Hepatitis A

Hepatitis A is an acute (short-term) infection of the liver

What is hepatitis A?

The hepatitis A virus can survive in the environment on hands for several hours and in food kept at room temperature for considerably longer and is relatively resistant to detergents. Hepatitis A occurs worldwide. In developing countries, most people are infected during childhood due to poor sanitation. With good sanitation and hygiene in the developed world, most people now reach adulthood without being exposed to the hepatitis A virus.

 

In Australia, there are approximately 300-500 cases of hepatitis A reported per year. The number of cases reported has been declining nationally since the late 1990’s (DoHA 2006). In 2011 there were 144 diagnosed cases of hepatitis A in Australia (Kirby Institute: 2012). The real number of hepatitis A infections is likely to be more than the number of infections reported. This is because many people with hepatitis A do not have obvious symptoms, do not go to the doctor and so are not tested for hepatitis A.

 

Up to 40% of people with hepatitis A have no identifiable risk factors for infection.

Hepatitis A is most commonly spread by the faecal-oral route. Faecal-oral transmission of the hepatitis A virus may occur when anything that has been contaminated with infected faeces is put in the mouth, for example:

  • Food, liquid or eating utensils can transmit the virus from an infected person
  • Touching nappies, linen and towels soiled with the faeces of an infectious person, and
  • Direct contact (including sexual) with an infectious person

Testing is done with a simple blood test. The incubation period (time between exposure to the virus and the development of symptoms) varies between 15 and 50 days, with an average of 30 days. Hepatitis A virus is excreted for up to two weeks before the onset of symptoms. Therefore, people with hepatitis A should be considered infectious for a week after the onset of jaundice.

Symptoms of hepatitis A include:

  • fever
  • weakness
  • fatigue
  • loss of appetite
  • nausea
  • joint aches and pains
  • vomiting, and
  • jaundice (yellowish eyes and skin, dark urine and pale-coloured faeces)

The duration of the illness varies but most people feel better and their Liver Function Tests (LFTs) begin to normalise a month after the onset of infection. Hepatitis A infection never causes a chronic (long-term) infection. Death because of hepatitis A infection is very rare. The likelihood of severe disease or death resulting from hepatitis A infection is much greater in people with pre-existing liver damage, including people with chronic liver disease due to hepatitis B or C, and people over 50 years of age.

There are no medical treatments for hepatitis A, however bed rest, a healthy diet and plenty of fluids are recommended for a quick recovery. Medications should be limited to those considered essential and alcohol should be avoided. Hepatitis A is an acute infection and will not become a chronic (long term) infection. Some people can still work while experiencing symptoms of hepatitis A, however people working with food or drink, or in professions requiring close personal contact (such as child and health care workers), should not work for at least one week after the onset of jaundice.

A vaccine is available to protect against hepatitis A infection in people two years of age and older. There are currently five hepatitis A vaccines and two combined hepatitis A/hepatitis B vaccines registered for use in Australia. The vaccines are made from inactive hepatitis A virus. The body reacts with the inactive virus to produce antibodies that protect against infection. Clinical trials have shown that the hepatitis A vaccine is effective in preventing infection in about 95% of people.

 

To avoid the transmission of hepatitis A:

  • Consider being vaccinated
  • Always wash hands thoroughly after going to the toilet, before preparing and eating food, after handling soiled linen e.g. nappies
  • Avoid sharing food, cutlery, crockery, cigarettes and drinks with other people
  • When travelling in regions with poor sanitation, drink bottled water and avoid eating food that has been cleaned or prepared using contaminated water, and
  • In a natural disaster, listen to warnings about contaminated drinking water and follow any instructions issued by the relevant authorities

The Australian Immunisation Handbook recommends hepatitis A vaccinations for:

  • Travellers to endemic areas, which means developing countries
  • All Aboriginal and Torres Strait Islander children between 18 months and six years of age in north Queensland
  • Workers in rural and remote Indigenous communities
  • Child day-care and pre-school staff
  • People with intellectual disabilities and their carers
  • Healthcare workers employed in paediatric wards, intensive care units and emergency departments that provide for substantial populations of Aboriginal and Torres Strait Islander children and nursing and medical staff on rural and remote Indigenous communities
  • Sewage workers
  • Men who have sex with men
  • People who inject drugs
  • People with chronic liver disease of any aetiology, and
  • People with haemophilia who may receive pooled plasma concentrates

Infants and young children infected with hepatitis A will rarely show symptoms of infection and may appear quite well, or have only mild symptoms. The majority of adults will show symptoms.

 

Pregnant women should delay being immunised against hepatitis A until after the pregnancy, unless there is a substantial risk of them being exposed to the virus. People who are in close household or sexual contact with someone with hepatitis A should receive normal human immunoglobulin within two weeks of exposure. Administration of the immunoglobulin will prevent infection for approximately six weeks.

 

Hepatitis A vaccine can be given at the same time as the immunoglobulin.