Arkansas is experiencing an outbreak of Hepatitis A, with 421 confirmed cases and three deaths to date, according to the Arkansas Department of Health (ADH). The ADH has tracked the first outbreak to Northeast Arkansas in February 2018. It has since spread to other parts of the state.

Part of the reason for the rapid spread of this disease may be that it’s not diagnosed correctly. During ADH’s case investigations of the most recent Hep-A outbreak, many patients said they had visited multiple doctors for their symptoms before they were correctly diagnosed. Half of these patients required hospitalization.

Causes of Hep-A

Hepatitis-A is caused by the Hepatitis-A virus (HAV). This very contagious disease causes inflammation of the liver and can affect your liver’s ability to digest food, store energy and remove poisons from your body. Inflammation and infection can affect its proper functioning.

Hep-A is spread through touching objects, or consuming food or water that has been contaminated by a small amount of feces. Contamination of food (including frozen and undercooked food) by Hep-A can happen at any point: growing, harvesting, processing, handling and after cooking. A significant number of cases are traced to the failure to wash hands after going to the bathroom and then preparing or serving food. It can also be spread after close personal contact with an infected person such as through sex or caring for someone who is ill.

Most Hep-A cases cause a short-term infection with mild symptoms, lasting a few weeks. Some Hep-A infections can be severe, lasting several months. In rare cases it can cause liver failure or death. Severe cases are more common in older people and those with other liver diseases.

Symptoms

Symptoms of Hep-A include:

  • Fever
  • Fatigue
  • Jaundice (yellowish skin and eyes)
  • Lack of appetite
  • Nausea or stomach pain
  • Vomiting
  • Diarrhea
  • Body or joint aches
  • Dark urine
  • Clay-colored stools

Milder symptoms usually go away within two months of infection. Because Hep-A symptoms overlap the symptoms of many other common illnesses, it can be difficult to correctly diagnose Hep-A. Children younger than age 6 rarely have symptoms. Your doctor or other medical provider should use the Hepatitis A IgM test to diagnose the disease.

Prevention

The Hep-A vaccine is 95% effective and provides protection for about 20 years. This vaccine is a great example of the value of prevention. Since the Hep-A vaccine was introduced in 1996, the number of annual cases in the United States has dropped from 31,000 to less than 1,500.

If you have been exposed to Hep-A, get a vaccination within two weeks of exposure for the most protection. However, symptoms start anywhere from two to seven weeks after exposure. That means most people will not know they have the virus during the two-week vaccination window. If you have ever had Hep-A, you have a lifetime immunity that protects against reinfection.

The ADH strongly recommends testing for Hepatitis B and C and HIV for anyone getting a Hep-A vaccine after exposure. These diseases can make a person who has an active case of Hep-A much sicker.

Even if you have not been exposed to Hep-A, everyone at risk of getting it should be vaccinated. People who have any of the following are at high risk of getting Hep-A:

  • Traveling abroad to areas with poor sanitation practices
  • Long-term liver disease
  • Illegal drug use, including drugs injected with a needle
  • Homelessness
  • Men who have sex with men
  • Blood clotting problem
  • Hepatitis B or C, or HIV/AIDS diagnosis
  • Infection of skin or soft tissue
  • Have osteomyelitis or endocarditis

Routine Hep-A vaccinations are recommended for all children at age 1. Routine vaccination requires two shots, given six months apart. The second shot results in long-term protection. Some shots combine the Hep-A and Hep-B shots. There is no vaccine for Hep-C.

HAV can survive outside the body for months. Boiling or cooking food or liquids for at least one minute at 185 degrees will kill the virus. However, freezing temperatures will not kill HAV. A person can transmit HAV to others for up to two weeks before their symptoms appear.

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