hepatitis- 2

Symptoms:Symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the skin and whites of the eyes). Not everyone who is infected will have all of the symptoms.
Adults have signs and symptoms of illness more often than children. The severity of disease and fatal outcomes are higher in older age groups. Infected children under 6 years of age do not usually experience noticeable symptoms, and only 10% develop jaundice. Among older children and adults, infection usually causes more severe symptoms, with jaundice occurring in more than 70% of cases. Hepatitis A sometimes relapses.
-Who is at risk? anyone who has not been vaccinated or previously infected can get infected with hepatitis A virus. In areas where the virus is widespread (high endemicity), most hepatitis A infections occur during early childhood. Risk factors in intermediate and high endemicity areas include : poor sanitation , lack of safe water, living in a household with an infected person , being a sexual partner of someone with acute hepatitis A infection; and travelling to areas of high endemicity without being immunized
Diagnosis:Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis. Specific diagnosis is made by the detection of HAV-specific Immunoglobulin G (IgM) antibodies in the blood. Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA, and may require specialised laboratory
Prevention :Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A. The spread of hepatitis A can be reduced by
1-adequate supplies of safe drinking water
2-proper disposal of sewage within communities
3-personal hygiene practices such as regular hand-washing with safe water
4 -HA vaccine
Vaccination should particularly be considered in countries with improving socioeconomic status when there is a change from high to intermediate endemicity and when the age of infection shifts to older age group thus increasing the risk of more severe disease and mortality.

Licensed doses and schedules for Havrix

ELU, ELISA units of inactivated hepatitis A virus
# Licensed doses and schedules for Twinrix1 ( The hepatitis A and B combination vaccine (Twinrix®, GlaxoSmithKline)?18 years , 1ml ,3 doses (0,1,6 months)
5- post-exposure prophylaxis : immunoglobulin (IG) & HA vaccine.
Indications : Post exposure prophylaxis should be considered in individuals who have been exposed to HAV and have not previously received hepatitis A vaccine. Such patients should receive a single antigen vaccine or IG (0.02 ml/kg) as soon as possible
(Hepatitis A vaccine or IG should be administered to persons who have close contact with index patients) .For children aged <12 months, immunocompromised persons, persons who have had chronic liver disease diagnosed, and persons for whom vaccine is contraindicated , IG should be used . Recommended doses of immune globulin (IG) to protect against hepatitis