Hepatitis A

(Hep A)

by Rick Alan

En Español (Spanish Version)

Definition

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

Hepatitis

Causes

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

Putting something in your mouth that has been infected with the hepatitis A virus
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
Sexual contact with a partner infected with the hepatitis A virus, particularly anal sex

Risk Factors

Risk factors for hepatitis A include:

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

Symptoms

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

Symptoms include:

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

Diagnosis

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

Tests may include:

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

Treatment

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

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

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 9 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

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

Vaccination or Immune (Gamma) Globulin

This contains antibodies that provides 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:

All children aged 12 months
Children aged 12 months or older in high-risk areas
People traveling to areas where hepatitis A is prevalent
People who have anal sex
Drug users
People with chronic liver disease
People with blood-clotting disorders, like hemophilia
Children who live in areas where hepatitis A is prevalent
People who will have close contact with an adopted child from a medium- or high-risk area

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

RESOURCES:

American Liver Foundation
http://www.liverfoundation.org/

Hepatitis Foundation International
http://www.hepfi.org/

CANADIAN RESOURCES

Canadian Institute for Health Information
http://www.cihi.ca/cihiweb/

Canadian Liver Foundation
http://www.liver.ca/Home.aspx/

REFERENCES:

Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov .

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/ .

¹9/25/2009 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.

Last reviewed January 2010 by David L. Horn, MD, FACP
Last Updated: 1/15/2010

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