Hepatitis A

Hepatitis A is a liver infection caused by the hepatitis A virus. Hepatitis A occurs worldwide but is more common in developing countries. Most people get hepatitis A directly from an infected person.  Hepatitis A is spread via the faecal-oral route.

What is hepatitis A

Hepatitis means inflammation of the liver. It can be caused by chemicals or drugs, or by different kinds of viral infections. Hepatitis A is usually self-limiting infection of the liver caused by the hepatitis A virus.

The virus survives well in the environment, persisting on hands for several hours and in food kept at room temperature for much longer. It is also can survive in food even after cooking and/or freezing. Hepatitis A occurs worldwide. Most cases diagnosed in Australia are infected overseas.

Symptoms

Symptoms of hepatitis A infection include:

• abdominal pain
• loss of appetite and weight loss
• nausea and sometimes vomiting
• fever and chills
• mild headache
• yellow skin and eyes (jaundice)
• dark urine and pale faeces.

Symptoms usually start within 28 to 30 days of exposure to the virus, but this can range from 15 to 50 days. Symptoms usually last for 1 to 2 weeks but can last for several months.

People are infectious in the two weeks before symptoms appear, and remain infectious for a week after the onset of jaundice. Infants and young children infected with hepatitis A may not show symptoms of infection and may appear quite well. Complications from hepatitis A infection are uncommon, and the virus does not cause long-term liver disease.

How hepatitis A is spread

Most people get hepatitis A directly from an infected person.

Transmission may occur when a person:

• eats food handled by an infectious person
• eats food (such as shellfish) that has been contaminated with sewage
• touches nappies, linen or towels soiled by an infectious person
• has direct contact (including sexual) with an infectious person
• drinks contaminated water.

Who is at risk of infection

Those who have not had hepatitis A infection before and who have not been vaccinated are at risk of infection.

Diagnosis and treatment

A diagnosis of hepatitis A is based on laboratory testing of a blood sample. There is no specific treatment for hepatitis A.

Prevention

Hepatitis A infection can be prevented by:

• washing hands thoroughly after going to the toilet, before preparing and eating food, and after handling soiled linen, nappies and condoms
• not sharing food, cutlery, crockery, cigarettes and drinks with other people
• when travelling in regions with poor sanitation, drinking bottled water and avoiding undercooked food, food that may have been washed or prepared using contaminated water, and ice cubes made using local tap water.
• hepatitis A vaccination.

If you have contact with someone with hepatitis A

Close contacts of an infectious person, including household contacts and sexual partners, can be given the hepatitis A vaccine. This may prevent or reduce the severity of illness if given within two weeks of contact with the infectious person. Some high risk contacts may require immunoglobulin to prevent or reduce severity of illness.

Vaccination

The hepatitis vaccine is safe and effective. A single dose of hepatitis A vaccine provides protection for at least a year. A second dose is recommended to provide long lasting protection.

Hepatitis A vaccination is recommended for:

• people aged one year or older who travel to, or are living in, moderately to highly endemic areas (including all developing countries). Country specific travel advice is available from Smarttraveller or from your GP.
• Aboriginal and Torres Strait Islander children (at 12 and 18 months of age) residing in the NT, Qld, SA and WA. The vaccine is provided free for these children.
• people who live or work in rural and remote Aboriginal and Torres Strait Islander communities in the NT, Qld, SA and WA.
• people whose occupation may put them at risk, including:
  • early childhood educators and carers
  • people who regularly provide care for Aboriginal and Torres Strait Islander children in the NT, Qld, SA and WA
  • carers of people with intellectual disabilities
  • plumbers or sewage workers
  • sex workers
  • those whose lifestyle may put them at risk of acquiring hepatitis A, including men who have sex with men and injecting drug users
  • people with developmental disabilities
  • inmates of correctional facilities
  • people chronically infected with either hepatitis B or hepatitis C viruses
  • people with chronic liver disease.

Hepatitis A vaccines are available on private prescription. There is a monovalent hepatitis A vaccine, as well as combination vaccines, (either hepatitis A + hepatitis B vaccine; or hepatitis A/typhoid vaccine). Your GP can provide advice about which vaccine you should receive base on your risk factors.

More information

Hepatitis A is a notifiable condition. For more information about hepatitis A, contact your doctor or call ACT Health on 02 5124 9213 (during business hours) to report a notifiable condition.

Acknowledgements

Heymann, DL. Control of Communicable Diseases Manual, 19th edition, 2008.
NHMRC, The Australian Immunisation Handbook, 10th edition, 2013.