Viral hepatitis A (epidemic hepatitis, infectious hepatitis) is an acute viral infectious disease with a good prognosis, with rare complications and low mortality.  The disease is transmitted by the faecal-oral route(way). It is a contagious disease that can occur sporadically or in epidemic form, especially in poor sanitary and hygienic conditions, after floods or other natural disasters.

Infectious jaundice occurs in all parts of the world, but endemic (continuous presence), with occasional outbreaks more common in less developed or underdeveloped countries in the world (eg. Countries of Africa, the Middle and Far East, South and Central America ). In developed countries, viral hepatitis A affects all age groups, with(where) the child’s age is the most typical. Also, outbreaks in developed countries develop gradually and cover larger geographical areas and last for several months. Every fourth epidemic have not determined the source of infection.

In temperate climate areas there is a marked seasonal dynamics in the emergence of this disease (most of the patients are registered in late summer and early fall).


Hepatitis A virus RNA belongs to the family Picornaviridae, which is similar to enteroviruses by their morphological and biochemical properties.

Reservoir of infection

The only reservoir of viral hepatitis A is the man, whether(whenever) he’s diseased with typical , atypical clinical or asymptomatic form of disease. The virus can be found in the stool(stolica-gomno), blood, bile, and rarely in the urine of the patient.

Period of communicability (infection)

Diseased (The ill-bolniot) is infected during the second half of the incubation period, and with the occurrence of jaundice the infection begins to reduce, (In reference to/concerning,in regard to )or for several days after the onset of jaundice.

Route(The way/manner) of transmission

The main route of transmission is faecal-oral route of transmission from human to human (disease of dirty hands) or by direct contact, which is accomplished through hands contaminated with feces containing the virus. Also, the infection is transmitted by indirect contact through contaminated things(objects) for personal or general use.

Children are most susceptible to this type of infection, and  the infectious hepatitis usually has a milder and shorter course. The emergence of viruses depends on the sanitary conditions of the environment, hygiene habits and the size of the group with who is in close contact (family, pre-school, school etc..). Unlike countries with low hygienic standards, hepatitis A in developed countries with better socio-economic conditions of life occurs in older categories.

An important way of conveying is water, especially in circumstances of bad water suplying - водоснабдување ((individual water facilities and smaller-controlled irregular water supply, particularly(especially) after major flooding or damages). Then Hepatitis A usually appears in the form of massive epidemics with explosive character and affects all age groups.

The Food is the rarest transmitting, usually one that is not cooked (eg. Salads, sandwiches, fruit, seafood, etc..) Or cooked food which  is secondary contaminated by those who handle food (it is important to go to health control persons who are working with food!).

Sensitivity and immunity

Susceptibility(sensitivity) is general. Immunity acquired after прележаното having a disease is permanent, and possibly lifelong.

Clinical picture and course of the disease

Incubation time that passes from the moment of entry of the virus into the body until the appearance of the first symptoms of the disease ranges from 15 to 50 days (usually 30 days).

Symptoms of the disease include: fever, weakness, loss of appetite, nausea and vomiting, and sometimes diarrhea. You may experience pain below the right costal arch, and after a few days of the first symptoms it is noticed dark urine (the color of the beer), chair with bright color and appearance of yellowing of skin and whites of the eyes. Usually, symptoms disappear within 1-2 weeks, but complete recovery takes a longer period of time (4-6 weeks).

The disease may have a different clinical course from asymptomatic forms (especially important for the spread of infection) or clinically mild to severe, which can last several months, but that is extremely rare. Symptoms of the disease depends on the patient’s condition, and his age. For children especially in the first years of life, the disease is mild, and often goes(passes/resolves) unnoticed. However, infection on/for?? adults can get a more severe form.

The disease usually resolves spontaneously, and never run into a chronic form.

laboratory diagnosis

Infection is confirmed based on the presence of specific antibodies IgM anti-HAV, which affected the blood retained 6-12 months after the first symptoms. The presence of IgG anti-HAV antibodies in serum are indication of a history of hepatitis A or acquired immunity after vaccination against hepatitis A. Laboratory findings showed elevated liver enzymes (AST, ALT) as a result of damage to the liver cells, and elevated bilirubin.


Treatment is symptomatic, and consists reducing of the temperature, maintaining balance of the electorlitis, strictly stationary and appropriate dietary regime.

preventive measures

The primary prevention of hepatitis A is the same as in other intestinal infectious diseases, regular maintenance of personal and general hygiene.

Тhe continuing(-ous) education of the population on the daily maintenance of good hygiene habits is the best way to prevent viral hepatitis A. Proper hand washing with soap and drinking(cista, hemiski ispravna) water after every use of the toilet, before and during food preparation, as well as before any consumption of foods, it is enough to prevent the immediate spread of this infection.

Also, it is important to use hygienic drinking water and to take care of the hygienic disposal of waste(rubbish/sweepings/garbage) products./materials

The disease can be prevented and by giving vaccine against hepatitis A. Vaccination against hepatitis A is recommended for certain classes of citizens, mostly of travelers to endemic areas and in countries with poor hygiene and sanitary conditions, the people who work in food production, people who work in utilities, staff working virus in research laboratories etc.. Systematic vaccination and prophylactic drugs are not implemented.

Measures to combat Outbreaks (epidemic)

It is mandatory(obligatory) to report )reporting of all cases. It implements continuous disinfection (during the period of infectivity) and final disinfection for substances secreted from sick persone and diseased subjects that have been in contact. is home isolation of patients,  is Sufficient, and hospital implemented(care) if there are no opportunities for home care or in case of severe clinical picture.

Conduct epidemiological investigation to determine the mode of transmission of infection, determining the source / sources of contamination and their elimination.