How Do You Die from Hepatitis A?

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A woman in Australia died after eating frozen pomegranate seeds that were linked to an outbreak of hepatitis A, health officials announced this week.

The 64-year-old woman's death is the first in the hepatitis A outbreak tied to pomegranate seeds that has sickened 24 people in Australia, according to SA Health, the public health system in South Australia. Although the product tied to the outbreak — packets of Creative Gourmet's frozen pomegranate arils — was recalled two months ago, it can take up to seven weeks for people to show symptoms of the viral illness after they've been infected, SA Health said in a June 5 statement.

But how do you die from a hepatitis A infection?

Hepatitis A is a contagious liver infection caused by the hepatitis A virus, according to the U.S. Centers for Disease Control and Prevention (CDC). The virus attacks and destroys liver cells, said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, who was not involved in the Australia case. The vast majority of people with hepatitis A have only mild symptoms and recover completely from the infection without incurring lasting damage to their liver, he said. [27 Devastating Infectious Diseases]

But a small proportion of people, about 1 in every 250 people with hepatitis A (0.4 percent), develop life-threatening complications from the infection, such as liver failure, according to the United Kingdom's National Health Service (NHS).

People who die from a hepatitis A infection usually have an underlying liver disease, such as an infection with the virus hepatitis B or C, or alcoholic liver disease, that already caused damage to their liver.

"If you have hepatitis C and are infected with hepatitis A on top of that, that could lead to a fatal infection," Adalja told Live Science. It's unclear, however, if the woman in Australia had an underlying liver disease.

Several recent U.S. outbreaks of hepatitis A, which have affected primarily the homeless population and illicit-drug users, have had relatively high death rates. For example, an outbreak in Michigan has been linked with 838 cases of illness and 27 deaths since August 2018, meaning the death rate is 3.2 percent, according to the Michigan Department of Health and Human Services. This higher death rate may be because this population has higher rates of both hepatitis C and alcoholic liver disease, Adalja said.

Liver damage can be fatal because the liver is "one of the most vital organs that you have," Adalja said. It's responsible for many functions, including clearing toxins from the body and making compounds that help blood clot.

Because people with underlying liver disease are at higher risk for complications from hepatitis A, it's very important that they be vaccinated against hepatitis A virus, Adalja said.

Symptoms of hepatitis A infection usually don't appear until two to six weeks after a person has been infected, and include fever, fatigue, nausea, vomiting, dark-yellow urine, joint pain and jaundice (a yellowing of the skin and eyes), according to the CDC.

Original article on Live Science.

Rachael Rettner

Rachael is a Live Science contributor, and was a former channel editor and senior writer for Live Science between 2010 and 2022. She has a master's degree in journalism from New York University's Science, Health and Environmental Reporting Program. She also holds a B.S. in molecular biology and an M.S. in biology from the University of California, San Diego. Her work has appeared in Scienceline, The Washington Post and Scientific American.