Hepatitis A

Hepatitis A is a vaccine-preventable, highly contagious liver disease caused by the hepatitis A virus (HAV). It is spread through close contact with someone who already has the disease. Infection with hepatitis A can cause mild to severe illness, which usually begins within two to seven weeks and may last for up to several months. Although some hepatitis A cases are asymptomatic, many patients experience symptoms of acute liver illness such as fever, nausea, abdominal pain, and jaundice (yellowing of the skin and eyes). In rare cases, hepatitis A infection may cause more severe complications or death. After a person has been infected with hepatitis A once, their immune system will protect against getting the disease again in the future.

Vaccines against hepatitis A are safe and effective, preventing more than 90% of cases. The hepatitis A vaccine is recommended as a routine childhood immunization. Certain groups of adults should also be vaccinated against hepatitis A because they are at high risk of illness. This includes, among others, people who have one or more of the following risk exposures: travel to a country where hepatitis A is common, drug use (either injection or non-injection), HIV, chronic liver disease, homelessness, and men who have sex with men.

Risk Factors 

How is hepatitis A spread?

It is transmitted person-to-person when a person ingests tiny amounts of fecal matter from contact with objects, food, or drinks contaminated by the feces of an infected person. It can also be spread from close personal contact with an infected person, for example, through sex or caring for someone who is ill.

Food contamination by hepatitis A can happen at any point – growing, harvesting, processing, handling, or even after cooking. However, the CDC states food or water contamination is more likely to occur in countries where hepatitis A is more common and in areas where there are poor sanitary conditions or poor personal hygiene. In the United States, chlorination of water kills HAV that enters the water supply, and the Food and Drug Administration routinely monitors natural bodies of water used for recreation.

What are the risk factors for hepatitis A?

You are at risk for hepatitis A if you:

• Have close contact with someone who has hepatitis A
• Travel to a country where hepatitis A is common
• Are a man who has sex with men
• Use illegal drugs (by injection or otherwise)
• Have occupational exposure to hepatitis A (such as handling hepatitis A specimens)
• Have close contact with an international adoptee
• Are homeless
• Live in a group setting for people with developmental disabilities
• Are incarcerated

You are at risk for more severe disease from hepatitis A if you:

• Are living with HIV
• Are living with chronic liver disease

If you have had another type of viral hepatitis in the past, can you get hepatitis A?

Yes. A person who has had other types of viral hepatitis, such as hepatitis B or hepatitis C, can still get hepatitis A.

Can you get hepatitis A more than once?

No. People who have had hepatitis A and have cleared the virus once have immunity against future hepatitis A infections.

Symptoms 

What are the symptoms of hepatitis A?

Most people who get hepatitis A (though not all) will experience one or more of the following symptoms:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored feces
• Joint pain
• Yellowing of the skin and eyes (known as jaundice)

Who is most likely to experience symptoms of hepatitis A?

Older children and adults typically have symptoms that can appear to develop abruptly. Most children younger than age 6 do not have symptoms and, when symptoms are present, young children typically do not have jaundice.

How soon after exposure to hepatitis A do symptoms appear?

Symptoms may appear within two to seven weeks, although typically symptoms start to show four weeks after exposure. Symptoms usually last less than two months, but about 10 to 15 percent of people can have symptoms last as long as six months.

Can you spread hepatitis A without having symptoms?

Yes. An infected person can pass the virus to others up to two weeks before symptoms appear. By the week after the onset of symptoms, transmission of hepatitis A is less likely.

Prevention 

What steps can you take to prevent hepatitis A?

The best way to prevent hepatitis A is through vaccination and by practicing good hand hygiene – including thoroughly washing hands after using the bathroom, changing diapers and before preparing or eating food.

Who should be vaccinated against hepatitis A?

The hepatitis A vaccine is recommended for all children. As of 2014, one dose of the vaccine is required for entry into kindergarten and first grade.

Most adults are likely not vaccinated unless they received vaccinations prior to traveling internationally. If you are in one of the groups described in What are the risk factors for hepatitis A? above, you should be vaccinated for hepatitis A if you are not already. You can receive the vaccine even if you have a compromised immune system.

How many doses of the hepatitis A vaccine are needed?

The hepatitis A vaccine is given as two shots, six months apart. Both shots are needed for long-term protection. Getting extra doses of the vaccine is not harmful.

Does the hepatitis A vaccine protect against other diseases?

No. The vaccine will only protect you against hepatitis A. There is a separate vaccine available for hepatitis B, although there is a combination of hepatitis A and hepatitis B vaccines that can be given to anyone age 18 or older. This combination vaccine is given as three shots over six months. There is no vaccine for hepatitis C at this time.

Where can I find the hepatitis A vaccine?

The Hepatitis A vaccine is available at Local Health Units for children aged 18 and younger. Please call ahead to schedule an appointment.

Local Health Units cannot offer hepatitis A vaccine to adults age 19 and older. However, many other facilities have the hepatitis A vaccine available. Talk with your healthcare provider to find one near you.

Exposure 

What should you do if you suspect exposure to hepatitis A?

People who believe they have been exposed to hepatitis A should contact a health professional or their local health unit if they have never been vaccinated against hepatitis A or are unsure of their vaccination status. A blood test is available for hepatitis A screening.

Even after exposure, a person can effectively prevent getting hepatitis A if he or she receives the hepatitis A vaccine or an immune globulin injection, which contains antibodies to hepatitis A, within two weeks of exposure. If illness does occur, it will usually be milder after receiving immune globulin.

Treatment 

What should you do if you are diagnosed with hepatitis A?

Talk with your healthcare provider. There are no specific treatments once a person gets hepatitis A, but doctors usually recommend rest, adequate nutrition and fluids to treat symptoms. Some people will need additional medical care at a hospital.

What is the prognosis for hepatitis A?

The disease can range from a mild illness lasting a few weeks to a severe illness lasting several months. According to the Centers for Disease Control and Prevention (CDC), although rare, hepatitis A can cause liver failure and death in some people. This is more common in people who are at least 50 years old and in people with other liver diseases.

Case Reporting (for healthcare providers) 

How do you report hepatitis A to ADH?

Hepatitis A is a reportable disease in Arkansas. This means that healthcare providers and laboratories must report any hepatitis A diagnosis in an Arkansas resident to ADH. For information on how to report hepatitis A and other diseases to ADH electronically, refer to the Promoting Interoperability webpage. Electronic reporting via this method is strongly preferred. However, if your facility is not able to report hepatitis A electronically, you can complete the Communicable Disease Reporting Form and fax it to (501) 661-2428.

Additional Information

Much of the information on this page is taken from the following sources. You can follow the links below to find out more:

• Hepatitis A Questions and Answers for the Public from CDC
• Epidemiology and Prevention of Vaccine-Preventable Diseases from CDC
• Data about viral hepatitis epidemiology in the United States is available on CDC’s viral hepatitis webpage
• Data about viral hepatitis in Arkansas is available at the ADH data hub

Healthcare providers who want to learn more about preventing, diagnosing, or treating hepatitis A can refer to the following resources:

• Hepatitis A Questions and Answers for Health Professionals from CDC
• Prevention of Hepatitis A Virus Infection in the United States from the Advisory Committee on Immunization Practices

If you have a question about hepatitis A that is not answered by any of these resources, you can contact the ADH Outbreak Response Section.

Downloads​

• Public Health Grand Rounds: “Update on the Hepatitis A Outbreak in Arkansas”
• Hepatitis A Fact Sheet
• Hepatitis A Patient Education Resources

Contact Information

Outbreak Response Section
4815 W. Markham St., Slot 48
Little Rock, AR 72205
Phone: 501-537-8969
Fax: 501-661-2300