What is hepatitis?
Hepatitis means inflammation of the liver. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis but a virus often causes hepatitis.
In the United States, the most common hepatitis viruses are hepatitis A virus, hepatitis B virus, and hepatitis C virus.
What is hepatitis A?
It is a highly contagious liver infection caused by the hepatitis A virus. It can range from a mild illness lasting a few weeks to a severe illness lasting several months. Although rare, it can cause death in some people. It is usually spread when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person.
How serious is hepatitis A?
Most people who get it feel sick for several weeks, but they usually recover completely and do not have lasting liver damage. In rare cases, it can cause liver failure and death; this is more common in people older than 50 and in people with other liver diseases.
What Are the Symptoms of Hepatitis A?
If you have this infection, you have inflammation in your liver that’s caused by a virus. You don’t always get symptoms, but when you do, you might have:
- Jaundice (yellow eyes and skin, dark urine)
- Pain in your belly
- Loss of appetite
- Nausea
- Fever
- Diarrhea
- Fatigue
Children often have a disease with few symptoms.
You can spread the virus about 2 weeks before your symptoms appear and during the first week they show up, or even if you don’t have any.
What Causes Hepatitis A?
It is caused by a virus that infects liver cells and causes inflammation. The inflammation can affect how your liver works and cause other signs and symptoms of hepatitis A.
The virus most commonly spreads when you eat or drink something contaminated with fecal matter, even just tiny amounts. It does not spread through sneezing or coughing.
Here are some of the specific ways the hepatitis A virus can spread:
- Eating food handled by someone with the virus who doesn’t thoroughly wash his or her hands after using the toilet
- Drinking contaminated water
- Eating raw shellfish from water polluted with sewage
- Being in close contact with a person who’s infected — even if that person has no signs or symptoms
- Having sex with someone who has the virus
What Are the Risk Factors for Hepatitis A?
You’re at increased risk of hepatitis A if you:
- Travel or work in areas of the world where it is common
- Attend childcare or work in a childcare center
- Live with another person who has hepatitis A
- Are a man who has sexual contact with other men
- Have any type of sexual contact with someone who has hepatitis A
- Are HIV positive
- Are experiencing homelessness
- Have a clotting-factor disorder, such as hemophilia
- Use any type of illegal drugs (not just those that are injected)
Who is at risk of getting hepatitis A?
It is usually spread from person to person, making it highly contagious. However, certain factors can increase your risk of contracting it, including:
- living in (or spending an extended time in) an area where it is common, including most countries with low sanitation standards or a lack of safe water
- injecting or using illegal drugs
- living in the same household as someone who is hepatitis A-positive
- having sexual activity with someone who is hepatitis A-positive
- being HIV-positive
The WHOTrusted Source reports that more than 90 percent of children living in countries where there are low sanitation standards will have had the infection by age 10.
Diagnosis / Treatment
How do doctors diagnose hepatitis A?
Doctors diagnose it based on symptoms and a blood test. A health care professional will take a blood sample from you and send the sample to a lab. A blood test will detect antibodies to the hepatitis A virus and show whether you have it.
How do doctors treat hepatitis A?
Treatment includes resting, drinking plenty of liquids, and eating healthy foods to help relieve symptoms. Your doctor may also suggest medicines to help relieve symptoms.
Talk with your doctor before taking any prescription or over-the-counter medicines, vitamins or other dietary supplements, or complementary or alternative medicines—any of these could damage your liver. You should avoid alcohol until your doctor tells you that you have completely recovered from the disease.
See your doctor regularly to make sure your body has fully recovered. If you have symptoms for longer than 6 months, see your doctor again.
Hepatitis A vaccine
All children should receive the vaccine between 12 and 23 months of age. People who are more likely to be infected and people with chronic liver disease should also receive the vaccine.
Doctors give the vaccine in two shots. You should get the second shot 6 to 12 months after the first shot. You need to get both shots to be fully protected against the virus.
If you are traveling to a developing country where it is common and you haven’t received the vaccine, try to get both shots before you go. If you don’t have time to get both shots, get the first shot as soon as you can. Most people gain some protection within 2 weeks of the first shot.
Reduce your chance of infection
You can reduce your chance of being infected by washing your hands thoroughly with soap and warm water for 15 to 30 seconds
- after using the toilet
- after changing diapers
- before and after handling or preparing food
When traveling in a developing country, drink bottled water. Use bottled water to brush your teeth, make ice cubes, and wash fruits and vegetables.
How will I know if I have hepatitis A? How is hepatitis A diagnosed?
A doctor can determine if you have the infection by discussing your symptoms and taking a blood sample.
How is hepatitis A treated?
Unvaccinated people who have been exposed recently (within 2 weeks) to the virus should get the hepatitis A vaccine or a shot of immune globulin to prevent severe illness. To treat the symptoms, doctors usually recommend rest, adequate nutrition, and fluids. Some people will need medical care in a hospital. It can take a few months before people with the disease to begin to feel better.
Prevention / Vaccination
Can hepatitis A be prevented?
Yes. The best way to prevent it is through vaccination with the hepatitis A vaccine. To get the full benefit of the vaccine, more than one shot is needed. The number and timing of these shots depend on the type of vaccine you are given. Practicing good hand hygiene – including thoroughly washing hands after using the bathroom, changing diapers, and before preparing or eating food – plays an important role in preventing the spread of hepatitis A.
Who should get vaccinated against hepatitis A?
The Advisory Committee on Immunization Practices (ACIP) recommends hepatitis A vaccination for the following people:
- All children at age 1 year
- Travelers to countries where it is common
- Family and caregivers of adoptees from countries where it is common
- Men who have sexual encounters with other men
- Users of recreational drugs, whether injected or not
- People with unstable housing or experiencing homelessness
- People with chronic or long-term liver disease, including hepatitis B or hepatitis C
- People with clotting factor disorders
- People with direct contact with others who have hepatitis A
- Any person wishing to obtain immunity (protection)
How is the hepatitis A vaccine given?
The vaccine is safe and effective and given as 2 shots, 6 months apart. Both shots are needed for long-term protection. The vaccine also comes in a combination form, containing both hepatitis A and B vaccine, that can be given to anyone 18 years of age and older. This combination vaccine is given as 3 shots, over 6 months. All three shots are needed for long-term protection for both hepatitis A and B.
Is the hepatitis A vaccine effective?
Yes, the vaccine is highly effective in preventing virus infection. A second hepatitis A shot results in long-term protection.
Is the hepatitis A vaccine safe?
Yes, the vaccine is safe. No serious side effects have been reported from the vaccine. Soreness at the injection site is the most common side effect reported. As with any medicine, there is always a small risk that a serious problem could occur after someone gets the vaccine. However, the potential risks associated with it are much greater than the potential risks associated with the vaccine. Since the licensure of the first vaccine in 1995, millions of doses of vaccine have been given in the United States and worldwide.
Who should not receive the hepatitis A vaccine?
People who have ever had a serious allergic reaction to the vaccine or who are known to be allergic to any part of the vaccine should not receive the vaccine. Tell your doctor if you have any severe allergies. Also, the vaccine is not licensed for use in infants under age 1 year.
What is immune globulin (IG)?
Immune globulin (IG) is a substance made from human blood plasma that contains antibodies that protect against infection. Immune globulin is a shot and provides short-term protection against the infection for up to 2 months depending on the dosage given. IG is sometimes used before travel to a country where it is common. IG is also used to prevent infection after exposure to the virus but must be given within 2 weeks after exposure for the best protection.
Will the hepatitis A vaccine protect me from other forms of hepatitis?
No, the vaccine will only protect you against hepatitis A. There is a separate vaccine available for hepatitis B. There is also a combination hepatitis A and hepatitis B vaccine that offers protection for both viruses. There is no vaccine for hepatitis C at this time.
Can hepatitis A vaccine be given to people with compromised immune systems, such as hemodialysis patients or people with AIDS?
Yes. The vaccine is inactivated (not “live”), so it can be given to people with compromised immune systems.
Is it harmful to have an extra dose of the hepatitis A vaccine or to repeat the entire hepatitis A vaccine series?
No, getting extra doses of the vaccine is not harmful.
What should be done if the last dose of hepatitis A vaccine is delayed?
If the second dose has been delayed (more than 6 months since the first dose was given), the second, or last dose, should be given as soon as possible. The first dose does not need to be given again.
Where can I get the hepatitis A vaccine?
Speak with your health professional or call your local public health department, where free or low-cost vaccines for adults may be offered. For children, check the Vaccines for Children Program.
Hepatitis A Vaccine and International Travel
Who should get the hepatitis A vaccine before traveling internationally?
Anyone who is susceptible (unvaccinated or never had hepatitis A) and planning to travel to countries where hepatitis A is common should be vaccinated with the vaccine or immune globulin (IG) before traveling. Even travelers to urban areas, resorts, and luxury hotels in countries where hepatitis A is common are at high risk. Even travelers reporting that they maintained good hand hygiene and were careful about what they drank and ate have been infected when traveling to countries where hepatitis A is common.
How soon before travel should I get the hepatitis A vaccine?
You should get the first dose of the vaccine as soon as you plan international travel to a country where it is common. Two weeks or more before departure is ideal, but getting the vaccine any time before travel will provide some protection.
For optimal protection, older adults (aged >40 years), people who are immunocompromised, and people with chronic liver disease or other chronic medical conditions who are planning to depart in less than 2 weeks should receive the first dose of vaccine and can get a shot of immune globulin at the same time, (0.1 mL/kg for travel up to 1 month; 0.2 mL/kg for travel up to 2 months; repeat dose of 0.2 mL/kg every two months) at a separate injection site.
I’m leaving for my trip in a few days, can I still get the hepatitis A vaccine?
Experts say that the first dose of the vaccine can be given any time before departure. This will provide some protection for most healthy people.
What should I do if I am traveling internationally but cannot receive the hepatitis A vaccine?
Travelers who are allergic to a vaccine component or who are younger than 6 months should receive a single dose of immune globulin (IG). Immune globulin provides effective protection against the virus infection for up to 2 months, depending on the dosage given. If you are staying longer than two months, you can get another dose of IG for continued protection.
Frequently Asked Questions about Hepatitis A
What is the recommended treatment for acute hepatitis A virus?
Unvaccinated individuals who have been exposed recently (within 2 weeks) to hepatitis A virus (HAV) should get the vaccine or immune globulin to prevent severe illness. There is no specific treatment for the infection. Supportive care, such as fluids, nutrition, and rest is also recommended.
How strict is the recommendation to administer the end dose of hepatitis A vaccine at 6 months? Are there data to support administering the 3rd dose if the 2nd dose is administered within 6 months of the 1st dose?
A decreased immune response may occur when doses are administered earlier than the recommended interval. Doses of any vaccine administered ≥5 days earlier than the minimum interval or age should not be counted as valid doses and should be repeated as age-appropriate. The repeat dose should be spaced after the invalid dose by the recommended minimum interval. For example, if the first and second doses of the vaccine were administered less than 6 months apart, the second dose is invalid and should be repeated at least 6 months after the invalid second dose.
Is there a risk of reactivation of hepatitis A post-infection?
Reinfection of the infection does not occur. Protective antibodies (IgG) develop in response to HAV infection and confer lifelong immunity. However, relapsing has been described as an atypical complication of the virus infection.
Are there any current issues with the hepatitis A vaccine supply on a national basis?
Yes, as of November 2017, in light of ongoing outbreaks of the infection among adults in several US cities, the demand for adult vaccine has increased substantially over the past 6 months and vaccine supply to meet this unexpected demand in the US has become constrained. The Centers for Disease Control and Prevention (CDC) website provides information on vaccine supply and shortages. Note that current constraints do not apply to the pediatric vaccine supply.