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Hepatitis A

This factsheet is for people who have been diagnosed with hepatitis A and those who want to know more about the virus.

Hepatitis means inflammation of the liver and can have many causes, the most common of which is an infection with a hepatitis virus. There are several different hepatitis viruses, including hepatitis A, and each differs in the way it is passed from person to person and the effect it can have on health. Hepatitis A is sometimes called hep A or HAV.

What causes hepatitis?

Hepatitis can have several causes including:

• infection
• excessive alcohol intake
• auto-immune disorders where the liver is attacked by the body's own immune system
• metabolic diseases (caused by a chemical imbalance in the body, such as diabetes)

Of these, viral infection is the most common cause.

How do you get hepatitis A?

Hepatitis A is contagious, which means it can be passed from person to person. The virus is present in the stools of an infected person.

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 an infected person does not wash their hands properly when they prepare food eaten by others
• eating shellfish contaminated by sewage

Occasionally hepatitis A is spread through blood.

Anyone at any age can develop hepatitis A but it is most common in young adults and children.

Where is hepatitis A common?

Hepatitis occurs in the UK but it is fairly uncommon due to generally good standards of sanitation.

High-risk areas for getting the infection include Eastern Europe, the Middle East, the Indian subcontinent, the Far East, Central America, South America and Africa.

Symptoms

Hepatitis A has an incubation period of about 15 to 40 days. This is the time from exposure to the virus to the start of symptoms. As with the other hepatitis viruses (hepatitis B and C), some people never have any symptoms. They are known as asymptomatic carriers; they are still infectious and can unknowingly pass on the disease to others.

Symptoms of the disease, when there are any, can be similar to severe flu. They can include:

• headache
• fever
• tiredness
• aching limbs
• loss of appetite
• nausea and vomiting
• stomach ache and/or diarrhoea

These symptoms may last for around a week or more. Jaundice then often develops.

Jaundice is caused by a yellow-coloured waste material called bilirubin, which is usually broken down by the liver. If your liver is affected by hepatitis, it is unable to process the bilirubin and raised levels in your blood cause the whites of your eyes to go yellow and your urine to become dark. Jaundice can also cause your skin to itch.

Children only rarely get jaundice from hepatitis A.

Complications

A very small percentage of people who are infected develop liver failure (called fulminant hepatitis). This is more common in older people and those with existing liver disease.

Diagnosis

Your doctor will examine you and ask you about your symptoms. He or she will also ask you a number of questions including if you have recently been abroad and if so which country or region you have visited.

Your doctor may ask you for a blood sample. The sample will be sent to a laboratory for:

• a test to see if you have hepatitis A antibodies
• a liver function test, which measures substances in the blood that indicate whether the liver is damaged

If tests results show that you have hepatitis A you may have further tests including a biopsy in which a small tissue sample is removed which is examined in a laboratory to find out if your liver is damaged.

Treatment

If you are diagnosed with hepatitis A, your GP will generally advise you to rest and to take care not to spread the infection to others (see Hygiene advice below).

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 is important that you stay well-hydrated by drinking plenty of fluids. As your liver will not be working properly, it is also strongly advisable to abstain from alcohol.

Getting better

Nearly everyone recovers from hepatitis A. The illness generally lasts around two to three weeks, although it can last longer in some people. It is unusual for people to need to be admitted to hospital.

Unlike some of the other forms of viral liver infections, hepatitis A does not usually cause long-term liver damage. Once you have recovered, you will have immunity from another infection of hepatitis A.

Prevention

It is not always possible to avoid exposure to hepatitis A, especially if you travel to areas where it is more common. If you are at risk, your options are long-term protection with an immunoglobulin injection and short-term protection through immunisation.

Immunisation

Immunisation can give protection for up to 10 years. It involves an initial injection preferably given four to six weeks before protection is needed (although you may still be advised to have it if there is less than two weeks before you travel), and followed by a booster 6 to 12 months later. Protection from hepatitis A provided by immunisation is around 95 percent.

A dose of immunoglobulin may be given with the vaccine if you are at high risk of severe disease. This may be because you also have chronic liver disease or if you have a low immune system and, therefore, may not respond to the vaccine.

Immunoglobulin

Immunoglobulin is a well-established method to protect against hepatitis A infection, when given by injection within two weeks of possible exposure to the virus. The protection given is immediate but relatively short-lived (up to about four months).

You may benefit from an immunoglobulin injection if your exposure to the hepatitis A virus has been identified too late to be protected by an immunisation (eight days or more from exposure). Immunoglobulin is no longer recommended for travellers to high-risk areas.

Who should be immunised?

The vaccine is recommended for people:

• who have chronic liver disease
• who are injecting drug users
• who are travelling to countries where the general standard of hygiene is poor
• whose sexual behaviour puts them at risk
• whose occupations involve the risk of exposure to the hepatitis A virus, for example, laboratory workers working directly with the virus and sewage workers who are likely to come into regular direct contact with raw sewage

For further advice on protection against hepatitis A, talk to your GP or practice nurse. See also the Department of Health advice booklet Health Advice for Travellers, available online at www.dh.gov.uk

Hygiene advice

Hepatitis A is usually spread by putting something in the mouth that has been contaminated with the stool of an infected person. Passing on the infection can be avoided 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 including:

• if you are in doubt about the local tap water, boil it or sterilise 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 from vendors where it may have melted
• take care with uncooked foods, including salads and fruit and vegetables (unless they are peeled by you, as the water they are 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
  0870 770 8028
  www.britishlivertrust.org.uk
• Medical Advisory Services for Travellers Abroad (MASTA)
  www.masta.org

Sources

1. Hepatitis A. PRODIGY PILS L85.
   www.prodigy.nhs.uk
   accessed 29 March 2006
2. NS Crowcroft et al on behalf of PHLS Advisory Committee on Vaccination and Immunisation. Guidelines for the control of hepatitis A virus infection. Commun Dis Public Health 2001; 4: 213-227.
3. Hepatitis A immunisation. PRODIGY PILS L86.
   www.prodigy.nhs.uk
   accessed 29 March 2006
4. Hepatitis A. Fighting Disease. British Liver Trust.
   www.britishlivertrust.org.uk
   accessed 29 March 2006
5. Fish and shellfish. Food Standards Agency.
   www.eatwell.gov.uk
   accessed 29 March 2006
6. Hepatitis A. Infections. Health Protection Agency.
   www.hpa.org.uk
   accessed 29 March 2006
7. Hepatitis A. Policy and Guidance: Health topics. Department of Health.
   www.dh.gov.uk
   accessed 29 March 2006
8. Hepatitis A - Chapter 1. Immunoglobulin Handbook. Health Protection Agency.
   www.hpa.org.uk
   em>accessed 29 March 2006
9. Hepatitis A. Chapter 18. The Green Book. Department of Health.
   www.dh.gov.uk
   November 2005

Reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP. partner/principal general practitioner at Rowcroft Medical Centre.

Published by BUPA's health information team, healthinfo@bupa.com, September 2006.

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