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Hepatitis A outbreak: An expert breaks down symptoms, risk and prevention

A hepatitis A outbreak in Minnesota has sickened more than 20 people. We asked Infectious Disease Physician Tyler Bold, MD, PhD, for helpful information about the disease.
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The Minnesota Department of Health has identified an outbreak of hepatitis A in Minnesota affecting more than 20 people across nine counties statewide.

The news is concerning to University of Minnesota Health Infectious Disease Physician Tyler Bold, MD, PhD, but the majority of Minnesotans are not at a substantially higher risk for contracting hepatitis A because of the outbreak, he said. That’s because the virus, which is often passed directly through contaminated food and water, currently appears to be clustered in certain at-risk populations.

“For most Minnesotans, the risk is probably not much higher than it has been in the past,” said Bold, who is a faculty member at University of Minnesota Medical School in the division of infectious disease and international medicine. “Because hepatitis A typically spreads directly from one person to the next, it isn’t often transmitted to widespread groups of many people at one time. But it is still worrisome to see this virus emerging as a potential new threat in Minnesota and other states.”

To help Minnesotans make sense of the hepatitis A outbreak, we asked Bold a few questions about the disease, its symptoms and vaccination prevention. Here’s what he had to say:

University of Minnesota Health experts represent a full range of specialty services, including treatment for hepatitis A, B, and C. Learn more about our care.

What is Hepatitis A?

Broadly, hepatitis is an inflammation of the liver. This condition has many causes. One of those causes is infection with a virus called the hepatitis A virus (HAV). This virus is one of several that can cause hepatitis. Others include hepatitis B (HBV) and hepatitis C (HCV). All types cause damage to the liver over time.

Unlike the other types, which often cause long-term, chronic conditions, hepatitis A is an acute, short-term illness, Bold said. It can range in severity from mild, flu-like symptoms to more advanced cases marked by jaundice—or yellowing of the skin or eyes. In the most severe cases, liver failure can occur. This, if left untreated, can be fatal.

Symptoms include a fever, tiredness or weakness, pain in the stomach area or over the liver, loss of appetite, yellowing of the skin and eyes, itchy skin, dark urine and light-colored stools.

People with flu-like symptoms that linger for more than several days and anyone experiencing jaundice should seek medical attention.

How does it spread?

Unlike a disease like measles, which is highly contagious and can affect large groups of people quickly, hepatitis A most often spreads among clusters of people who have frequent, direct contact with each other – and who may not have access to adequate sanitation. The virus usually enters the body through ingestion of food and water contaminated with tiny, undetectable amounts of fecal matter from an infected person. Unsanitary environments and lack of hand washing contribute to passing of the disease.

“Food preparation in unclean conditions is one of the most common ways it spreads,” Bold said.

Who is at risk?

The chance of acquiring a hepatitis A infection in a cafeteria, daycare, restaurant or other similar environment is not high at this time, Bold said.

People living in unsanitary conditions or in close confines with others are at greatest risk. So are people who use intravenous drugs and men who have sex with men, Bold said.

The majority of people who contract hepatitis A may mistake it for the flu, Bold said. That’s because many cases are relatively mild, and the body is able to fight it off. However, a smaller percentage of cases can cause significant liver damage or even liver failure.

“It’s hard to predict who will have this higher level of severity,” Bold said. “But the main risk factor for severe hepatitis A is a pre-existing liver disease or simultaneous infection with another hepatitis strain.”

Layering of hepatitis A on top of chronic hepatitis B or C can quickly compound the effects of the viruses, Bold said.

“For people with hepatitis B or C, a new hepatitis A infection can be devastating,” Bold said. “People who should definitely be vaccinated against hepatitis A include those with liver disease or chronic hepatitis B or C infections.”

What about prevention?

Fortunately, the vaccine for hepatitis A is very safe and highly effective—one of the best vaccines available today. It has an efficacy of 94% or higher after two doses, according to the Centers for Disease Control. Hepatitis A vaccination has been standard for all children since 2006. If a family has received regular pediatric care and has followed the recommended vaccination series, the risk is very low.

“If parents are concerned about whether or not their children are protected, and their children have gone through a normal vaccination series, the answer should be ‘yes,’” Bold said.

However, teens and many adults born before 2006 may not have received the vaccine unless they have traveled outside of the country to areas where the virus is more prevalent, Bold said.

The easiest way to prevent hepatitis A spread, Bold said, is to ensure proper hand-washing and sanitary conditions—particularly when cooking or consuming foods or liquids.


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