Hepatitis A is a viral disease that affects the liver. Anyone can be infected with hepatitis A if they have direct contact with food, drinks or objects contaminated by the faeces (poo) of an infected person. There have also been outbreaks associated with eating contaminated shellfish and among particular groups, including people who inject illegal drugs and men who have sex with men. Hepatitis A is also common in developing countries where hygiene standards are poor.
Outbreaks can also occur in childcare centres. Children under five years of age often don’t show any symptoms, but can infect childcare workers or other children, especially if care is not taken during nappy changing. The first sign of an outbreak is usually when a parent or childcare worker becomes sick.
Symptoms may last for several weeks, but full recovery usually occurs. A single infection of hepatitis A does lead to lifelong immunity.
To be protected against hepatitis A when you haven't had the disease, you need to have completed a course of hepatitis A vaccination. Hepatitis A vaccine courses are either two doses of hepatitis A vaccine, or three doses of the hepatitis A and hepatitis B vaccines are given as a combination. If you are unsure whether you have been vaccinated or have had an incomplete vaccine course, ask your doctor or vaccine provider.
It is important to remember that hepatitis A, hepatitis B and hepatitis C are caused by different viruses, are spread in different ways and require different treatments. This means that prior infection with one type of virus won’t offer any immunity against the others.
Symptoms of hepatitis A
You can fall ill any time between 15 and 50 days after catching the virus. The average incubation period for the virus is 28 days. Many infected people, particularly children less than five years old, show few or no symptoms.
For older children and adults, the symptoms include:
- abdominal discomfort
- dark urine
- yellow skin and eyes (jaundice).
Symptoms may last for several weeks, but full recovery usually occurs.
Complications of hepatitis A
Relapses of hepatitis A occur in around 10 per cent of cases, although people who have relapses fully recover. Hepatitis A does not cause chronic liver disease.
Complications of hepatitis A are rare but the infection can lead to fulminant hepatitis, which is an acute form of hepatitis that can cause liver failure. The risk of death from fulminant hepatitis increases with age.
Causes of hepatitis A
Hepatitis A is caused by a virus. The virus can survive for several hours outside the body but persists on the hands and in food for even longer and is resistant to heating and freezing.
The virus is spread when it enters the mouth, which can happen when hands, foods or other items are contaminated with the faeces of a person with hepatitis A. The disease can also be spread sexually by oral or anal contact. A person with hepatitis A is infectious from two weeks before they show symptoms to one week after they become jaundiced.
Reducing the risk of hepatitis A
The most important action you can take to protect yourself is to get vaccinated.
Practising strict personal hygiene is also essential to reducing the risk of hepatitis A. Steps you can take include:
- Washing your hands with soap and hot running water before handling food, after going to the toilet and after handling used condoms or having contact with nappies or the anal area of another person.
- Cleaning bathrooms and toilets often, paying attention to toilet seats, handles, taps and nappy change tables.
- Boiling your drinking water if it comes from an untreated source, such as a river.
- People travelling overseas, particularly to countries where hepatitis A is widespread, need to take special care to avoid hepatitis A. Before travelling, talk to your doctor about immunisation for protection.
Careful selection and preparation of food and drink in countries where hepatitis A is widespread is vital and suggestions include:
- Leave it alone if you cannot peel it or boil it.
- Don’t eat uncooked foods, particularly vegetables and fruit that cannot be peeled before eating.
- Don't eat shellfish or unpackaged drinks or ice.
Diagnosis of hepatitis A
Tests used to diagnose hepatitis A may include:
- medical history – plus immunisation status and travel history
- physical examination
- blood test – a sample of your blood will be sent to a laboratory to confirm the diagnosis.
Treatment for hepatitis A
There is no specific treatment for hepatitis A. In most cases, your immune system will clear the infection and your liver will completely heal. Treatment aims to ease symptoms and reduce the risk of complications. Options may include:
- Rest – hepatitis A can make you tired and you have less energy for day-to-day life, so you should rest when necessary.
- Eat small meals more often - nausea can affect your ability to eat and can contribute to tiredness, so eat high-calorie foods if nausea is a problem.
- Protect your liver – the liver processes medication and alcohol, so avoid alcohol and review any medication with your doctor.
Exposure to hepatitis A
If you’ve been in contact with someone with hepatitis A and you are not immune (have not been immunised or have never had a hepatitis A infection), speak with your doctor about your treatment options.
Immunisation against hepatitis A
Healthy people 12 months of age and over receive two doses of hepatitis A vaccine, or three doses if the hepatitis A and hepatitis B vaccines are given as a combination. If your vaccine course is complete, you do not need a booster dose of hepatitis A vaccine. You can complete any missed vaccine doses, even if the recommended time frame has passed. You do not need to start the vaccine course again.
Close contacts of a person with hepatitis A should receive the hepatitis vaccine, if they have not already completed a vaccine course. For babies under 12 months of age and for people who have a medical condition such as a weakened immune system, who are also in close contact with a person with hepatitis A, an injection of normal human immunoglobulin (also called passive immunisation) can be used.
Immunisation is the best protection against hepatitis A infection and is recommended for people in high-risk groups. Immunisation against hepatitis A includes a course of injections over a six- to 12-month period. Protection against hepatitis A is available free of charge under the National Immunisation Program Schedule for Aboriginal and Torres Strait Islander children (between 12 and 24 months) who live in high-risk areas (Queensland, Northern Territory, Western Australia and South Australia).
In Victoria, the vaccine is recommended (but not free) for:
- people (12 months of age and over) travelling to places where hepatitis A is common
- people whose work puts them at increased risk of infection including plumbers or sewage workers and those who work with children, with people with developmental disabilities or with Aboriginal and Torres Strait Islander children in rural or remote Northern Territory, Queensland, South Australia or Western Australia
- people with developmental disabilities
- people with liver disease or people who have had a liver transplant or have chronic hepatitis B or hepatitis C
- workers in the sex industry.
Remember that immunisation against hepatitis A does not protect you against hepatitis B or hepatitis C. It is important that you take precautions to make sure you are not exposed to these diseases.
Pregnancy and hepatitis A immunisation
Hepatitis A immunisation is not usually recommended for women who are pregnant or breastfeeding although vaccination might be recommended in some situations. You should speak with your doctor if you are not immune to hepatitis A and you are at increased risk of infection or if you have a pre-existing medical condition such as liver disease.
Before receiving the vaccine, tell your doctor or nurse if you (or your child):
- are unwell (temperature over 38.5 ˚C)
- have allergies to any other medications or substances
- have had a serious reaction to any vaccine
- have had a serious reaction to any component of the vaccine
- have had a severe allergy to anything
- have a disease or you are having treatment that causes low immunity
- are taking any prescription or over-the-counter medications
- are pregnant or intend to become pregnant.
Side effects of immunisation against hepatitis A
Immunisations against hepatitis A are effective and safe, although all medications can have unwanted side effects.
Side effects from the vaccine are uncommon and usually mild, but may include:
- localised pain, redness and swelling at the injection site
- low-grade temperature (fever).
Managing fever after immunisation
Common side effects following immunisation are usually mild and temporary (occurring in the first few days after vaccination). Specific treatment is not usually required.
There are a number of treatment options that can reduce the side effects of the vaccine including:
- giving extra fluids to drink and not overdressing if there is a fever although routine use of paracetamol after vaccination is not recommended, if fever is present, paracetamol can be given - check the label for the correct dose or speak with your pharmacist, (especially when giving paracetamol to children).
Managing injection site discomfort
Many vaccine injections may result in soreness, redness, itching, swelling or burning at the injection site for one to two days. Paracetamol might be required to ease the discomfort.
Concerns about immunisation side effects
If the side effect following immunisation is unexpected, persistent or severe or if you are worried about yourself or your child’s condition after a vaccination, see your doctor or immunisation nurse as soon as possible or go directly to a hospital. Immunisation side effects may be reported to SAEFVIC, the Victorian vaccine safety and central reporting service.
You can discuss with your immunisation provider how to report adverse events in other states or territories. It is also important to seek medical advice if you (or your child) are unwell, as this may be due to other illness rather than because of the vaccination.
Rare side effects of hepatitis A immunisation
There is a very small risk of a serious allergic reaction (anaphylaxis) to any vaccine. This is why you are advised to stay at the clinic or medical surgery for at least 15 minutes following immunisation in case further treatment is required.
Immunisation and HALO
The immunisations you may need are decided by your health, age, lifestyle and occupation. Together, these factors are referred to as HALO.
Talk to your doctor or immunisation provider if you think you or someone in your care has health, age, lifestyle or occupation factors that could mean immunisation is necessary. You can check your immunisation HALO using the downloadable poster (pdf)
Where to get help