Hepatitis A

You Should Know About Hepatitis A

Hepatitis A is still a health problem in many parts of the world.  Incidence of hepatitis A endemic disease is more common in countries that are developing.  This is related to population density and the presence of environmental sanitation and hygiene practices are poor population.  Whereas in developed countries, the incidence of hepatitis is more epidemic, this happens because most environmental sanitation and hygiene practices are good citizens.  The presence of hepatitis A disease incidence in developed countries is mainly due to the occurrence of acute contact with patients drawn from the results of the visit / tourists who travel to countries endemic hepatitis.
Hepatitis A is an infectious disease caused by a virus hepatitis.A where humans serve as reservoirs.  Modes of transmission of this disease is from person to person through the faecal-oral route mainly through food. Parenteral transmission through water and are rarely found.  A weak immune system also affects the increased incidence of hepatitis A.  The spread of HAV from person to person enhanced by poor personal hygiene and overcrowding, as well as in the case of sporadic attacks on the food on a large contaminated.  The spread on the family and close friends also frequently occur
Approximately 1.4 million per year in the world’s population are infected with hepatitis A disease and the majority of cases unreported.  In the United States reported an epidemic in the 1980s, where an increase in cases from 1983 to 1989 by 58%.  And then the number of cases gradually declined because of the quality of food sanitation and hygiene improved.  Generally disease epidemic is related to food contaminated by hepatitis A virus obtained from tourists visiting countries endemic hepatitis A.  Sanitation and hygiene of food becomes a major role in the spread of this disease.  While the incidence of hepatitis A in the State of India was first reported in 1955 by source of transmission of river water contaminated with hepatitis A virus used in people for their daily needs.
Indonesia is a developing country with large population and is an endemic country of hepatitis A.  This can be seen from the description contained the number of hepatitis patients in Indonesia in 2002 is quite high.  This can be seen from the data of East Java province, West Java, North Sumatra, Lampung and South Sulawesi, there are around 700 to 2600 cases, while the Province of Jakarta, Yogyakarta, Central Java, West Sumatra, East Kalimanta, South Kalimantan, North Sulawesi, Maluku, Papua West side, has a number kases ranging from 0 to 100 cases of hepatitis.  Meanwhile, in the province of West Nusa Tenggara, East Nusa Tenggara and Papua east did not have data about cases of hepatitis A.
Government programs in the prevention of diseases such as hepatitis immunization program.

Hepatitis A immunization given to children aged between 2 to 18 years once.  Adults require re-immunization (booster) after 6 to 12 months of first immunization.  Acquired immunity from immunization is able to survive for 15 to 20 years.  Because the price is expensive then this program does not touch the whole community.  Another program is the extension activities to the public about personal hygiene and environmental sanitation.
Hepatitis is a diffuse inflammatory process of liver tissue with a cause is a virus (hepatitis A, B, C, D, E, F and G, as well as cytomegalovirus, Epstein Barr, Rubella, Yellow Fever, Coxakie, etc.), bacteria and induction of drug-obatan.Hepatitis viral disease is a viral infection by providing a spectrum of signs of extensive laboratory manifestations (PAPDI, 1996)

Epidemic jaundice (hepatitis) was first reported by Hippocrates, and many reports about the epidemic of this disease especially during World War 2.  The increasing knowledge in medicine, classification of viral hepatitis is increasing.  Most cases of acute viral hepatitis caused by hepatitis virus is one of the Viru Hepatitis A, B, C, D, E and G (PAPDI, 1996).
Hepatitis A
Hepatitis A due to a virus called Infectious hepatitis, Epidemic hepatitis, Epidemic jaundice, jaundice Catarrhal, Hepetitis Type A, HA (Chin J, 2006)


Symptoms of hepatitis A in adults in the region nonendemis usually marked by fever, malaise, anorexia, nausea and abdominal discomfort, followed by the appearance of jaundice within a few days.  In the majority of countries bekembang, hepatitsi A virus infection occurs in childhood is generally asymptomatic or with mild symptoms.  Infections that occur in the next age can only be known by laboratory examination of liver function.  This disease has a spectrum of clinical symptoms ranging from mild to recover in 1-2 weeks with a severe disease with symptoms lasting up to several months.
Prolonged course of the disease and recurrence can occur and illness lasts more than 1 year was found in 15% of cases, there is no chronic infection with hepatitis A.  Konvalesens often lasts longer.  In general, the more severe disease with increasing age, but the healing is complete without sequelae may occur.
Death cases reported ranged from 0.1% – 0.3%, although mortality increased to 1.8% in adults with more than 50 years of age, a person with chronic liver disease when infected with hepatitis A will increase the risk for fulminant hepatitis A be fatal.  In general, hepatitis A is considered as a disease with case fatality rate is relatively low.
Diagnosis depends on detecting IgM antibodies against hepatitis A virus (IgM anti-HAV) in serum as a sign they suffer acute illness or the patient has just recovered.  IgM anti-HAV becomes detectable 5-10 days after exposure.  Diagnosis can also be enforced by specific antibody titer increased 4 times or more in the pair serum, antibodies can be detected by RIA or ELISA.  (Kit for IgM and total antibodies of the virus more widely available commercially).  If the laboratory examination is not possible to be done, then the epidemiological evidence to support the diagnosis.  (Chin J, 2006)

Cause Disease
The cause of the disease is viral hepatitis A (HAV), picornaviruses sized 27-nm (ie RNA viruses with positive strain).  Viruses are grouped into Hepatovirus, members of the family Picornaviridae. Virion has a polypeptide capsule, designed from VP1 to VP4, which after translational cleavage of poly protein producing genomnukleotida 7500.  The virus will be inactive when it’s done boiling for 1 minute, exposure to formaldehyde and chloride or with ultraviolet radiation (Sylvia and Lorrainne, 2003).
Incident cases of hepatitis A is influenced by age, race (tribe), socio-economics and geography of a region.  The biggest incident was found at age <15 years.  Lali men have a higher risk than women.  More often attack humans with low body resistance, though the disease is more frequently found in adults than children.  The report on the epidemic are often found in institutional, military barracks, restaurants and child care center. (Rahardjo, BS, 2003)
The spread of HAV from person to person enhanced by poor personal hygiene and overcrowding, as well as in the case of sporadic attacks on the food on a large contaminated, drinking water, milk and fish.  The spread on the family and close friends are also common.  Epidemiological observation is estimated that the predilection of hepatitis A occurred in late autumn and early winter, while in temperate regions, epidemic waves of hepatitis A occur every 5 to 20 years in the new population that is not in immunization. (US. Food Drug Administration, 2005)
In developing countries, adults are usually immune and epidemics of hepatitis A (HA) are rare.  However, the improvement of environmental sanitation in most countries in the world was created by the people groups of young adults become more vulnerable to the frequency of outbreaks tends to increase.  In developed countries, disease transmission often occurs because of contacts within the family and sexual contacts of acute cases, and also appeared sporadically in places where child care age peers, attacked the tourists who travel to countries where the disease is endemic, attacked users of injection drug addicts and homosexual men.  Areas with lower environmental sanitation, infection generally occurs at a very young age.  In the United States, 33% of the general population serologically proved to have been infected with HAV.  (Chin J, 2006)
In developed countries with outbreaks often runs very slowly, usually covering a wide geographic area and lasted a few months; outbreaks with a pattern of “common source” to spread rapidly.  In the United States, a national epidemic cycle peak occurred in 1961, 1971 and 1989.  During an outbreak, staff and visitors daycare, men with multiple sexual partners and drug addicts who use injections have a higher risk than the general population infected.  However, nearly half the cases, and the source of infection is unknown. (Chin J, 2006)
The disease is most common among school children and young adults. In recent years, outbreaks of a very broad transmission generally occurs in society, However outbreaks because the pattern of transmission of “common source” related to food contaminated by food handlers and food products contamination still occurs.  Outbreaks have been reported among people who work with primates that live wild. (MOH, 2000)
Humans act as a reservoir, is rare in chimpanzees and other nonhuman primates.  (Chin J, 2006)
Modes of Transmission From person to person through the faecal-oral route, food.  Parenteral transmission through water and are rarely found.  (Sylvia and Lorrainne, 2003). The virus found in feces, reaching a peak 1-2 weeks before the onset of symptoms and decreases rapidly after liver dysfunction symptoms coincided with the appearance of circulating antibodies to HAV.  (Chin J, 2006)
Source of outbreaks with a pattern of “common source” is generally associated with contaminated water, food contaminated by food handlers, including foods that are not cooked or cooked foods that are not managed well before serving, because eating shellfish (squid), raw or not cooked from water contaminated and therefore consuming contaminated products such as salad (lettuce) and strawberries.  Several outbreaks in the United States and Europe associated with the use of illegal drugs with mauoun syringes without needles among addicts.  Although rare, has been reported of transmission through transfusion of blood and blood clotting factors derived from the donor viremik within the incubation period. (Chin J, 2006)

Incubation period
Incubation of viral hepatitis occurred during 15-45 days, average 28-30 days after exposure to the virus.  The virus is confined to replicate in the liver, but also found in other organs such as gallbladder, blood and bone after an incubation period of the disease (Sylvia and Lorrainne, 2003).
Period and Risk of Transmission
From various studies on ways of transmission to humans and from various epidemiological evidence indicates that maximum infectivity occurred in the last days of half of the incubation period and continues for a few days after onset of jaundice (or at the peak of aminotransferase activity in anicteric cases).  Most cases are probably noninfectious after the first week of jaundice, although the virus excretion lasts longer (up to 6 months) have been reported to occur in infants and children.  Chronic shedding of HAV in feces does not occur.  (Chin J, 2006)
The risk of transmission occurs in poor sanitation, crowded areas such as polyclinics, psychiatric hospital, infected food services, health care workers, international travelers, drug users, sexual contact with people infected and endemic areas (Sylvia and Lorrainne, 2003).
Susceptibility and resistance
Everyone is susceptible to infection.  This disease in infants and preschool children rarely show clinical symptoms, this as evidence that mild and anicteric infections are common.  Homologous immunity after infection probably lasts a lifetime.  (Chin J, 2006)

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