Hepatitis A
Understanding Hepatitis A: Symptoms, Transmission, and Prevention
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A largely communicable liver infection caused by the Hepatitis A virus. Hepatitis A is preventable by vaccine. It spreads from contaminated food or water, or contact with someone who’s infected.
Symptoms include fatigue, nausea, abdominal pain, loss of appetite, and low-grade fever. The disease clears up on its own in one or two months. Rest and adequate hydration can help.
Hepatitis A is a viral disease that affects the liver. The Hepatitis A virus is highly contagious and is spread when traces of feces (poo) containing the virus pollute hands, objects, water, or food.
Anyone can be at risk of Hepatitis A through ingesting food or drinks containing traces of the virus contaminated by a person with Hepatitis A.
Hepatitis A Outbreaks
There have been outbreaks of Hepatitis A associated with eating contaminated farmed and distributed foods (for example, shellfish), and among particular groups (people experiencing homelessness, people who inject drugs, and men who have sex with men).
Hepatitis A is more common in low socioeconomic countries with reduced access to clean water supplies and sanitation facilities.
Hepatitis A outbreaks can occur in childcare centers. Children under 5 years of age often don’t show any symptoms, but can infect childcare workers or other children (for example, during nappy changes). The first sign of an outbreak is generally when a parent or childcare worker becomes sick.
Symptoms of Hepatitis A
You can become ill any time between 2 and 4 weeks after coming into contact with the Hepatitis A virus.
The average incubation period (the time between infection taking place and symptoms appearing) for the virus is 28 days.
Many infected people, particularly children under 5 years old, show few or no symptoms.
For older children and adults, the symptoms of Hepatitis A include:
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Fever
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Nausea
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Abdominal discomfort and pain
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Dark urine
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Yellow skin and eyes (jaundice)
Symptoms may last for several weeks. Most people completely recover from Hepatitis A infection.
A single infection of Hepatitis A leads to lifelong immunity. Previous infection with Hepatitis B or Hepatitis C doesn’t offer immunity for Hepatitis A.
Complications of Hepatitis A
Around 10% of people who have had Hepatitis A experience a relapse (become sick again with Hepatitis A). Most people who have a relapse completely recover.
Hepatitis A doesn’t cause chronic (long-term) liver disease.
The severity of the disease is more pronounced in older age groups and for people with existing liver fibrosis and cirrhosis.
Complications of Hepatitis A are rare, but the infection can lead to fulminant hepatitis. This is an acute form of hepatitis that can cause liver failure. The risk of death from fulminant hepatitis increases with age.
Causes of Hepatitis A
Hepatitis A is caused by a virus. The virus can survive for several hours outside the body but persists on surfaces and in food for even longer. It’s resistant to heating and freezing.
The virus spreads when it enters the mouth, which can happen when hands, foods, or other items are contaminated with the feces of a person with Hepatitis A. The disease can also be spread sexually by oral or anal contact.
A person with Hepatitis A is contagious from 2 weeks before they show symptoms to one week after they develop jaundice (yellow skin and eyes).
If an infected person doesn’t develop jaundice, they may pass on the virus up to 2 weeks after they first have symptoms (about 4 weeks in total). Caution is advised beyond this period as the virus can still be shed in feces for longer periods.
Reducing the Risk of Hepatitis A
Protecting Yourself from Hepatitis A
The most important action you can take to protect yourself against Hepatitis A is to get vaccinated.
Practicing strict personal hygiene is also essential to reducing the risk of Hepatitis A. Steps you can take include:
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Wash your hands with soap and warm running water before handling food, after going to the toilet, and after handling used condoms, nappies, or the anal area of another person. Use a clean towel to dry your hands.
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Use barrier protection (dental dams) when engaging in oral-anal sex and avoid sex with someone who has Hepatitis A.
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Vaccination may help prevent illness if given within 2 weeks of contact with a contagious person.
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Clean bathrooms and toilets frequently, paying attention to toilet seats, handles, doors, and nappy change tables.
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Boil your drinking water if it comes from an untreated source, such as a river.
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If you’re travelling overseas, particularly to countries where Hepatitis A is common, take special care to avoid it. Before travelling, talk to your doctor about immunization for protection.
Protecting Others from Hepatitis A
If you have Hepatitis A:
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Don’t prepare food or drinks for other people.
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Don’t share eating or drinking utensils with other people.
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Don’t share linen and towels with other people.
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Don’t have sex.
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Wash eating utensils in hot soapy water, and machine-wash linen and towels.
Household contacts and sexual partners of a contagious person may need to be immunized.
All people who have Hepatitis A should check with their doctor before returning to work or school.
The following people have an increased risk of passing Hepatitis A on to others and must check with their doctor before returning to work or school:
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People who handle food or drink
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People whose work involves close personal contact, such as childcare workers and healthcare workers
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Children who attend childcare facilities
Guarding Yourself from Hepatitis A when Overseas
Careful selection and preparation of food and drink in countries where Hepatitis A is common is vital. Suggestions include:
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Only drink bottled water with an unbroken seal.
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Avoid unpackaged drinks or ice.
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Avoid eating raw food such as fruit or salad that may have been washed or prepared with polluted water.
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Avoid raw foods, particularly vegetables and fruit that you haven’t peeled, prepared, or boiled yourself.
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Avoid raw or undercooked meat and fish.
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Make sure cooked food is hot and eat it right away.
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Avoid shellfish and unpasteurized dairy products.
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Avoid eating food from street vendors.
Diagnosis of Hepatitis A
Tests used to diagnose Hepatitis A may include:
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Medical history – including immunization status and travel history
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Physical examination
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Blood test – a sample of your blood will be sent to a laboratory to confirm the diagnosis
Treatment for Hepatitis A
There’s no specific treatment for Hepatitis A. In most cases, your immune system will clear the infection and your liver will fully heal. Treatment aims to ease symptoms and reduce the risk of complications. Options may include:
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Rest – Hepatitis A can make you tired and lacking energy for day-to-day life, so rest when you can.
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Eat small meals more frequently – nausea can affect your ability to eat and can contribute to fatigue, so eat small quantities of high-calorie foods frequently if nausea is a problem.
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Drink fluids.
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Protect your liver – the liver processes medicine and alcohol, so avoid alcohol and review any medication with your doctor.
Exposure to Hepatitis A
If you’ve been in contact with someone with Hepatitis A and you aren’t immune (have not been immunized or have never had a Hepatitis A infection), speak with your doctor about your treatment options.
Immunization against Hepatitis A
Immunization is the best protection against Hepatitis A infection and is recommended for people in high-risk groups, and for unvaccinated people who have been in close contact with someone who has Hepatitis A.
Immunization against Hepatitis A includes a course of injections over a 6 to 12-month period. Healthy people 12 months of age and over receive 2 doses of the Hepatitis A vaccine, or 3 doses if the Hepatitis A and Hepatitis B vaccines are given as a combination.
You can complete any missed vaccine doses, even if the recommended time frame has passed. You don’t need to start the vaccine course again.
If you’re in close contact with someone who has Hepatitis A, be sure to have the Hepatitis A vaccine if you haven’t already completed a vaccine course.
Babies under 12 months of age and people who have a weakened immune system who are also in close contact with a person with Hepatitis A can have an injection of normal human immunoglobulin (also called passive immunization) instead of the Hepatitis A vaccine.
Protection against Hepatitis A is available free of charge under the National Immunization Program Schedule for Aboriginal and Torres Strait Islander children (between 12 and 24 months) who live in high-risk areas (Queensland, Northern Territory, Western Australia, and South Australia). (It’s also recommended for people who work with Aboriginal and Torres Strait Islander children and communities in these areas.)
Hepatitis A Immunization is Recommended for High-Risk Groups
In Victoria, the vaccine is recommended (but not free) for:
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People (12 months of age and over) travelling to places where Hepatitis A is common
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People whose work puts them at increased risk of infection, including:
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Plumbers and sewage workers
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People who work with children
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People who work with people with intellectual disabilities
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People with intellectual disabilities
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People with liver disease or people who have had a liver transplant or have chronic Hepatitis B or Hepatitis C
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People who have anal intercourse (including men who have sex with men, and workers in the sex industry)
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People who inject drugs
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Prisoners of correctional facilities
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Remember that immunization against Hepatitis A doesn’t protect you against Hepatitis B or Hepatitis C.
Pregnancy and Hepatitis A Immunization
Hepatitis A immunization isn’t generally recommended for women who are pregnant, although vaccination might be recommended in some situations.
Speak with your doctor if you aren’t immune to Hepatitis A and you’re at increased risk of infection, or if you have a pre-existing medical condition such as liver disease.
Pre-Immunization Checklist
Before receiving the vaccine, tell your doctor or nurse if you (or your child):
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Are unwell (temperature over 38.5˚C)
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Have allergies to any other medicines or substances
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Have had a serious reaction to any vaccine
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Have had a serious reaction to any component of the vaccine
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Have had a severe allergy to anything
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Have a disease, or are having treatment, that causes low immunity
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Are taking any prescription or over-the-counter medicines
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Are pregnant or intend to become pregnant
Which Regions Do You Need Hepatitis A Vaccine?
The Hepatitis A combination vaccine is recommended for all persons 18 years of age or older who are at risk from infection due to their jobs, lifestyle, or from traveling to the following regions:
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Africa
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Central and South America
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Eastern and Southern Europe
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South and Southeast Asia (except Japan)
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The Caribbean
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The Middle East
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The former Soviet Union
Side Effects of Immunization against Hepatitis A
Immunizations against Hepatitis A are effective and safe. All medicines can have side effects.
For most people, the chance of a serious side effect from a vaccine is much lower than the chance of serious harm if you catch the disease.
Common side effects from the Hepatitis A vaccine include:
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Localized pain, redness, and swelling at the injection site
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Low-grade fever
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Headache
Managing Fever after Immunization
Common side effects following immunization are generally mild and temporary (occurring in the first few days after vaccination). Specific treatment isn’t generally needed.
There are a number of treatment options that can reduce the side effects of the vaccine, including:
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Drink extra fluids and don’t overdress if you have a fever.
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Although routine use of paracetamol after vaccination isn’t recommended, if fever is present, paracetamol can be taken – check the label for the correct dose or speak with your pharmacist (especially when giving paracetamol to children).
Managing Injection Site Discomfort
Many vaccine injections may result in soreness, redness, itching, swelling, or burning at the injection site for 1 to 2 days. Paracetamol might be needed to ease the discomfort.
Occasionally, a small, hard lump (bump) at the injection site may persist for some weeks or months. This shouldn’t be of concern and requires no treatment.
Rare Side Effects of Hepatitis A Immunization
There’s a very small risk of a serious allergic reaction (anaphylaxis) to any vaccine. This is why you’re advised to stay at the clinic or medical practice for at least 15 minutes following immunization in case further treatment is needed.
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