Hepatitis A

What is hepatitis A?

Hepatitis A is a liver infection caused by a virus. It goes away on its own in almost all cases. Hepatitis A does not lead to long-term liver problems.

Other forms of the virus (hepatitis B and hepatitis C) also cause hepatitis. Hepatitis A is the most common type.

How is hepatitis A spread?

The disease is caused by the hepatitis A virus. The virus is found in the stool of an infected person. It is spread when a person eats food or drinks water that has come in contact with infected stool.

Sometimes a group of people who eat at the same restaurant can get hepatitis A. This can happen when an employee with hepatitis A doesn't wash his or her hands well after using the bathroom and then prepares food.

The disease can also spread in day care centers. Workers can spread the virus if they don't wash their hands well after changing a diaper.

Some things can raise your risk of getting hepatitis A, such as eating raw oysters or undercooked clams. If you're traveling in a country where hepatitis A is common, you can lower your chances of getting the disease by avoiding uncooked foods and tap water.

What are the symptoms?

After you have been exposed to the virus, it can take from 2 to 7 weeks before you see any signs of it. Symptoms usually last for about 2 months.

Common symptoms are:

• Feeling very tired.
• Feeling sick to your stomach.
• Not feeling hungry.
• Losing weight without trying.
• Pain on the right side of the belly, under the rib cage (where your liver is).
• A fever.
• Sore muscles.

Older people with hepatitis A may get yellow skin (jaundice), along with dark urine and clay-colored stools.

All forms of hepatitis have similar symptoms. Only a blood test can tell if you have hepatitis A or another form of the disease.

Call your doctor right away if:

• You have any signs of hepatitis A.
• Someone you live with has hepatitis A.
• You have eaten in a restaurant that has had an outbreak of the virus.
• Your child goes to a day care center where hepatitis A has been reported.

How is hepatitis A diagnosed?

Your doctor will ask questions about your symptoms and where you have eaten or traveled. You may have blood tests if your doctor thinks you have the virus. These tests can tell if your liver is inflamed and whether you have antibodies to the hepatitis A virus. These antibodies prove that you have been exposed to the virus.

Take steps to avoid passing hepatitis A on to others. Tell people you live with or have sex with that you have hepatitis A. Wash your hands with soap and hot water right after you use the bathroom or change a diaper and before you prepare food.

How is it treated?

Topic Overview

(continued)

Hepatitis A goes away on its own in most cases. You can help yourself get better faster by drinking lots of water and eating a healthy mix of foods.

Unlike other forms of hepatitis, the hepatitis A virus does not lead to long-term illness or serious liver damage. Most people get well within a few months.

While you have hepatitis A, cut back on daily activities until all of your energy returns. As you start to feel better, take your time in getting back to your regular activities. If you try to meet your regular pace too soon, you may get sick again.

You can only get the hepatitis A virus once. After that, your body builds up a defense against it.

Can hepatitis A be prevented?

You can protect yourself from hepatitis A by getting a vaccine (Havrix or Vaqta). You will get it in a series of two shots. It is usually 100% effective if you get both shots before you are exposed to the virus.

The U.S. Centers for Disease Control and Prevention advises that all children get the hepatitis A vaccine when they are at least 1 year old.

If you have been around someone who you know has hepatitis A, getting an injection of immune globulin (IG) may prevent you from getting the disease. It’s important for you to get the shot within 2 weeks of being exposed to the virus.

Cause

Hepatitis A is caused by a virus (hepatitis A virus, or HAV) that multiplies in liver cells and is shed in stool.

How HAV is spread

Hepatitis A virus is found in the stool (feces) of a person who has hepatitis A. The virus is spread most commonly when people put food or objects contaminated with stool containing HAV into their mouths.

Large numbers of people get the virus after drinking contaminated water because, in many parts of the world, drinking water is contaminated with raw sewage. The virus also may be spread by eating uncooked food (such as raw shellfish) and unpeeled fruits and vegetables washed in contaminated water. Hepatitis A outbreaks caused by contaminated drinking water are rare in the United States because water supplies are treated to destroy the virus and other harmful organisms.

In the United States, HAV is spread mainly among people who have close contact with someone who has the virus. You can become infected with HAV if you:

• Eat food prepared by someone who does not wash his or her hands well after using the bathroom or changing a diaper.
• Don't wash your hands after changing a diaper.
• Eat raw or undercooked shellfish that was harvested from waters contaminated with raw sewage.
• Are a man and have sex with men.

Outbreaks of hepatitis A among children in day care facilities occur because children, especially those who wear diapers, may get stool on their hands and then touch objects that other children put into their mouths. Caregivers in day care centers can spread the virus if they do not wash their hands thoroughly after changing a child's diaper.

It is very rare for hepatitis A virus to be spread by infected blood or blood products. It is not known to be spread through saliva or urine.

Some people fear that hepatitis A infection is related to or increases the risk of contracting acquired immunodeficiency syndrome (AIDS). This is not true. The hepatitis A virus is not related to the human immunodeficiency virus (HIV), which causes AIDS, nor does it increase your risk of HIV infection. A person can be infected with both hepatitis A and HIV, but the two infections have nothing to do with each other.

Incubation and contagious periods

After the hepatitis A virus enters your body, the number of virus grows and grows for 2 to 7 weeks. The average incubation period is about 4 weeks.

Your stools and body fluids contain the highest levels of the virus 2 weeks before symptoms start. This is the time when you are most contagious, but you still may spread the virus after symptoms appear.

 

Symptoms

Symptoms usually appear 15 to 50 days (2 to 7 weeks) after you have been exposed to the hepatitis A virus (HAV). The average time is 4 weeks. Symptoms usually are mild and may not be noticed in children younger than 6 years of age. In older children and adults, early symptoms are often similar to those of a stomach virus. Possible symptoms include:

• Extreme tiredness (fatigue).
• Fever.
• Sore muscles.
• Headache.
• Pain on the right side of the abdomen, under the rib cage (where the liver is located).
• Nausea.
• Loss of appetite and weight loss.
• Yellowing of the skin and the white part of the eyes (jaundice), sometimes accompanied by dark urine and clay-colored (whitish) stools. Jaundice is less common in children and younger adults.

Up to 15% of people who have hepatitis A may have a second flare-up of HAV infection 1 to 4 months after infection first occurred.¹ The infection is usually not any more severe than it was the first time, but arthritis can occur with it. After the infection goes away, the person usually returns to normal health. In rare cases, cholestatic hepatitis occurs, which can cause itching and can last throughout the infection.

In general, by the time symptoms appear, the amount of virus being shed in your stools is declining. You still may spread the virus, but you are less likely to do so after symptoms appear.

Symptoms of hepatitis A usually last less than 2 months.

 

When To Call a Doctor

Contact a health professional immediately if a person diagnosed with hepatitis A develops severe dehydration (caused by vomiting and an inability to hold down fluids) or any signs of rapidly developing liver failure, which include:

• Extreme irritability (greater than would be expected when a person is ill).
• Impaired ability to think clearly or reason.
• Extreme drowsiness.
• Loss of consciousness.
• Swelling of the face, hands, feet, ankles, legs, arms, or abdomen (edema).
• Bleeding from the nose, mouth, or rectum (including blood in stools), or under the skin.

Call a health professional today if:

• Any of the signs or symptoms of hepatitis A develop. For more information, see the Symptoms section of this topic.
• Someone in your household has been diagnosed with hepatitis A.
• You have eaten in a restaurant or any other dining facility known to be the source of an outbreak of hepatitis A.
• A child or another family member has been in a day care center or another institution where a hepatitis A outbreak has occurred.
• Your sex partner has been diagnosed with hepatitis A.
• You are planning a trip to a foreign country or have any other reason to believe you should be vaccinated against hepatitis A. Plan for vaccination 6 months before travel, if possible. If time is running short, getting vaccinated at least 1 month before travel offers some protection, and 2 weeks before travel may also be helpful.³

Watchful Waiting

Watchful waiting, or surveillance, is not advised if you think you have been exposed to the hepatitis A virus (HAV) or if you have symptoms of the illness.

It is important to see a health professional when symptoms develop, because all forms of viral hepatitis have similar symptoms. Only a blood test can determine whether you have hepatitis A or another hepatitis virus. A health professional also can advise you about how to prevent the spread of hepatitis A.

Who To See

Most of the time, the following health professionals can diagnose and treat hepatitis A:

• Family medicine doctor
• Pediatrician
• Internist
• Nurse practitioner
• Physician assistant

If complications develop, you may need care from:

• A gastroenterologist.
• A liver specialist (hepatologist).
• An infectious disease specialist.

 

Exams and Tests

A thorough medical history and physical examination provide valuable information about your symptoms and whether it is likely that you have been exposed to the hepatitis A virus (HAV).

While taking a medical history, your health professional usually will ask where you have traveled, if you work in or have a child in a day care center, and if you live with someone known to have hepatitis A.

If you may have been exposed to hepatitis A, you will have blood tests to study liver function and to see whether your liver is damaged or inflamed. Blood tests to study liver function include:

• Bilirubin. When bilirubin builds up in the blood, it may indicate hepatitis.
• Albumin. Lower than normal levels may indicate hepatitis or other liver problems.
• Prothrombin time, a blood test that measures how long it takes blood to clot. An abnormal prothrombin time can be caused by liver disease or injury.

Blood tests that may be done to determine whether the liver is damaged or inflamed include:

• Alanine aminotransferase (ALT). When the liver is damaged or diseased, ALT is released into the bloodstream, causing levels of the enzyme to rise.
• Aspartate aminotransferase (AST). When body tissues or organs such as the heart or liver are damaged, AST is released into the bloodstream. The amount of AST in the blood is directly related to the extent of the tissue damage.
• Alkaline phosphatase (ALP). Large amounts of ALP in the bloodstream may indicate liver damage.
• Lactic dehydrogenase (LDH). Many diseases can cause elevations in LDH levels. In addition to the LDH test, your doctor will usually run other tests to confirm a diagnosis of hepatitis A.

If tests show your liver is inflamed, you will have an antibody (anti-HAV) test on a sample of your blood. The presence of HAV antibodies means that HAV infection is the most likely cause of your hepatitis.

If the results of the anti-HAV test show that HAV is not multiplying in your body, your doctor may do other hepatitis blood tests to find out whether hepatitis B virus, hepatitis C virus, or Epstein-Barr virus (which causes infectious mononucleosis, or "mono") is causing your hepatitis.

Early Detection

If you are concerned that you have been exposed to the virus and you have not been previously infected or vaccinated, contact your health professional. If you get a shot of immune globulin (IG) within 2 weeks of being exposed to HAV, you probably will not develop symptoms of HAV infection.

Routine vaccination of hospital workers, food handlers, and child care center workers and attendees does not occur at this time because their chance of infection generally is no greater than that of the wider community. But some child care centers have workers get the shot because it works so well to prevent the disease. Plus there is very low chance of side effects from the vaccine. If outbreaks of HAV infection do occur in those settings, people who were exposed to the virus should receive a shot of immune globulin (IG).⁴

 

Treatment Overview

Hepatitis A goes away on its own in almost all cases. No medications are used to treat the illness. Home treatment will usually help relieve your symptoms and help you prevent the spread of hepatitis A virus (HAV).

Slow down

Reduce your activity level to match your energy level. Do not stay in bed, because that may slow your recovery. Don't go to work or school unless your workload can be decreased to match your energy level. Avoid strenuous exercise, until you are fully recovered. As you start to feel better, go back to your regular activities gradually. If you try to meet your regular pace too soon, you may get sick again.

Eat right

Even though food may not appeal to you, it is important for you to get adequate nutrition. Try eating small, frequent meals instead of three large meals. For most people, nausea and loss of appetite don't set in until later in the day. Try eating more in the morning and less later in the day.

Doctors used to recommend a high-calorie, protein-rich diet to people who have hepatitis. This is no longer believed to be of any benefit, and such foods can be hard to eat when you feel nauseated. Try to maintain a balanced diet while eating foods that appeal to you.

Avoid dehydration

It is very important to keep your body well-hydrated when you have hepatitis A, especially if you have been vomiting. Drink plenty of water. If you can tolerate them, fruit juices and broth are other good choices because they provide additional calories. Many of the sports drinks available in grocery stores (such as Gatorade) can help replace essential electrolytes (salts) that are lost through vomiting.

Avoid alcohol and drugs

Hepatitis impairs your liver's ability to break down certain medicines and alcohol. If you take drugs (legal or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some medications can make liver damage worse.

Make sure your health professional knows all the medications you are taking, including herbal products. Do not take any new medications or stop taking existing prescription medications without your doctor's approval. Talk to your health professional about when it is safe to drink alcohol in moderation.

Try to control itching

People with hepatitis sometimes develop itchy skin. You can use nonprescription medications, such as Benadryl or Chlor-Trimeton, to control the itching. Be sure to follow the instructions for use that are provided with the product, and stop using the product if you have any side effects. Tell your health professional before you start any new medicine.

Symptoms of hepatitis A usually begin to go away on their own in about 2 weeks. You can still spread the infection to others as long as you have symptoms, because your stools carry the virus.

If you have been around someone who you know has hepatitis A, getting an injection of immune globulin (IG) within 2 weeks of exposure may prevent you from getting hepatitis A.

 

Home Treatment

Although no specific medical treatment is given for hepatitis A, home treatment can help relieve symptoms and prevent the spread of the virus.

Slow down

• Reduce your activity level to match your energy level. Do not stay in bed, because that may slow your recovery. Listen to your body, and slow down when you become tired.
• Don't go to work or school unless your workload can be decreased to match your energy level.
• Avoid strenuous exercise.
• As you start to feel better, go back to your regular activities gradually. If you try to meet your regular pace too soon, you may get sick again.

Eat right

• Even though food may not appeal to you, it is important for you to get adequate nutrition. Try eating small, frequent meals instead of three large meals. For most people, nausea and loss of appetite don't set in until later in the day. Try eating more in the morning and less later in the day.
• Doctors used to recommend a high-calorie, protein-rich diet to people who have hepatitis. This is no longer believed to be of any benefit, and such foods can be hard to eat when you feel nauseated. Try to maintain a balanced diet while eating foods that appeal to you.

Avoid dehydration

It is very important to keep your body well hydrated when you have hepatitis A, especially if you have been vomiting. Contact your health professional immediately or go to the nearest emergency room if you have vomited more than two times in one day.

• Drink plenty of water.
• If you can tolerate them, fruit juices and broth are other good choices because they provide additional calories.
• Many of the sports drinks available in grocery stores (such as Gatorade) can help replace essential electrolytes that are lost through vomiting.

Avoid alcohol and drugs

Hepatitis impairs your liver's ability to break down certain medicines and alcohol. If you take drugs (legal or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some medications can make liver damage worse.

Make sure your health professional knows all the medications you are taking, including herbal products. Do not take any new medications or stop taking existing prescription medications without your doctor's approval.

Talk to your health professional about when it is safe to drink alcohol in moderation.

Try to control itching

People with hepatitis sometimes develop itchy skin. You can use nonprescription medications, such as Benadryl or Chlor-Trimeton, to control the itching. Be sure to follow the instructions for use that are provided with the product, and stop using the product if you have any side effects.

Tell your health professional before you start any new medicine.

Tips to prevent the spread of hepatitis A

If you have been infected with HAV, there are steps you can take to avoid infecting the people you are in close contact with.

• Inform those you live with or have sex with that you have hepatitis A. They should ask their doctor whether they need a shot of immune globulin. If given within 2 weeks of possible exposure to the virus, immune globulin (IG) is effective in preventing hepatitis A or reducing its symptoms. For more information, see the Medications section of this topic.
• Wash your hands with soap and hot water immediately after using the toilet or changing a diaper and before preparing food.
• Avoid any anal contact with a sex partner while you are infected

 

Medications

Although no medication can treat HAV symptoms after they develop, the hepatitis A vaccine is the most effective means of preventing hepatitis A virus (HAV) infection. The vaccine provides 94% to 100% protection if you receive both of the shots in the vaccination series.⁵ However, the vaccine may not be as effective in those with weakened immune systems, such as people who have human immunodeficiency virus (HIV).⁵

If you are not protected against HAV infection-either by vaccination or by previous exposure to the virus-and you have had close personal contact with someone who has hepatitis A, you should receive a shot of immune globulin (IG). IG is more than 85% effective in preventing HAV infection if you get it within 2 weeks of being exposed to the virus.⁵

IG is also recommended for:

• People who are known to be allergic to other vaccines containing the same ingredients found in the hepatitis A vaccine.
• Children younger than age 1 who have not been immunized with the hepatitis A vaccine and have been exposed to HAV, particularly children who spend time in day care centers.

Medication Choices

Hepatitis A vaccine

Immune globulin

For more information about the hepatitis A vaccines, see the Prevention section of this topic.

What To Think About

Immune globulin has been effective in controlling some outbreaks of the hepatitis A virus.

 

Surgery

Hepatitis A is a viral infection, so no surgical treatment is used.

A very small number of people, most often people with long-term (chronic) liver disease or older adults, develop liver failure when they become infected with the hepatitis A virus. This condition, called fulminant hepatitis, is life-threatening. For some people who have it, a liver transplant offers the only hope for survival.

 

WebMD Medical Reference from Healthwise

Last Updated: November 15, 2006

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External Link:

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