Three households in Barry, South Wales, have reported cases of the same strain of hepatitis A, public health officials have confirmed. Public Health Wales, working alongside the local health board and council, said the infection pattern suggests the virus may be spreading locally. Those affected are receiving appropriate care and recovering well, the agency added.
As a precaution, vaccination has been offered to people identified as having had close contact with the infected individuals. Public Health Wales has contacted everyone deemed to need a vaccine. The wider public is advised not to contact their GP to request a hepatitis A jab unless they are travelling to a country where the virus is common.
Preventing the spread
Health officials are urging parents in Barry to be “vigilant with their children’s handwashing” to halt further transmission. In a letter being sent to families with children at primary schools in the town, Dr Susan Mably, consultant in health protection for Public Health Wales, stressed that thorough handwashing with soap and water is the single most effective defence. This is critical after using the toilet, after changing nappies, and before preparing or eating food.
Young children infected with hepatitis A may not show any symptoms at all, yet they can still pass the virus to others, who may then become unwell. Parents and carers are being told to help and remind young children to wash their hands properly. The virus spreads via the faecal-oral route – typically through contaminated food or water, or when an infected person fails to wash their hands after using the toilet. Once swallowed, the virus attacks the liver.
In households where someone is infected, extra hygiene measures are recommended. The infected person should not prepare food. Soiled bedding and clothing should be washed on a hot cycle. If multiple toilets are available, the infected person should use one exclusively. Towels should not be shared. Surfaces such as toilet seats, flush handles and taps should be cleaned daily with bleach. When cleaning up diarrhoea or vomit, rubber gloves should be worn, the surface washed with hot soapy water, and disposable cloths used.
Recognising the symptoms
Symptoms of hepatitis A usually appear around four weeks after exposure and can last up to six months, though most people recover within a couple of months. The infection is generally mild, but it can occasionally lead to serious liver problems or liver failure, particularly in older adults or those with pre-existing liver conditions. The fatality rate is around 0.2 per cent, rising to about 1.8 per cent in people over 50.
Dr Mably advised: “If you or your child feels unwell and has symptoms such as a fever, feeling very tired, a loss of appetite, feeling sick or being sick, or have yellow skin or eyes, you should contact your GP or NHS 111 Wales.” A full list of symptoms includes a high temperature; flu-like tiredness, headache and muscle pains; nausea or vomiting; pain in the upper tummy; diarrhoea or constipation; pale yellow or grey poo; dark brown urine; itchy skin, sometimes with a raised rash (hives); yellowing of the skin and the whites of the eyes (jaundice – harder to see on brown or black skin); loss of appetite; headache, sore throat and cough; joint and muscle pain; and a swollen, tender area in the upper right part of the tummy.
There is no specific cure for hepatitis A. Treatment focuses on supportive care: rest, adequate nutrition and hydration. Patients should avoid paracetamol (acetaminophen) and other medications that can harm the liver, and should not drink alcohol until they have fully recovered, to reduce strain on the liver.
Anyone diagnosed with hepatitis A should stay at home and avoid close contact with others for at least seven days after symptoms start or jaundice appears, and until they feel better. They should not go to work, school, or visit friends and family during this period.
Hepatitis A vaccines are not routinely offered on the NHS in the UK because the risk of infection is low – around 20 cases are reported in Wales each year, often linked to travel abroad. The vaccine is available free on the NHS for those at higher risk, including close contacts of a case (within 14 days of exposure), travellers to high-risk countries, people with long-term liver disease, men who have sex with men, people who inject illegal drugs, healthcare and sewage workers, individuals with blood clotting disorders, and those aged 60 and over or with a weakened immune system (who may also be offered human normal immunoglobulin as post-exposure prophylaxis). The vaccine can prevent infection if given within 14 days of exposure. There are three types: hepatitis A only, a combined hepatitis A and B vaccine, and a combined hepatitis A and typhoid vaccine.