Hepatitis A

January 2010    View PDF    En español    Email a question

Hepatitis A is an infection of the liver caused by the hepatitis A virus, or HAV. It’s the most common type of hepatitis virus and can be prevented. It accounts for almost half of all hepatitis cases and about 100 deaths in the US each year. One in three people have had HAV. Once you’ve had HAV you cannot get it again, though you can still get other hepatitis viruses. Nearly all people with HAV disease recover without any long-term problems.

Hepatitis A appears as an acute disease in people. This means that there’s normally a sudden start of illness, a sharp rise in symptoms and then a short duration of being sick. Some people, though, will not have symptoms or confuse them with having the flu.

HAV does not increase your chance for HIV. However, a person can have both viruses at the same time, which can make dealing with each of them more difficult. Although most liver disease in people with HIV is caused by hepatitis B and C, HAV can pose its own health concern for some.

How do you get hepatitis A?

In the US, most people get HAV by contact with a person in the same household or a sex partner. It’s important to remember that you can pass the virus onto others while you’re sick. You are most contagious about 2 weeks before symptoms appear.

The virus is passed mainly through oral contact with stool (feces) that contains HAV. This can happen when someone has not washed their hands well enough after using the bathroom and then touches food, water or shared surfaces. Outbreaks can occur in restaurants, day care centers, prisons and other places where people have close contact with each other. Raw or undercooked shellfish, like clams or oysters, can also carry HAV because of infected water.

HAV may also be passed during sex, but it’s quite rare for it to be passed through infected blood. HAV is not known to be spread through spit or urine. Casual contact between people does not spread the virus.

What are the symptoms?

Symptoms may or may not appear. Many think they have the flu. However, adults are more likely to have symptoms than children. If they do occur, symptoms may include fever, tiredness, headache, loss of appetite, body aches, nausea, stomach pain, itchy skin and diarrhea. More serious symptoms include dark urine, change in stool and yellowing of the skin and eyes (jaundice).

Symptoms generally last less than 2 months. Some people, about 15%, can be sick for up to 6–9 months. A very small number of people—most often older adults or those with long-term liver disease—rapidly develop severe liver failure when they get HAV, called fulminant hepatitis. Nearly 3 in 4 people recover without major treatment, though some may need a transplant.

Who is at risk for hepatitis A?

Several groups of people are at risk for HAV. They include men who have sex with men, injecting and non-injecting drug users, and people who live in the same household or who have sex with a person with HAV. People traveling to countries where HAV is common are also at higher risk.

How do you test for hepatitis A?

If you think you’ve been exposed to HAV or other hepatitis virus, talk to your doctor and explain why. Your doctor can do a physical exam, liver function tests (LFTs), and a blood test called IgM anti-HAV, which checks for HAV antibodies. If it comes back negative, it’s likely you’ve never had HAV. You may then want to consider getting the HAV vaccine.

If you do have antibodies, then you’ve been exposed to HAV. If the LFTs are not normal, then it shows your liver is not working properly and may indicate a problem like HAV, or other infection. Rarely, a liver tissue sample is needed.

How do you prevent hepatitis A?

The best way to prevent the virus is by getting the HAV vaccine, which is nearly 100% effective. Other ways to prevent HAV are by taking immune globulin and keeping good personal hygiene.

VACCINES
The hepatitis A vaccine is recommended for 2 groups of people. The first are those who are identified in Who Is at Risk for HAV?. The second are those who may get seriously ill should they get HAV. These include those who have chronic liver disease, have had or are waiting for a liver transplant, or have blood disorders like hemophilia.

Two vaccines are available: Havrix and VAQTA, which are made from inactive virus. Both are given as 2 shots into a shoulder muscle to people 1 year of age or older. The booster shot is given at least 6 months later. Both vaccines are safe and effective in people living with HIV. The HAV vaccine also comes bundled with the HBV vaccine, called Twinrix.

If side effects do occur, the most common are mild and include soreness at the site of the shot. Less common are headache, fever and fatigue. Children normally face the same side effects, though drowsiness, irritability and loss of appetite may also occur.

IMMUNE GLOBULIN
The next way to prevent HAV is by getting a dose of immune globulin, or IG. This can be given before an exposure to HAV for about 3–6 months of protection. It can also be given to people after a very recent exposure, within two weeks of the exposure and the sooner the better. Side effects may include soreness and swelling at the injection site and low-grade fever.

PERSONAL HYGIENE
Another way to help prevent infection is by keeping good personal hygiene. This includes washing your hands after using the bathroom, after changing a diaper or before preparing or eating food. Using condoms and refraining from unprotected anal contact during sex can also help reduce the risk. Keeping common surfaces clean also helps.

How do you treat hepatitis A?

No medicines are used to treat hepatitis A. It will go away on its own in almost all cases. However, it’s still important to take care of yourself while you’re sick and to help prevent passing it onto others. A few things that you can do are drink plenty of fluids, eat right, avoid alcohol and drugs, and slow down.

It’s important to keep your body well hydrated. It’s also important to eat even though you may not feel like it, like eating smaller meals more often during the day. Eating fatty or greasy foods is hard on the liver.

Another thing that helps is to stop taking or cut down on alcohol, drugs and herbs. Any of these may make your illness worse and last longer. You may also need to take time off work or school to help recover.

Concerns for people living with HIV

People with HIV are at no higher risk than others for getting HAV. However, they may face longer symptoms, illness and time to recover. This can be due to taking HIV and other meds that the liver breaks down as well as other liver disease that they may have like hepatitis B or C.

It’s recommended that people with HIV get the HAV vaccine if they haven’t had hepatitis A. The vaccine is safe to use in people with HIV, and is best done when CD4 counts are above 300.

Concerns for women, children and older adults

Having hepatitis A does not increase the risk of stillbirth, miscarriage or birth defects. Using IG to prevent HAV is safe for pregnant women who have been exposed to the virus.

It’s not known if the HAV vaccine is passed through breast milk, so care should be taken when giving the vaccine to nursing mothers. The vaccine is not currently given to children under 1 year of age. There’s a somewhat higher rate of illness in people aged 50 years and over who get HAV. It is unknown if people over 65 years of age respond differently to the HAV vaccine than younger adults.
The HAV vaccine is probably safe to use in pregnant women, although it’s listed as Pregnancy Category C. This means that the risk is possible but unknown.