Hepatitis A

This factsheet is for people who have hepatitis A, or who would like information about it.

Hepatitis A is a liver disease caused by infection with the hepatitis A virus (also known as HAV). Hepatitis A can be prevented with the use of a vaccine.

About Hepatitis A
Hepatitis means inflammation of the liver and can have many causes, the most common of which is an infection with a hepatitis virus.

You can get hepatitis A in the UK but it's fairly uncommon due to generally good standards of sanitation. The number of people affected is unknown as people who only have mild symptoms may not go to a doctor. It's more common in countries where water supplies, sanitation and sewage disposal are poor, such as Africa, parts of Asia and southern and eastern Europe.

Hepatitis A can occur at any age, although children tend not to show any symptoms. Hepatitis A is usually an acute and generally mild infection that is typically over quite quickly. The term acute refers to the length of time a person has had it, not how serious a condition is. However, it may be a more serious disease as you get older or if you already have liver disease. As the virus is found in the faeces (stools) of people with hepatitis A, the infection is mainly caught by putting something in your mouth that they have touched. The illness can spread easily within families and where people live closely together.

Symptoms of Hepatitis A
Hepatitis A has an incubation period of about two to seven weeks. This is the time from exposure to the virus to the start of symptoms. As with the other hepatitis viruses, you may never have any symptoms but you will still be infectious and can unknowingly pass on the infection to others (if this is the case, you're an 'asymptomatic carrier' of hepatitis A).

If you have hepatitis A you may have symptoms similar to those of flu. They can include:
* fever;
* tiredness;
* loss of appetite;
* feeling sick and vomiting;
* stomach ache and/or diarrhoea;

These symptoms may last for around a week or more.

You may also develop jaundice, which makes your skin and the whites of your eyes go yellow. This is caused by a yellow-coloured substance in your blood called bilirubin. Bilirubin is usually broken down by your liver, but this doesn't happen if your liver is affected by hepatitis. Jaundice can also cause your urine to darken and your skin to itch.

These symptoms aren't always due to hepatitis A but if you have them, you should visit your GP.

Complications of Hepatitis A
Complications are rare with hepatitis A and most people make a full recovery with no permanent liver damage. If you're elderly, or already have liver disease or a medical condition such as diabetes or heart disease, you may take longer to recover from the infection. Hepatitis A can occasionally be fatal due to liver failure (fulminant hepatitis), although this is rare. You should contact your GP immediately if you have been exposed to hepatitis A, particularly if you have liver disease or a weakened immune system.

Causes of Hepatitis A
Hepatitis A is contagious and spread by contaminated faeces. The infection is easily spread in areas of overcrowding and poor sanitation and hygiene. You're at a higher risk of catching hepatitis A if you travel to countries where the disease is common.

You can get hepatitis A by:
* eating contaminated food or drinking contaminated water - this is the most common way of catching hepatitis A and can happen when infected people don't wash their hands properly before preparing food for others;
* eating shellfish contaminated by sewage;
* participating in high-risk sexual practices;
* having poor hygiene, such as not washing your hands when in high-risk areas;

Occasionally hepatitis A is spread through contaminated needles that have been used by an infected person.

Diagnosis of Hepatitis A
Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. He or she will also ask you a number of questions including, for example, whether you have recently been abroad, and if so, which country or region you have visited.

Your GP will ask for a blood sample which will be tested in a laboratory. The diagnosis of hepatitis A is made on the basis of the presence of antibodies against hepatitis A virus in your blood.

Additional blood tests for liver function can also help your GP to check the severity of your disease and assess how badly your liver is affected by the virus.

Treatment of Hepatitis A
There is no specific treatment for hepatitis A and most people recover completely within two months. If you're diagnosed with hepatitis A, your GP will generally advise you to rest and to take care not to spread the infection to others.

If you have jaundice and your skin is itchy, you can get advice from a pharmacist and try preparations such as calamine lotion or crotamiton (Eurax).

It's important that you stay well hydrated by drinking plenty of fluids. As your liver won't be working properly, it's best not to drink any alcohol until your liver is fully recovered.

Nearly everyone recovers from hepatitis A. The illness generally lasts around two to three weeks, although you may feel tired and lack energy for up to two months. It's unlikely that you will need to be admitted to hospital, unless you have fulminant hepatitis.

Unlike some of the other forms of viral liver infection, hepatitis A doesn't usually cause long-term liver damage. You will never be infected with hepatitis A again after you have recovered.

Prevention of Hepatitis A
It isn't always possible to prevent exposure to hepatitis A, especially if you travel to areas where it's common. If you're at risk, you should receive short-term protection with an immunoglobulin injection and long-term protection through immunisation with hepatitis A vaccine. This protection is available from your GP or a travel clinic. A joint vaccine is also available, which can provide long-term protection against hepatitis A and hepatitis B. This isn't available on the NHS and you will need to pay for it.

Hepatitis A Vaccine
Hepatitis A vaccine contains inactivated viruses and can give you protection from hepatitis A for up to 10 years. You should have your first injection four to six weeks before you travel, followed by a booster six to 12 months later. The hepatitis A vaccine works in around 19 out of 20 people. You can still have the vaccine if there is less than two weeks before you travel.

The vaccine is recommended if:
* you have chronic liver disease (the term chronic refers to time, not how serious a condition is);
* you inject drugs;
* you're travelling to countries where the general standard of hygiene is poor;
* your sexual behaviour puts you at risk ;
* your occupation involves the risk of exposure to the hepatitis A virus, for example, laboratory workers directly working with the virus and sewage workers;
* you have a weakened immune system ;
* you're pregnant and at a high risk from hepatitis A;

For further advice on protection against hepatitis A, talk to your GP, practice nurse or occupational health professional.

Human Normal Immunoglobulin (HNIG)
An injection of antibodies called human normal immunoglobulin (HNIG) is a well-established method for protecting against hepatitis A infection. However, now that there is a hepatitis A vaccine, using HNIG is hardly ever required. Hepatitis A vaccine can be given up until the day you travel and is the preferred means of protection should you come into close contact with an infected person. If more than one week has gone by since your exposure, an injection of HNIG may be given to you in addition to the hepatitis A vaccine.

A dose of HNIG may also be given with the vaccine if you're at high risk of severe disease. This may be because you're elderly, already have liver disease or if you have a weakened immune system.

Hygiene Advice
Passing the infection on can be prevented by always washing your hands after using the toilet.

If travelling in a high-risk country there are a number of precautions you should take. * ;
* Boil or sterilise the local tap water if you're unsure about it (preferably with an iodine-based preparation) - alternatively, drink only bottled water (and break the seal yourself);
* Don't have ice in drinks;
* Don't buy ice cream if it may have melted and been re-frozen;
* Take care with uncooked foods, including salads and fruit and vegetables (unless they're peeled by you), as the water they're washed in may be contaminated;
* Wherever possible, only eat freshly cooked food that is served piping hot and ensure that cold food has been kept cool;
* Don't eat undercooked shellfish;

Further Information * ;
* British Liver Trust
www.britishlivertrust.org.uk - Tel: 0800 652 7330;
* Medical Advisory Services for Travellers Abroad (MASTA)
www.masta-travel-health.com;
* Health Protection Agency
www.hpa.org.uk;

Sources
* What is hepatitis A? British Liver Trust. www.britishlivertrust.org.uk, accessed 8 July 2008;
* Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:496;
* Hepatitis A. Immunisation against infectious disease 2006. Green Book, Department of Health. 2007. www.dh.gov.uk;
* Immunizations - travel - background information. Hepatitis A. http://cks.library.nhs.uk, accessed 8 August 2008;
* Crowcroft NS, Walsh B, Davison, KL et al. Guidelines for the control of hepatitis A virus infection. Commun Dis Public Health 2001; 4:213-227. www.hpa.org.uk;
* Symptoms. Hepatitis A. British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008;
* Treatment. Hepatitis A. British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008;
* Prevention. Hepatitis A. British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008;
* Fish and shellfish. Food Standards Agency. www.eatwell.gov.uk, accessed 13 July 2008;
* Joint Formulary Committee, British National Formulary. 54th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2007: 595;
* Hepatitis A - Chapter 1. Immunoglobulin Handbook. Health Protection Agency. www.hpa.org.uk, accessed 8 July 2008;

Related Topics:
Hepatitis A
Hepatitis B
Hepatitis C
Travel Vaccinations' Advice