What is hepatitis A?
Hepatitis A is a liver disease that is caused by the hepatitis A virus (HAV). Hepatitis means inflammation of the liver and there are many types of this condition. Hepatitis A is very contagious. In fact, it was previously called infectious hepatitis.
How common is hepatitis A?
In the U.S. in 2017, there were about 6,700 reports of hepatitis A infection. This was the year that large person-to-person outbreaks began occurring among certain populations, such as those using drugs and those experiencing homelessness.
How do you get hepatitis A?
Hepatitis A can be spread by sexual contact with an infected person or close personal contact (like taking care of an infected person). However, it is most often spread by what scientists call the ‘fecal-oral’ route. This happens when one person eats or drinks something that has small amounts of fecal matter (stool) from another person who has hepatitis A. This can happen by touching something that has the virus on it and then putting your hands in your mouth. It can happen when food is grown, picked, processed or served. Water can also be contaminated.
Mothers do not pass on hepatitis A in breast milk. You cannot be infected with HAV by sitting near to or hugging someone with hepatitis A. It does not spread through coughs or sneezes.
Who is likely to be affected by hepatitis A?
Certain people are more at risk than others for hepatitis A. These include:
- People who use recreational drugs, both injected and non-injected types.
- Men who have sex with men.
- People who have close contact with someone who already is infected.
- People who have close contact with someone adopted from a country where hepatitis A is common, or people who travel to countries where hepatitis A is common.
- People who work with non-human primates.
- People who have clotting factor issues, including hemophilia.
- People who work in child care, or children who are in childcare.
Symptoms and Causes
What causes hepatitis A?
Hepatitis A is caused by the hepatitis A virus (HAV). The virus is spread when one person ingests (puts into their mouth) tiny unseen pieces of fecal matter from an infected person. It takes about two to seven weeks after exposure to the virus for symptoms to start.
Water and ice can be contaminated with HAV. Raw shellfish from contaminated water can cause hepatitis A, as can other foods that are not cooked, such as fruits and vegetables.
When will symptoms appear after you have been exposed to HAV?
It generally takes about 4 weeks for symptoms to appear, but they can start at 2 weeks or they can start up to 8 weeks after you have been exposed. You probably won’t get every symptom immediately, but they tend to emerge over days.
Also, you can have no symptoms and have the virus and be contagious. Children especially may be free of symptoms despite being infected.
What are the symptoms of hepatitis A?
Symptoms of hepatitis A may include:
- Fatigue, joint pain.
- Stomach pain, vomiting, loss of appetite.
- Diarrhea, stools that are light in color (‘normal’ stools are shades of brown).
- Jaundice, which means that skin and eyes are yellow. This happens primarily to older children and adults. Kids younger than 6 years old do not generally have jaundice.
- Urine that is dark yellow in color.
Diagnosis and Tests
How do you know if you have hepatitis A?
If you find you have symptoms of hepatitis A or you know you have been in close contact with someone who has hepatitis A, you should contact your healthcare provider.
How is hepatitis A diagnosed?
Your healthcare provider will listen to your symptoms and will take a blood test to confirm the diagnosis of hepatitis A. If the test finds immunoglobulin M (IgM) antibodies, you have an acute hepatitis A. If there are antibodies, but not IgM antibodies, you are immune to the virus either because you had a case of it and recovered, or you got the hepatitis A vaccine.
Management and Treatment
What are the treatments for hepatitis A?
If you have not had the vaccine, and your infection has been confirmed by a blood sample, your healthcare provider might give you the hepatitis A vaccine or immune globulin (IG). This only works if the medicine is given within two weeks of you being exposed to HAV.
If you were exposed and are unable to get the vaccine or the immune globulin, you are likely to recover without treatment. However, your healthcare provider will probably recommend that you follow the following self-care recommendations:
- Get plenty of rest.
- Drink liquids.
- Eat a healthy diet.
- Avoid alcohol.
- Review any type of medicine—prescription and over-the-counter—that you take with your healthcare provider. Even things like supplements or vitamins could cause damage to your liver.
How can you prevent hepatitis A?
There is a vaccine, made from an inactivated—dead—virus to prevent hepatitis A. If you are not sure you have had the vaccine, you can ask your doctor to test you to see if you have been vaccinated.
You can also practice good hand washing hygiene. Make sure you use soap and warm water to wash your hands for at least 15 to 30 seconds after you use the toilet, change diapers, and before and after touching food.
If you are traveling in another country, especially a developing country, drink only bottled water and use only bottled water to brush your teeth, wash your produce, and freeze for ice cubes.
Who should get the hepatitis A vaccine?
The Advisory Committee on Immunization Practices (ACIP) recommends that all children in the U.S. get vaccinated against hepatitis A at age 12 months. However, if an infant aged 6-11 months will be traveling to a country with a significant number of people with hepatitis A, the child should get one dose before leaving the U.S. The child should then get 2 doses separated by 6 to 18 months when the child is between 12 months and 23 months.
You should also get the hepatitis A vaccine if you fall into one of the following groups:
- Men who have sexual contact with other men.
- Users of any type of illegal drugs.
- People with blood clot disorders, such as hemophilia.
- People who have chronic liver disease.
- Homeless people.
- People who will be closely involved with a person being adopted from a country with high rates of hepatitis A infections.
How long does the hepatitis A vaccine last?
We don’t know exactly how long the protection of the vaccine lasts, but studies have indicated that it lasts at least 20 years in some people and it could last as long as 40 years or more. Having only one dose of the recommended two-dose vaccine has shown to provide protection for at least 10 years.
How can you be protected against hepatitis A virus (HAV) if you are allergic to something in the vaccine or are younger than six months old when traveling outside of the U.S.?
These people can get one dose of immune globulin (IG) before the leaving the U.S. This will protect against HAV for as long as two months. If you stay out of the country for longer than two months, you can receive another dose of IG.
Can bleach or cleaner kill hepatitis A?
Disinfectant that contains bleach can kill the hepatitis A virus (HAV) on hard non-porous surfaces like toilet seats. However, freezing does not kill HAV.
If you cook food that is contaminated for one minute at cooking temperatures higher than 185ºF (85ºC), it will kill HAV. However, food can be contaminated after cooking, so it is very important to wash your hands well with soap and water.
Outlook / Prognosis
What is the prognosis/outlook for patients who have hepatitis A?
Most cases of hepatitis A are short-lived, but the disease doesn’t always look the same for everyone. Some people have short illnesses that only last a few weeks and have mild symptoms. Others can be very ill for several months. Hepatitis A is rarely fatal, but death has happened due to liver failure brought on by HAV. This tends to happen more often in people who are over 50 years old or and in people who have another liver condition.
Can you get hepatitis A more than once?
No. Your body develops antibodies to HAV, so you will not get hepatitis A again. However, you still can be infected by other types of hepatitis viruses.
How long will it take to recover from hepatitis A?
You probably will have symptoms for less than two months. However, some people have symptoms that last for six months or so.
How long are you contagious if you have hepatitis A?
You are contagious for about seven to 14 days before your symptoms appear and for about one week after you display the symptom of jaundice (yellow eyes and skin). You can return to school or work if you do not have symptoms, but continue to be very careful about washing your hands.
When should you see a healthcare provider about hepatitis A?
If you think you have been exposed to hepatitis A, contact your healthcare provider or your state health department to find out what you need to do next. If you were diagnosed with hepatitis A and you have any kind of relapse or new symptom, call your provider.
What are some resources for people with hepatitis A?
If you are in the United States, you can contact your state or county health department. The following is not intended to be a complete list, but you might find these resources to be helpful:
- National Viral Hepatitis Roundtable, Patient Resources
- Centers for Disease Control and Prevention, Viral Hepatitis Resource Center
- U.S. Department of Veterans Affairs
Even though hepatitis A is rarely fatal, prevention is the best path, while taking good care of yourself in terms of rest, diet and exercise is good sense when you have hepatitis A and when you don’t.