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Hepatitis A

What is hepatitis A?

Hepatitis A, sometimes called Hep A or HAV is an infection of the liver caused by a virus. A virus is a tiny organism (it cannot be seen without a microscope) that needs to get inside living cells to live and reproduce (replicate).

The hepatitis A virus infects the cells in your liver, causing inflammation (swelling and tenderness).

Hepatitis A is usually a self-limiting condition (an illness which will either clear up on its own or which has no long-term harmful effect on a person’s health). Once you have had hepatitis A, you usually develop lifelong immunity to the virus (you should not get it again).

How common is hepatitis A?

In the UK, it is uncommon to become infected with hepatitis A. Most reported cases occur after travelling to countries where hepatitis A is more common, by coming into contact with someone who has recently been infected with the virus or, more rarely in the UK, through contaminated food and drink.

Hepatitis A is more common in:

  • Sub-Saharan and North Africa
  • Indian Subcontinent (particularly India, Bangladesh, Nepal and Pakistan)
  • some parts of the Far and Middle East (excluding Japan)
  • South and Central America
  • Eastern Europe.

How is hepatitis A passed on?

The hepatitis A virus is highly infectious; you can get the virus even if you have only been in contact with a very small amount of it.

It is most commonly passed on (transmitted) through ‘faecal-oral’ routes. This means that the virus is passed out in bowel motions (faeces) and finds its way into the mouth (orally); usually through close contact with someone who has the virus or through food and water contaminated by sewage or the hepatitis A virus.

It is important to wash your hands when you have been to the toilet, to practise good hygiene when handling food and to only drink safe water.

The virus can also be spread through blood to blood contact but this is rare.

The following activities all pose some risk of passing on the hepatitis A virus:

  • travelling to areas where the virus is more common
  • injecting drugs (including steroids)
  • family and social contact high risk
  • unprotected sex
  • work and environment.

How to prevent hepatitis A

If you are at risk of hepatitis A, it is recommended that you are vaccinated to lower your risk of becoming infected. The vaccine works by causing your body to make antibodies which will stop you becoming infected if you come into contact with the virus.

Hepatitis A can be given as a sole vaccine or in combination with other vaccines such as Typhoid fever and/or hepatitis B.

Please see the downloadable publication below for full information.

Immunisation is one way to protect yourself from getting hepatitis A, however no vaccine is 100% guaranteed. To protect yourself further you should:

  • make sure you practise good hygiene;
  • avoid eating raw or not quite cooked shellfish, raw salads, vegetables and fruits that may have been washed in unclean water. Also avoid foods that may have been grown close to the ground, such as strawberries
  • avoid drinking untreated drinking water including ice cubes and only use treated or bottled water when brushing your teeth
  • avoid unpasteurised milk, cheese, ice cream and other dairy products
  • avoid pre-prepared foods such as buffets or foods from street vendors which you have not seen being cooked, foods which are served at room temperature or could have had flies on them
  • have safer sex; use a condom or a dental dam
  • never share anything you use for injecting or snorting drugs and/or steroids.

If you have been diagnosed with hepatitis A, reducing the risk of spreading the infection is important. You should:

  • ensure very good personal hygiene; wash your hands after you have been to the toilet and before eating or drinking
  • avoid handling or preparing food
  • practise protected sex;
  • avoid sharing drug injecting equipment and all other drug paraphernalia.

Symptoms

Hepatitis A has four stages. Not all patients experience all of the stages but being aware of them will help you to recognise them if they occur.

It takes between two and six weeks after you have been infected with hepatitis A for symptoms to appear, this is known as the incubation period and is the first stage. Although you may not have any symptoms at this stage you may be infectious (able to pass on the virus).

Stage two lasts around ten days. Symptoms in this stage can be similar to flu and can include:

  • a mild temperature (fever), usually no more than 39.5oC/ 103.1oF
  • feeling sick or being sick
  • sore throat
  • loss of appetite
  • weight loss
  • feeling tired all the time (fatigue)
  • joint and muscle pain
  • abdominal (stomach) pain.

Other symptoms at this stage can include a cough, headache, being itchy or having urticaria (hives) and a change in bowel movements (colour, shape, smell, consistency and how often you go to the toilet).

During stage three you may have the following symptoms – these symptoms usually last for one to three weeks but can last up to 12 weeks:

  • jaundice – yellowing of the skin and whites of the eyes
  • dark urine (pee) and pale stools (poo)
  • itchy skin
  • your liver, spleen and lymph nodes may feel swollen and sore.

You may find some of the flu-like symptoms you were feeling during stage two get better.

Stage four is the final stage and most people fully recover from hepatitis A within a couple of months, however it can take up to six months for all of the symptoms to get better. A small number of people relapse (their symptoms return) or develop serious complications.

Once you have fully recovered from hepatitis A you are usually immune (protected lifelong) and should not get the virus again.

Diagnosis

If you have recently been in contact with someone who has hepatitis A, feel you may be at risk of getting the virus or you start to have symptoms that may be caused by having hepatitis A, it is important that you visit your doctor.

Your doctor may ask you some questions about the symptoms you are having. They may also ask if you, a friend or family member have recently been travelling. If your doctor thinks you may have hepatitis A, they are likely to carry out a blood test to see if you have hepatitis A antibodies. If you had hepatitis A but have now recovered, you will have a different type of antibody in your blood.

Your doctor is also likely to do a liver function test (LFT), a type of blood test, to check how well your liver is working and if it is inflamed (swollen or irritated).

Full information on testing and diagnosis can be found in our publication downloadable below.

Treatment

There is no specific treatment of hepatitis A; it is usually a self-limiting condition. This means that it normally gets better without any treatment. Any treatment given is usually aimed at easing the symptoms of the virus.

It is common to feel more tired than normal, especially during the early stages of the virus, so you may need to get plenty of rest.

Your doctor may give you medication to help with any sickness or some pain relief if needed.  It is important to only take the dose (amount of medication) recommended by your doctor as these will be processed by your liver and taking too many may put your liver under more strain. Avoiding fatty foods and eating smaller regular meals and snacks may also help you avoid feeling sick.

Looking after yourself

Alcohol
Alcohol is a toxin processed by your liver and as a result can be dangerous for anyone with liver problems. It is strongly advised that you should not drink any alcohol while you are ill with hepatitis A.

Smoking
Smoking is dangerous to everyone’s health. Smoking can increase the severity of liver damage. People with liver disease are more vulnerable to infection and to poor health overall, so smoking or exposure to passive smoking is not advisable.

Diet
For most people with hepatitis A there is no special diet. However, eating a good, balanced diet is one of the most important things you can do to keep yourself well. Regular balanced meals containing protein (such as meat, fish or beans), starch (such as bread, potatoes or rice) and vitamins (in fruit and vegetables) is the best approach

If you are feeling or being sick and are having trouble eating, or are concerned about losing weight, you can ask your GP or hospital consultant to be referred to a dietitian (a specialist in nutrition and diet) for further advice. You can also find some more information about diet, cutting down on fatty foods and coping with eating difficulties in our ‘Diet and liver disease’ section.

Important issues to consider

Confidentiality
Any doctor who diagnoses viral hepatitis is legally required to report this information to the local public health doctors who are responsible for preventing the spread of infection. These doctors work under the strictest guidance about confidentiality. National data is reported anonymously to help monitor the number of people infected and to help the prevention and treatment of hepatitis.

The local Health Protection Unit (HPU) will also carry out an assessment on how the infection was passed on and may contact those who may be at risk of getting the virus. The HPU will not disclose your name or any other details about you to those at risk if you do not wish them to.

Who should I tell?
If you are diagnosed with hepatitis A you will need to inform close friends and family members, such as your partner or children, so that they can consult a doctor to be tested and vaccinated to prevent the virus being passed on.

It is important that you take the time to understand the routes of transmission (how the virus is passed on). This will help you to understand who else will need to know you have the virus, such as recent sexual partners or anyone you have prepared food for. When you are considering who to tell you may want to talk it over with your doctor. They can help you decide who to tell and help you work out the best way to tell them.

If you have been diagnosed with hepatitis A, it is likely that you will be signed off work and asked not to go to public places (a place that may have many people), especially schools or nurseries, until at least seven days after you are no longer infectious (stage three). This is to avoid the spread of infection.

The type of work that you do will influence the level of risk to others. Working with your employer means you can prevent others being infected. Your employer is obliged to keep this information confidential and cannot pass it on without your consent.

It is particularly important to inform your employers if you have hepatitis A if you are a health care provider or if you prepare or handle food.

Generally, unless you want to you have no legal obligation to inform other people you have hepatitis A. However, you do have a legal duty to ensure your own health and safety and that of others. The Health Protection Unit (HPU) that is informed of your diagnosis should ensure that all close friends or family members are vaccinated.

Complementary and alternative medicines and therapies

Many complementary and alternative medicines available suggest they can ease the symptoms of liver disease. As with any other medicine, you should use them with care; before taking any medicine you should check with your doctor that it is safe to do so.

Most medicines are processed by the liver so they can be toxic to people with liver problems. Some can damage the liver and make you more severely ill. At present, healthcare professionals are not clear on the role and place of some complementary medicines in managing liver disease; more research is needed on their use.

Licensing has been introduced for some traditional herbal medicines. However, many herbal products are not classified as a medicine and so can be legally sold as food or cosmetic; this means there is no regulation of the product and so you cannot be sure how much of the active ingredient you are getting, or how pure it is. Unregulated products are not monitored or assessed for how effective or safe they are. Some remedies can damage the liver and make you more severely ill. It is wise to be cautious about the claims made about herbal remedies, particularly those advertised on the internet.

It is very important to discuss the use of these remedies with your doctor before considering taking them.

Further information

Please visit the support section of our website for information on Support groups in your area or visit our Useful Links section for other organisations who may be able to offer information and support. Other sources of information include:

www.nathnac.org – information on travel health, including how to protect yourself against hepatitis A, B and C

www.fitfortravel.nhs.uk  – advice on travel vaccinations

Download publication

  Download:  Hepatitis A HEA 0417.pdf

Last Updated June 2017