Hepatitis A

In food and water

The hepatitis A virus is frequently transmitted by eating contaminated foods, such as salads and vegetables that were grown using faeces as a fertiliser, or seafood such as mussels or oysters. Pathogens can also get into food from unwashed hands, for example when preparing meals. Dirty drinking water or bathwater can also be a source of infection.

From person to person

Transmission from one person to another is possible if they are in close contact, for example a shared household or childcare facilities. In such cases, the pathogens are spread by smear infection through tiny traces of faeces on hands or objects.

Infection can also result from sexual contact, generally oral-anal practices or if fingers come into contact first with the anus and then the mouth.

Transmission through blood and blood products is also possible.

Anybody who has not been infected previously and people who are not sufficiently protected by a full vaccination can contract hepatitis A. The risk of a hepatitis A infection is particularly high amongst the following groups of people:

• Travellers to regions in which hepatitis A is widespread,
• People in close contact with hepatitis A sufferers.

Older people and those with pre-existing liver conditions are at higher risk of developing serious illness.

• There is no specific treatment for hepatitis A. It is only possible to alleviate symptoms such as vomiting or flu-like symptoms.
• In the acute phase of the illness, you should avoid physical exercise wherever possible. Depending on the severity of the symptoms, staying in bed may be useful.
• In the initial phase of the illness, you should eat high-carb and low-fat foods.
• It is particularly important to avoid alcohol.
• Avoid taking any medicines that could place a strain on your liver unless advised to do so by a doctor.
• Wash your hands regularly and thoroughly, especially after going to the toilet, before preparing food and before eating. After washing, dry your hands with your own personal towel or disposable paper towels.
• If possible, use your own toilet.
• Keep as far away as possible from other people for the first two weeks after the first symptoms appear and up to one week after contracting jaundice.
• Do not prepare meals for others if you are infected yourself.
• The provisions of the German Law on the Prevention and Control of Infectious Diseases apply to hepatitis A. People suffering from or thought to be suffering from hepatitis A must not visit or work in community institutions such as schools or nurseries. This also applies to anyone living in a residential community in which there is an actual or suspected case. Affected persons must notify their residential community of the infection. Your attending physician or the competent health authority will decide when you can return to work or resume visits to community institutions.
• Anybody who comes into contact with certain foods as part of their job has to temporarily stop work while suffering from hepatitis A. This also applies as soon as there is any suspicion of hepatitis A.

Vaccination

• Vaccinations against hepatitis A are available. The German Standing Committee on Immunisation recommends vaccination for people at risk, in particular for:
• People at a high risk of infection due to their sexual behaviour (e.g. men who have sex with other men),
• People suffering from diseases of the liver or diseases that affect the liver,
• People who receive frequent transmissions of blood components (e.g. in haemophilia),
• Drug users who use needles,
• People undergoing treatment in psychiatric or similar care facilities,
• People at a greater risk of infection as a result of their occupation or voluntary activities (e.g. healthcare professionals, employees of community institutions and those in contact with wastewater, e.g. in sewerage facilities and wastewater treatment plants),
• Travellers to regions in which hepatitis A is widespread.

Unprotected people who have had contact with hepatitis A sufferers should preferably be vaccinated within 14 days. People who are at an increased risk will also be given immunoglobins.

Hygiene

• Observe strict hygiene measures if you come into contact with sufferers:
• Wash your hands regularly and thoroughly.
• If caring for an infected person, you should wear disposable gloves.
• Pay attention to cleanliness, especially in the toilet area and kitchen.
• It may be wise to use special “virucidal” disinfectants, as long as they are recommended by your health authority or doctor.

When travelling to areas in which hepatitis A is widespread, you should observe thorough hand and sanitary hygiene and ensure good food hygiene:

• Drink bottled or boiled water.
• Eat only food that has been cooked thoroughly wherever possible.
• Raw fruits and vegetables should be freshly peeled.
• Avoid raw salads and juices.

Your local health authority can provide further advice. Because hepatitis A is a notifiable disease, you will also find information there on the current situation and a great deal of experience dealing with the illness.

You can find additional (specialist) information on the website of the Robert Koch-Institut (www.rki.de/hav). Travellers should also pay attention to the advice of the Auswärtiges Amt (www.auswaertiges-amt.de).

Further information about infection protection through vaccination is available on the website of the Bundeszentrale für gesundheitliche Aufklärung (www.infektionsschutz.de).