Hepatitis A

Published by Bupa's Health Information Team, November 2010.

This factsheet is for people who have hepatitis A, or who would like information about it.

Hepatitis A is a liver disease caused by an infection with the hepatitis A virus (also known as HAV). Hepatitis A can be prevented with a vaccine.

About hepatitis A

Hepatitis means ‘inflammation of the liver’ and can be caused by infection with a hepatitis virus. It can also be caused by alcohol, drugs and other toxins.

You can get hepatitis A in the UK, but it's fairly uncommon because of good standards of sanitation. It's more common in countries where water supplies, sanitation and sewage disposal are poor. High-risk areas include Africa, the Middle and Far East and southern and eastern Europe. The exact number of people affected isn’t clear as many people often have only mild symptoms and therefore don’t go to a doctor.

Hepatitis A is usually an acute illness that is typically over quickly. When describing an illness, the term ‘acute’ refers to how long a person has had it, not to how serious the condition is.

Hepatitis A can be a more serious disease as you get older or if you already have liver disease.

Symptoms of hepatitis A

Hepatitis A has an incubation period of about two to seven weeks. The incubation period is the time from being exposed to the virus to the start of your symptoms. However, some people don’t have any symptoms and are known as ‘asymptomatic carriers’. They are still infectious and can unknowingly pass on the disease to others.

If you do have symptoms, they may be similar to those of flu and include:

• fever
  
• tiredness
  
• aching limbs
  
• loss of appetite
  
• feeling sick and vomiting
  
• stomach ache and/or diarrhoea
  
• intolerance to alcohol

You may also develop jaundice, which makes your skin and the whites of your eyes go yellow. This is caused by a yellow-coloured substance in your blood called bilirubin. Bilirubin is usually broken down by your liver, but this doesn't happen if your liver is affected by hepatitis. Jaundice can also cause your urine to darken and your skin to itch.

These symptoms aren't always caused by hepatitis A but if you have them, see your GP.

Complications of hepatitis A

A very rare complication of acute hepatitis A is liver failure (known as fulminant hepatitis). This can be fatal. If caught early enough, it can be treated with a liver transplant.

Causes of hepatitis A

Hepatitis A is caused by the hepatitis A virus. It can be spread between people through contact with an infected person’s faeces. You can get it if you put something in your mouth that an infected person has touched.

The infection is easily spread in overcrowded areas where there is poor sanitation and hygiene. You're at a higher risk of catching hepatitis A if you travel to countries where the condition is common. Hepatitis A can spread easily within families and where people live closely together.

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 infected people don't wash their hands properly before preparing food for others
  
• eating shellfish contaminated with sewage
  
• having poor hygiene, such as not washing your hands when in high-risk areas
  
• having sex with an infected person
  
• using contaminated needles to inject drugs

Diagnosis of hepatitis A

If you think you have been exposed to the hepatitis A virus, contact your GP. He or she will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may ask you for a blood sample. This will be sent to a laboratory for testing to find out if you're infected with the hepatitis A virus. The test won't show if the virus is present, but will show if your body has produced antibodies against it. Antibodies are proteins made by the immune system that fight against viruses and bacteria.

If the results show that there are hepatitis A antibodies in your blood, you may have additional tests. For example, a liver function blood test can measure substances in your blood that indicate any liver damage.

Treatment of hepatitis A

There isn’t any specific treatment for hepatitis A. Your GP will usually advise you to rest, drink enough water and to take care not to spread the infection to others. Always wash your hands after going to the toilet and before preparing food. Having good personal hygiene can reduce the risk of passing it to others. It’s also best not to have unprotected sex until you have fully recovered.

As your liver won't be working properly, it's important not to drink any alcohol until your liver has fully recovered.

Most people with hepatitis A recover without treatment within about two months. Complications are rare and most people make a full recovery with no permanent liver damage. You will never get hepatitis A again after you have recovered.

Prevention of hepatitis A

Hepatitis A vaccine

The hepatitis A vaccine can give you protection against hepatitis A for at least 20 years. You need to have two injections for long-term protection – the second ‘booster’ dose is usually given six to 12 months after the first.

The vaccine is recommended if:

• you're travelling to countries where the general standard of hygiene is poor
  
• you have chronic (long-term) liver disease
  
• you inject drugs
  
• your sexual behaviour puts you at risk
  
• you have a weakened immune system
  
• your occupation involves risk of exposure to the hepatitis A virus; for example, if you’re a laboratory worker directly working with the virus or work in a sewage works

Vaccination is sometimes recommended if you have recently been in close contact with someone who has hepatitis A.

If you think you're at risk of getting hepatitis A, for example if you’re going on holiday to a high-risk area, contact your GP to discuss whether or not you should have a vaccination against the disease.

If you’re having the vaccine before travelling to a high-risk area, you should ideally have the first injection at least two weeks before you leave but it’s still worth having, even if you’re vaccinated the day you travel.

The hepatitis A vaccine can have some side-effects, including soreness in the area where you had the vaccine, headache, poor appetite and feeling tired. Occasionally, people have a more serious allergic reaction but this is rare.

For further advice on protection against hepatitis A, talk to your GP, practice nurse or occupational health professional.

Human normal immunoglobulin

An injection of antibodies called human normal immunoglobulin (HNIG) is another method of protecting against hepatitis A infection. However, since the hepatitis A vaccine was developed this is hardly ever required. You may be given a dose of HNIG with the hepatitis A vaccine if you're at high risk of severe disease. This may be because you're elderly, already have liver disease or if you have a weakened immune system.

If you haven’t been vaccinated and come into contact with hepatitis A, HNIG can either prevent the disease developing or reduce its severity. The injection is more effective the sooner it's given after exposure to the virus.

Travel advice

If you’re travelling to a country where hepatitis A is common, there are a number of precautions you can take.

• Boil or sterilise the local tap water if you're unsure about it (preferably with an iodine-based preparation) – alternatively, drink only bottled water (and break the bottle seal yourself).
  
• Don't have ice in drinks.
  
• Don't buy ice cream if it may have melted and been re-frozen.
  
• Take care with uncooked foods, including salads and fruit and vegetables (unless you peel them yourself), 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.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.