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Hepatitis A

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

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Alternative Names

Viral hepatitis; Infectious hepatitis

Causes

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

  • 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 disease.
  • You come in contact with the stool or blood of a person who currently has the disease.
  • A person with hepatitis A passes the virus to an object or food due to poor hand-washing after using the bathroom.
  • You take part in sexual practices that involve oral-anal contact.

Not everyone has symptoms with hepatitis A infection, so many more people are infected than are diagnosed or reported.

Risk factors include:
  • Overseas travel, especially to Asia or South or Central America
  • IV drug use
  • Living in a nursing home 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.

Symptoms

Symptoms most often show up 2 to 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)

Exams and Tests

The doctor will perform a physical exam, which may show that your liver is enlarged and tender.

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.

  • You should rest when the symptoms are the worst.
  • People with acute hepatitis should avoid alcohol and drugs that are toxic to the liver, including acetaminophen (Tylenol).
  • Fatty foods may cause vomiting and are best avoided during the acute phase of the illness.

Outlook (Prognosis)

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

Most people with hepatitis A recover within 3 months. Nearly all patients get better within 6 months.

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

When to Contact a Medical Professional

Call 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 well 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.

Ask your doctor or nurse about getting either immune globulin or the hepatitis A vaccine if you are exposed to the disease and have not had hepatitis A or the hepatitis A vaccine.

Common reasons for getting one or both of these treatments 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

Vaccines that protect against hepatitis A infection are available. The vaccine begins to protect 4 weeks after you get the first dose. You will need to get a booster shot 6- to 12-months later for long-term protection.

Travelers should take the following steps to protect against getting the disease:

  • Avoid dairy products.
  • Avoid raw or undercooked meat and fish.
  • Beware of sliced fruit that may have been washed in unclean 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 bottled water is not available, boiling water is the best way to get rid of hepatitis A. Bring the water to a full boil for at least 1 minute to make it safe to drink.
  • Heated food should be hot to the touch and eaten right away.

References

Centers for Disease Control and Prevention. Recommended adult immunization schedule - United States, 2012. MMWR. 2012;61(4).

Centers for Disease Control and Prevention. Recommended Immunization Schedules for Persons Aged 0 Through 18 Years - United States, 2012, MMWR 2012;61(05);1-4.

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.

Wedemeyer H, Pawlotsky JM. Acute viral hepatitis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 150.

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.

Updated: 10/13/2013

George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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