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Hepatitis A

Definition

Hepatitis A is inflammation (irritation and swelling) of the liver from the hepatitis A virus.

See also:

• Hepatitis
• Hepatitis A vaccine
• Hepatitis B
• Hepatitis C

Alternative Names

Viral hepatitis; Infectious hepatitis

Causes, incidence, and risk factors

The hepatitis A virus is found mostly in the stools and blood of an infected person about 15 - 45 days before symptoms occur and during the first week of illness.

You can catch hepatitis A if:

• You eat or drink food or water that has been contaminated by stools (feces) containing the hepatitis A virus (fruits, vegetables, shellfish, ice, and water are common sources of the hepatitis A virus)
• You come in contact with the stool or blood of a person who currently has the disease
• A person with hepatitis A does not wash his or her hands properly after going to the bathroom and touches other objects or food
• You participate in sexual practices that involve oral-anal contact

About 3,600 cases of hepatitis A are reported each year. Because not everyone has symptoms with hepatitis A infection, many more people are infected than are diagnosed or reported.

Risk factors include:

• International travel, especially to Asia or South or Central America
• IV drug use
• Living in a nursing home or rehabilitation center
• Working in a health care, food, or sewage industry

Other common hepatitis virus infections include hepatitis B and hepatitis C. Hepatitis A is the least serious and mildest of these diseases. The other hepatitis infections may become chronic illnesses, but hepatitis A does not become chronic.

Symptoms

Symptoms will usually show up 2 - 6 weeks after being exposed to the hepatitis A virus. They are usually mild, but may last for up to several months, especially in adults.

Symptoms include:

• Dark urine
• Fatigue
• Itching
• Loss of appetite
• Low-grade fever
• Nausea and vomiting
• Pale or clay-colored stools
• Yellow skin (jaundice)

Signs and tests

The doctor will perform a physical examination and may discover that you have an enlarged and tender liver.

Blood tests may show:

• Raised IgM and IgG antibodies to hepatitis A (IgM is usually positive before IgG)
• Elevated liver enzymes (liver function tests), especially transaminase enzyme levels

Treatment

There is no specific treatment for hepatitis A. Rest is recommended when the symptoms are most severe. People with acute hepatitis should avoid alcohol and any substances that are toxic to the liver, including acetaminophen (Tylenol).

Fatty foods may cause vomiting, because substances from the liver are needed to digest fats. Fatty foods are best avoided during the acute phase.

Support Groups

Expectations (prognosis)

The virus does not remain in the body after the infection has gone away.

Over 85% of people with hepatitis A recover within 3 months. Nearly all patients get better within 6 months.

There is a low risk of death, usually among the elderly and persons with chronic liver disease.

Complications

There are usually no complications. One in a thousand cases becomes fulminant hepatitis, which can be life threatening.

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of hepatitis.

Prevention

The following tips can help reduce your risk of spreading or catching the virus:

• Always wash your hands thoroughly after using the restroom and when you come in contact with an infected person's blood, stools, or other bodily fluid.
• Avoid unclean food and water.

The virus may spread more rapidly through day care centers and other places where people are in close contact. Thorough hand washing before and after each diaper change, before serving food, and after using the restroom may help prevent such outbreaks.

If you have recently been exposed to hepatitis A and have not had hepatitis A before or have not received the hepatitis A vaccine series, ask your doctor or nurse about receiving either immune globulin or the hepatitis A vaccine. Common reasons why you may need to receive one or both of these include:

• You live with someone who has hepatitis A
• You recently had sexual contact with someone who has hepatitis A
• You recently shared illegal drugs, either injected or noninjected, with someone who has hepatitis A
• You have had close personal contact over a period of time with someone who has hepatitis A
• You have eaten in a restaurant where food or food handlers were found to be infected or contaminated with hepatitis A

Vaccines that protect against hepatitis A infection are available. The vaccine begins to protect 4 weeks after receiving the first dose. The 6- to 12-month booster is required for long-term protection. See: Hepatitis A vaccine

Travelers should take the following precautions:

• Avoid dairy products.
• Avoid raw or undercooked meat and fish.
• Beware of sliced fruit that may have been washed in contaminated water. Travelers should peel all fresh fruits and vegetables themselves.
• Do not buy food from street vendors.
• Get vaccinated against hepatitis A (and possibly hepatitis B) if traveling to countries where outbreaks of the disease occur.
• Use only carbonated bottled water for brushing teeth and drinking. (Remember that ice cubes can carry infection.)
• If no water is available, boiling water is the best method for eliminating hepatitis A. Bringing the water to a full boil for at least 1 minute generally makes it safe to drink.
• Heated food should be hot to the touch and eaten right away.

References

Advisory Committee for Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Recommended immunization schedules for children, adolescents, and adults -- United States, 2010 (accessed November 9, 2010).

Advisory Committee for Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC) Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2007;56:1080-1084.

Hoofnagle JH. Acute viral hepatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 151.

Sjogren MH, Cheatham JG. Hepatitis A. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 77.

Victor JC, Monto AS, Surdina TY, Suleimenova SZ, Vaughan G, Nainan OV, Favorov MO, Margolis HS, Bell BP. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med. 2007;357:1685-1694.