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Health Matters

Hepatitis A

Dr. Luís Lebre . 03/04/2017

Hepatitis A (HAV) is an RNA virus of the Picornaviridae family, which occurs endemically all over the world, but with greater incidence in developing countries where sanitation networks are more scarce.

Almost 100% of children come into contact with the virus before the age of 9, although most cases are asymptomatic. Transmission takes place primarily through faeco-oral contact through faeces, which may include sexual contact, or through infected foods. HAV infection provides lifelong protection.

The disease’s evolution is extremely variable. The vast majority of infected people does not present symptoms, however some may display symptomatic signs such as jaundice, and a small percentage, especially among the elderly, may develop fulminant hepatic failure, which can be fatal. Hepatitis A never becomes chronic, and detection is only possible through blood tests.

In developing countries with a good sanitation network, and except for sporadic cases usually imported from developing countries, hepatitis A is not cause for great concern. However, since 2016, there has been a notable outbreak in the Netherlands with dozens of infected cases, namely in the gay community. This outbreak has spread to other countries such as Germany, Italy, Spain and, in recent weeks, to Portugal, leading to a warning by the health authorities, namely the DGS (national Directorate-General for Health). In Portugal the profile is not very different, mostly afflicting the gay community. It is possible that sexual practises such as chemsex (chemical sex) where drugs like mephedrone and amphetamine crystals are used to enhance sexual performance, which can lead users to stay awake for between 48 and 72 hours, can substantially increase the duration of exposure to the virus in the case of infected partners.

All infected people at risk of developing hepatitis A should be vaccinated, namely those travelling to endemic zones (Africa, Asia, Central & South America, Middle East and parts of Eastern Europe), immune-compromised people, haemophiliacs or other recipients of plasma-derived products, drug addicts and health workers, namely lab workers. In this critical phase, anyone engaging in sexual risk practises should be vaccinated.

Treatment is limited to supportive care and only complications should be treated. Liver transplantation is the best option for fulminant hepatic failure.

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