Hepatitis A

What is hepatitis A?#

Hepatitis A is a viral disease that affects the liver. The virus is highly infectious and spreads when traces of faeces (stools) containing the virus contaminate hands, objects, water or food.

Anyone can be at risk of hepatitis A by swallowing food or drink contaminated with the virus by a person who has the infection. Outbreaks have been linked to contaminated foods such as shellfish, and to particular groups, including people experiencing homelessness, people who inject drugs, and men who have sex with men. Hepatitis A is more common in places with limited access to clean water and sanitation.

Outbreaks in childcare settings#

Outbreaks can occur in childcare centres. Children under five years of age often show no symptoms but can still infect childcare workers or other children, for example during nappy changes. The first sign of an outbreak is usually when a parent or childcare worker becomes sick.

Symptoms#

You can become ill any time between two and four weeks after coming into contact with the virus. The average incubation period (the time between infection and symptoms appearing) is about 28 days.

Many infected people, particularly children under five, show few or no symptoms. For older children and adults, symptoms can include fever, nausea, abdominal discomfort and pain, dark urine, and yellow skin and eyes (jaundice). Symptoms may last for several weeks.

Most people recover fully. A single infection leads to lifelong immunity. Previous infection with hepatitis B or hepatitis C does not protect against hepatitis A. Around 10% of people experience a relapse (become unwell again), but most who relapse still recover fully.

The illness tends to be more severe in older age groups and in people with existing liver disease. Complications are rare, but the infection can occasionally lead to fulminant hepatitis, an acute form that can cause liver failure. The risk of death from fulminant hepatitis increases with age. Hepatitis A does not cause chronic (long-lasting) liver disease or cirrhosis.

How hepatitis A spreads#

The virus can survive for several hours outside the body, and longer on the hands and in food. It is resistant to heating and freezing.

It spreads when it enters the mouth, which can happen when hands, food or other items are contaminated with the faeces of an infected person. It can also be spread through anal sexual contact.

A person with hepatitis A is infectious from about two weeks before symptoms appear until one week after they become jaundiced. If there is no jaundice, they may pass on the virus for up to two weeks after symptoms first appear (about four weeks in total). Caution is advised beyond this period, as the virus can still be shed in stools for longer.

Protecting yourself and others#

The most important action you can take is to get vaccinated. Strict personal hygiene is also essential. Steps you can take include:

• washing your hands with soap and hot running water before handling food, after going to the toilet, and after handling used condoms or having contact with nappies or another person’s anal area
• using a clean towel to dry your hands
• using barrier protection (such as dental dams) during oral-anal sex
• avoiding sex with someone who has hepatitis A
• cleaning bathrooms and toilets often, paying attention to toilet seats, handles, taps and nappy change tables
• boiling your drinking water if it comes from an untreated source, such as a river

Vaccination may prevent illness if given within two weeks of contact with an infectious person.

If you have hepatitis A:

• do not prepare food or drink for other people
• do not share eating or drinking utensils, linen or towels
• do not have sex
• wash eating utensils in soapy water, and machine wash linen and towels

Household contacts and sexual partners of an infectious person may need to be immunised. Everyone who has hepatitis A should check with their doctor before returning to work or school. People who handle food or drink, whose work involves close personal contact (such as child carers and health workers), or children who attend childcare facilities, have an increased risk of passing it on and must check with their doctor first.

When travelling#

If you are travelling to areas where hepatitis A is widespread, take special care. Talk to your doctor about immunisation before you go, and select and prepare food and drink carefully. Suggestions include:

• only drink bottled water with an unbroken seal, and avoid unpackaged drinks or ice
• avoid raw food, such as fruit or salad, that may have been washed or prepared with contaminated water
• avoid uncooked vegetables and fruit you have not peeled, prepared or boiled yourself
• avoid raw or undercooked meat and fish
• make sure cooked food is hot and eat it straight away
• avoid shellfish, unpasteurised dairy products and food from street vendors

Diagnosis and treatment#

Diagnosis is based on your medical history (including immunisation status and travel history), a physical examination and a blood test sent to a laboratory to confirm the diagnosis.

There is no specific treatment for hepatitis A. In most cases the immune system clears the infection and the liver heals completely. Treatment aims to ease symptoms and reduce the risk of complications. Options may include:

• Rest – hepatitis A can leave you tired and lacking energy, so rest when you can.
• Eat small meals often – nausea can affect your appetite, so eat small amounts of high-calorie food often if nausea is a problem.
• Drink fluids to stay hydrated.
• Protect your liver – the liver processes medication and alcohol, so avoid alcohol and review any medication with your doctor.

If you have been in contact with someone with hepatitis A and you are not immune (you have not been immunised or had a previous infection), speak with your doctor about your options.

Immunisation#

Immunisation is the best protection against hepatitis A and is recommended for people in high-risk groups, and for unvaccinated people who have been in close contact with someone who has the infection.

Immunisation involves a course of injections over a 6 to 12-month period. Healthy people aged 12 months and over receive two doses, or three doses if hepatitis A and hepatitis B vaccines are given as a combination. If the recommended time frame has passed, you do not need to start the course again; you can simply complete any missed doses.

Babies under 12 months and people with a weakened immune system who are in close contact with an infected person can instead have an injection of normal human immunoglobulin (also called passive immunisation).

Immunisation is generally recommended for high-risk groups, which may include:

• people aged 12 months and over travelling to places where hepatitis A is common (endemic)
• plumbers and sewage workers
• people who work with children or with people with developmental disabilities
• people with developmental disabilities
• people with liver disease, a liver transplant, or chronic hepatitis B or hepatitis C
• people who inject drugs
• people who have anal intercourse, including men who have sex with men
• some populations who live in areas of higher risk

Remember that immunisation against hepatitis A does not protect you against hepatitis B or hepatitis C. Speak with your doctor if you are not immune and are at increased risk, or if you have a condition such as liver disease.

Hepatitis A immunisation is not usually recommended during pregnancy. Before receiving the vaccine, tell your doctor or nurse if you (or your child):

• are pregnant or intend to become pregnant
• are unwell (temperature over 38.5°C)
• have allergies to other medications or substances
• have had a serious reaction to any vaccine or vaccine component
• have had a severe allergy to anything
• have a condition, or are having treatment, that lowers immunity
• are taking any prescription or over-the-counter medications

Side effects of immunisation#

For most people, the chance of a serious side effect from a vaccine is far lower than the chance of serious harm from catching the disease. Common side effects are usually mild and temporary, occurring in the first few days, and may include pain, redness and swelling at the injection site, a low-grade fever, and headache. Specific treatment is not usually required.

To manage side effects:

• drink extra fluids and do not overdress if you have a fever
• although routine use of paracetamol after vaccination is not recommended, if fever is present paracetamol can be taken – check the label for the correct dose, or ask your pharmacist (especially for children)
• use paracetamol if needed to ease soreness, redness, itching, swelling or burning at the injection site, which may last a day or two

Sometimes a small, hard lump (nodule) at the injection site can persist for some weeks or months. This is not a cause for concern and needs no treatment.

There is a very small risk of a serious allergic reaction (anaphylaxis) to any vaccine. This is why you are advised to stay at the clinic for at least 15 minutes after immunisation, in case further treatment is needed. If a side effect is unexpected, persistent or severe, or if you are worried about yourself or your child after a vaccination, see your doctor or immunisation nurse as soon as possible, or go directly to a hospital. It is important to seek medical advice if you are unwell, as this may be due to another illness rather than the vaccination.

Key points#

• The average incubation period (the time between infection and symptoms appearing) is about 28 days.
• Many infected people, particularly children under five, show few or no symptoms.
• For older children and adults, symptoms can include yellow skin and eyes (jaundice).
• Symptoms may last for several weeks.
• The infection can rarely lead to fulminant hepatitis, an acute form that can cause liver failure.

Where to get help#