including fever, fatigue, nausea, diarrhea, weight loss, abdominal pain, jaundice, and light colored stools. Diagnosis can be made by the detection of specific blood markers. Anti-HAV IgM antibodies specify that there is an active infection, while Anti-HAV IgG antibodies indicates a previous infection or prior vaccination. The hepatitis A vaccine is effective for the prevention of infection, and is commonly provided to travelers who are likely to be exposed to the hepatitis A virus.

Matheny et al. review the Hepatitis A. They state that although less common in the United States than worldwide, Hepatitis A accounts for 50% of viral hepatitis in the U.S. They describe the infection as typically being asymptomatic in children, although they can still be sources for contamination. HAV is an acute hepatitis and does not lead to a chronic infection. Although there is no increased risk for hepatocellular cancer, as there is in hepatitis B and C, hepatitis A can lead to acute fulminant hepatitis.

Wue et al. discuss the association between international travel and Hepatits A infection. They state that HAV is very common in underdeveloped countries relative to developed countries. They describe the current risk of a non-immune person contracting HAV in an underdeveloped country ranging from 6 to 30 per 100,000 individuals per month traveled. Furthermore, they describe that consumption of shellfish is another common risk factor for becoming infected with HAV.

Figure A demonstrates conjunctival icterus and jaundice of the face. Illustration A demonstrates where HAV is most commonly found internationally.

Incorrect answers:
Answer 1: Although HAV may be transmitted via unprotected sexual contact (especially anal contact), it is rarely transmitted this way. Hepatitis B virus is most commonly associated with sexual transmission.
Answer 2 & 4: Although HAV may be transmitted via the parenteral route, it is very uncommon. A much more common risk factor is international travel. Hepatitis C virus is most commonly associated with parenteral transmission.
Answer 5: Alcohol consumption is not a major risk factor for HAV transmission.