Hepatitis A is a viral infection of the liver, transmitted through contaminated food or water or via an infected person.
How is hepatitis A spread?
Hepatitis A infection can be spread through direct person-to-person contact, from contaminated water, or from ice or food that has been contaminated by human sewerage or because of poor food handling techniques. The virus can live on a person's hands for several hours and in room temperature food for much longer.
It can also be contracted from shellfish that have come from sewage-contaminated water or from fruits or uncooked vegetables contaminated during handling.
Cooking will generally kill the hepatitis A virus but food can be contaminated after cooking. It may be spread among people through poor hygiene practices and close contact in areas of poor sanitation and overcrowding.
The disease is highly endemic throughout many of the developing countries but not as prevalent in developed countries such as Australia and the United States, where hygiene practices and immunisation have controlled the spread of the disease.
What are the symptoms of hepatitis A?
Symptoms usually start 2-4 weeks after being infected. They may be mild or severe.
- Hepatitis A starts with 4 to 10 days of fever, feeling weak and unwell, loss of appetite, nausea and vomiting, abdominal discomfort, and muscle aches.
- In the second stage when the liver becomes involved, the urine turns dark.
- A day or 2 later, the whites of the eyes and the skin turn yellow (jaundice) and the faeces turn pale, while the initial fever and vomiting go away. Malaise and abdominal pain may persist.
- Symptoms generally only last 1-3 weeks.
- However, some people with this disease, especially children, have few or no symptoms and therefore the disease may be misdiagnosed or ignored completely.
Your doctor will diagnose hepatitis A based on your symptoms and the history you give them. The diagnosis can be confirmed by blood test, which looks for antibodies to hepatitis A.
Generally, hepatitis A does not cause lasting damage to the liver, but in rare cases, severe liver failure may lead to coma and death. It may present a greater risk to those who already have chronic liver problems. However, most patients with acute hepatitis A recover completely from their infection (unlike viral hepatitis B and C which can cause chronic, persistent liver infections).
People who recover completely from the disease develop antibodies against hepatitis A and then have life-long immunity against future infections by the same virus.
How long am I infectious for?
People with hepatitis A should not attend work, school or childcare until at least 7 days after the jaundice started. They can be infectious for up to 2 weeks before the onset of symptoms.
Risks for travellers
The risk of contracting hepatitis A virus when travelling overseas varies with the type of accommodation stayed in and food hygiene precautions taken, length of stay, and the incidence of hepatitis A infection in the areas visited.
There is very little risk when travelling in developed countries, no more than there would be at home in Australia. However, travellers to developing countries who visit rural areas and eat and drink food of questionable hygiene are at risk.
If travelling in countries where there is a greater risk, you should avoid drinking water that may be contaminated (including ice in drinks), or eating uncooked shellfish or uncooked fruits or vegetables that are not peeled or prepared in sanitary conditions. The usual advice is to boil it, cook it, peel it or forget it.
Aside from hygiene precautions, immunisation remains the most effective approach to preventing hepatitis A infection. Immunisation against hepatitis A is recommended for travel to areas of the world with moderate or high rates of the disease. It can be carried out by your doctor before you travel. Given the prevalence of hepatitis A in developing countries, travellers to these countries should be vaccinated against hepatitis A. Your doctor or travel vaccination centre can advise you whether you will need hepatitis A vaccination for your destination.
Hepatitis A vaccine is available in formulations for adults and children over the age of 12 months. Vaccines combining hepatitis A and hepatitis B protection are also available in Australia for adults and children over the age of 12 months. So long as you have a booster 6 months after the first vaccination you will get long lasting immunity. A combination vaccine against typhoid fever and hepatitis A is also available for people aged 16 years and older. You should see your doctor at least 4 weeks before you travel to ensure your hepatitis A vaccine offers full protection.
Treatment of hepatitis A
Treatment of hepatitis A is primarily aimed at relieving any symptoms and replacing fluid lost by vomiting. Rest is recommended to avoid complications from liver damage and accompanying fatigue. In 98 per cent of cases, there is total recovery - this may take weeks or months.
2. Centers for Disease Control and Prevention [website]. Travelers health Yellow Book. Hepatitis A (updated July 2015).http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-a (accessed Sept 2015).
3. World Health Organization. Hepatitis A. Updated July 2015. http://www.who.int/mediacentre/factsheets/fs328/en/
4. NSW Health. Hepatitis. Updated Dec 2013. http://www.health.nsw.gov.au/Infectious/factsheets/Pages/Hepatitis_A.aspx (accessed Sept 2015).
5. eMIMS Consumer Medicines Information. Sept 2015.