Hepatitis A: Entire Lesson - Hepatitis A for Patients

Hepatitis A is a result of infection with the hepatitis A virus. Hepatitis A is a contagious liver disease that can range in severity from a mild illness lasting a few weeks to a severe illness causing liver failure. Most people infected with the virus get well within 6 months. However, hepatitis A can be serious for older people and people who already have liver disease such as hepatitis B or C.

The hepatitis A virus is usually spread by putting something in your mouth that is contaminated with the virus. The virus is found in the stool of people with hepatitis A and is spread when someone's stool accidentally contaminates food or water. This can happen when an infected person does not adequately wash their hands after using the bathroom then touches other things such as food. When other people eat that food, they can get infected with hepatitis A. Usually the transmission is between people in very close personal contact.

Foods themselves can be contaminated with hepatitis A virus, such as raw oysters harvested from sewage-contaminated water. When people eat food contaminated with hepatitis A virus, they can get infected with the virus.

Hepatitis A is usually spread through:

• household contact with an infected person
• sexual contact with an infected person
• eating or drinking contaminated food or water
• sharing eating utensils that are contaminated
• touching contaminated surfaces and then placing your hands near or in the mouth

Anyone can get hepatitis A. In the United States, certain groups are at higher risk, such as people who:

• Travel to or live in areas where hepatitis A is common
• Have been recently exposed to hepatitis A including during hepatitis A outbreaks, living with someone who has hepatitis A
• Are men who have sex with men
• Use drugs, whether injected or not
• Have sexual contact with someone who has hepatitis A
• People with occupational risk for exposure
• Are unvaccinated family members or caregivers of a recent adoptee from countries where hepatitis A is common
• Are experiencing homelessness

People at increased risk for complications if they became infected with hepatitis A:

• People living with chronic liver disease, including:
  • chronic hepatitis B
  • chronic hepatitis C
  • non-alcoholic fatty liver disease
  • alcoholic liver disease
• People awaiting liver transplant or post-liver transplant
• People with HIV
• People age 40 and older (more likely to be hospitalized)

Your provider can tell you if you have hepatitis A by taking a sample of your blood. A blood test for a specific antibody called an IgM antibody can tell if you are infected with hepatitis A. Your provider will also talk to you about your symptoms, which may include the following:

• Yellowing of the skin or eyes (called jaundice)
• Feeling very tired
• Stomach pain
• Not feeling very hungry
• Dark urine or light-colored stools
• Nausea or vomiting
• Diarrhea
• Low-grade fever
• Joint pain

Though some people do not have any symptoms, hepatitis A usually makes people feel sick:

• Adults with hepatitis A are often too ill to work for up to a month.
• People with hepatitis A sometimes have to be hospitalized (up to 1 person in 5).
• In rare cases, people die as a result of hepatitis A (about 3 to 6 deaths per 1,000 cases).

There are no special treatments for hepatitis A. Most people with hepatitis A recover without treatment within a few months by getting a lot of rest and drinking plenty of fluids.

Practice good personal hygiene

Because so many cases of hepatitis A are due to close contact with an infected person, you should always practice good personal hygiene, especially by washing your hands.

Be careful in high-risk situations

• Boil water or drink bottled water in areas where there is a risk for hepatitis A contamination.
• Eat cooked foods and fruits that you can peel and avoid eating vegetables or fruits that could have been washed with contaminated water, such as lettuce.
• Avoid eating raw or steamed shellfish, such as oysters, that live in contaminated waters.
• Use condoms correctly and every time you have sex. (See Tips for Using Condoms, on the VA HIV/AIDS website.)

Get vaccinated

The best way to prevent hepatitis A is to get vaccinated. The vaccine is very effective and can keep you from ever getting hepatitis A. You will not get hepatitis A from the vaccine.

The hepatitis A vaccine is a dose of inactive virus that stimulates your natural immune system. After the hepatitis A vaccine is given, your body makes antibodies that will protect you against the hepatitis A virus. You will NOT get hepatitis A from the vaccine, and receiving the vaccine is much safer than getting the disease itself.

Vaccination for hepatitis A requires 2 shots, 6 months apart. The vaccine is given with an injection, into the muscle of the upper arm. If for some reason the second injection doesn't take place at 6 months, you can receive the second dose at a later time.

If you need hepatitis B vaccination in addition to hepatitis A, you can do these individually or as a combined vaccine that covers both. The combination vaccine is given as 3 injections over a 6-month period--an initial dose, followed by a second dose 1 month later, and then a third dose 5 months after the second.

Hepatitis A vaccination is recommended for:

• Travelers to countries that have high rates of hepatitis A
• Men who have sex with men
• People who use injection and non-injection drugs
• People with recent exposure to hepatitis A
• People with chronic (lifelong) liver diseases, such as hepatitis B or hepatitis C
• People with occupational risk for exposure including those who work in settings providing services to adults at high risk for hepatitis A, hepatitis A-infected animals or in a hepatitis A research laboratory
• People who are experiencing homelessness
• People at increased risk for severe disease from hepatitis A infection who also have other risk factors
• People age 19 or older at increased risk for hepatitis A infection, or who are at increased risk for severe disease from hepatitis A infection who also have other risk factors
• Unvaccinated family members or caregivers of a recent adoptee from countries where hepatitis A is common
• People who are previously unvaccinated who want to be protected against hepatitis A

Health care providers recommend that all children receive a hepatitis A vaccination at around 1 year of age, but many adults have never received the vaccine because it only became available in 1995.

Health care personnel and patients with the following conditions should discuss the hepatitis A vaccination with their health care provider: pregnancy, immunocompromising conditions, heart disease, chronic lung disease, chronic alcoholism, asplenia, kidney failure.

You should NOT get the hepatitis A vaccination or you should wait, if you:

• Had a serious allergic reaction to a previous hepatitis A vaccination
• Are moderately or severely ill, with or without fever, at the time the vaccination is scheduled (if you are just mildly ill, ask your provider if it is OK for you to receive the vaccine)

Speak with your VA health care provider to see if you should be vaccinated against hepatitis A.

Should pregnant or breast-feeding women receive the hepatitis A vaccination?

The safety of hepatitis A vaccination during pregnancy has not been determined; however, because hepatitis A vaccine is produced from inactivated virus, the risk to the developing fetus is probably low. The hepatitis A vaccination appears safe for women during breastfeeding and their infants. The risk associated with hepatitis A vaccine should be discussed with your health care provider to determine if vaccination is right for you.

Your provider may decide to test your blood for antibodies to hepatitis A but this is not mandatory for everyone. If you have antibodies to hepatitis A already, it means either that you were infected with hepatitis A in the past or that you were previously vaccinated against hepatitis A. Either way, you don't need to get the hepatitis A vaccination if you already have antibodies to hepatitis A.

The hepatitis A vaccine is made from inactive virus and is quite safe. In general, there are very few side effects. The most common potential side effect is soreness at or around the injection site. Other potential side effects include mild headache, loss of appetite among children, and feeling tired. These side effects usually last 1 or 2 days. However, like any medicine, the vaccine could cause serious problems, such as an allergic reaction, which may appear within a few minutes or hours after getting the shot. This occurs very rarely, but if you believe you are having a reaction to the vaccine you should call your provider right away. Some warning signs of a serious allergic reaction include the following:

• High fever
• Behavior changes
• Difficulty breathing
• Hoarse voice or wheezing
• Hives
• Pale skin
• Weakness or dizziness
• A fast heart beat

There are 2 vaccines for hepatitis A on the market. There is 1 combination vaccine on the market for hepatitis A and B together.

Vaccination Schedule

Products and Publications

• Hepatitis A Fact Sheet
  Frequently asked questions about the symptoms, treatment, and prevention of hepatitis A.
• The ABCs of Hepatitis
  A comparison of the symptoms, treatment, and prevention of the major types of viral hepatitis: A, B, and C.
• Infectious Disease Screening and Vaccination
  Fact sheet for with key things to know about screening and vaccination for hepatitis A, hepatitis B, hepatitis C, HIV, human papillomavirus (HPV), syphilis, gonorrhea, and chlamydia.
• Glossary
  Definitions of terms commonly used with viral hepatitis and related conditions.

Web Resources

• American Liver Foundation
  A national nonprofit organization dedicated to the prevention, treatment, and cure of hepatitis and other liver diseases through research, education, and advocacy.
• Centers for Disease Control and Prevention: Viral Hepatitis
  Information on all types of viral hepatitis from the CDC's National Center for Infectious Diseases. Site features related CDC guidelines and recommendations as well as training materials, slide sets, fact sheets, and key CDC hepatitis documents.
• NATAP: Hepatitis
  Recogizing that coinfection with viral hepatitis among people with HIV is a growing problem, the National AIDS Treatment Advocacy Project (NATAP) developed an extensive amount of information on hepatitis, both in the context of HIV coinfection and as a separate illness.