Viral hepatitis is a major public health concern in the United States. While the hepatitis A virus (HAV) is heat-stable and will survive for up to a month at ambient temperatures in the environment, hepatitis A is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water.
Hepatitis A may be spread by household contact among family members or roommates, sexual contact, by the ingestion of contaminated water, by the ingestion of raw or undercooked fruits and vegetables or shellfish (like oysters), and by direct inoculation between illicit drug users. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play, either to other children or to their parents, who may later become infected from contact with their children. Link to person to person
Food can become contaminated with hepatitis A in a number of ways, including, for fresh produce, exposure to hepatitis A-contaminated flood or irrigation water and contamination by infected field workers who are shedding hepatitis A in their stool and do not practice proper hand-washing techniques. Link to fresh produce
Outbreaks associated with food contaminated by infected food workers have been increasingly implicated as a significant source of hepatitis A infection. Hepatitis A-infected food workers who do not follow proper food safety procedures and practice proper sanitation have been identified as the source of past hepatitis A outbreaks among restaurant patrons. Link to restaurants
Symptoms of hepatitis A infection typically begin about 28 days after exposure, but can begin as early as 15 days or as late as 50 days after. Symptoms include muscle aches, headache, anorexia (loss of appetite), abdominal discomfort, fever, and malaise. A person sheds the hepatitis A virus even before the onset of symptoms, thereby leaving a large window for infected individuals who do not adequately wash their hands and spread the virus before knowing they are ill. When jaundice, a yellowing of the skin and eyes, sets in, the initial systemic manifestations typically begin to subside. Most people remain infectious, shedding hepatitis A virus in their stool for approximately one week after first becoming jaundiced.
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