Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Hepatitis A

(Hep A)
by Rick Alan
Definition

Hepatitis A is an infection of the liver. It is caused by the hepatitis A virus.

Causes

This virus is usually found in the stool (feces) of people who have the infection. It is spread by:

  • Drinking water contaminated by raw sewage
  • Eating food contaminated by the hepatitis A virus, especially if it has not been properly cooked
  • Eating raw or partially cooked shellfish contaminated by raw sewage
  • Putting something in your mouth that has been infected with the hepatitis A virus
  • Sexual contact with a partner infected with the hepatitis A virus, particularly anal sex
Risk Factors

Risk factors for hepatitis A include:

  • Being in daycare centers
  • Being institutionalized
  • Having close contact with an infected person—although the virus is generally not spread by casual contact
  • Having sex with a partner who has hepatitis A
  • Having sex with multiple partners
  • Injecting drugs—especially if you share needles
  • Receiving plasma products (such as people with hemophilia)
  • Traveling to or spending long periods of time in a country where hepatitis A is common or where sanitation is poor
  • Using household items that were used by an infected person, and were not properly cleaned
  • Working as a childcare worker, changing diapers or toilet training children
Symptoms

Hepatitis A does not always cause symptoms. Adults are more likely to have them than children.

Symptoms include:

  • Abdominal pain or discomfort
  • Darker colored urine
  • Fever
  • Itching
  • Jaundice (yellowing of the eyes and skin)
  • Light or chalky colored stools
  • Loss of appetite
  • Muscle pain
  • Nausea
  • Rash
  • Tiredness
Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

  • Liver biopsy —removal of a sample of liver tissue to be examined, only done in severe cases
  • Blood test—to look for hepatitis A antibodies (proteins that your body has made to fight the hepatitis A virus)
  • Liver function studies
Treatment

There are no specific treatments. The goals of hepatitis A treatments are to:

  • Help you stay as comfortable as possible
  • Prevent more liver damage—prevent stress on the liver while it's healing by helping the patient avoid substances (eg, medications, alcohol)
  • Prevent the infection from being passed to others

The disease will usually go away without treatment within 2-5 weeks. About 15% of people who are infected by hepatitis A will have relapsing symptoms. This can happen for up to nine months. In almost all cases, once you recover, there are no lasting effects. You will also be immune to the virus.

In rare cases, the infection is very severe. A liver transplant may be needed.

Prevention
Proper Sanitary Habits
  • Avoid using household utensils that a person with hepatitis A may touch.
    • Make sure all household utensils are carefully cleaned
  • If you travel to a high risk region, take the following precautions:
    • Avoid ice chips
    • Drink bottled water
    • Eat well-cooked food
    • Wash the fruits well
  • Avoid injected drug use. If you do, do not share needles.
  • Avoid sexual contact with a person with hepatitis A.
  • Wash your hands with soap and water before eating or preparing food.
  • Wash your hands with soap and water. This is very important after using the bathroom or changing a diaper.
Vaccination or Immune (Gamma) Globulin

This contains antibodies that provide temporary protection from hepatitis A. It can last about 1-3 months. It must be given before exposure to the virus or within two weeks after exposure.

Hepatitis A Vaccine

This vaccine is made from inactive hepatitis A virus. It is highly effective in preventing infection. It provides full protection four weeks after the first injection. A second injection provides protection lasting up to 20 years.

The vaccine is also used after exposure. If given within two weeks, it can prevent disease.

The vaccine is recommended for:

  • People traveling to areas where hepatitis A is prevalent (The CDC's Traveler's Health website shows which areas have a high prevalence of hepatitis A.)
  • People with blood-clotting disorders, like hemophilia
  • All children aged 12-24 months
  • Children aged 23 months or older living in high-risk areas
  • Injection drug users
  • Men who have sex with men
  • People who desire immunity to hepatitis A
  • People who will have close contact with an adopted child from a medium- or high-risk area
  • People with chronic liver disease

Check with your doctor to see if you should receive the vaccine.

Last reviewed: March 2011 by David L. Horn, MD, FACP.

RESOURCES:
CANADIAN RESOURCES
References:
  • Baker CJ, Pickerling LK, Chilton L, et al; Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2011. Ann Intern Med . 1 Feb 2011. 154(3):168-173.
  • Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years —United States, 2011. MMWR 2011;60(5).
  • Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR 2010;59(No. RR-12):1-110.
  • Hepatitis A: questions and answers. Immunization Action Coalition website. Available at: http://www.vaccineinformation.org/hepa/qandavax.asp . Updated May 2008. Accessed January 21, 2009.
  • Hepatitis Foundation International website. Available at: http://www.hepfi.org .
  • The Merck Manual of Medical Information . Simon and Schuster, Inc.; 2000.
  • National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ .
  • 9/25/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for use of hepatitis A vaccine in close contacts of newly arriving international adoptees. MMWR Morb Mortal Wkly Rep . 2009;58:1006.