Hepatitis A

Topic Overview

What is hepatitis A?

Hepatitis A is a liver infection caused by a virus. It goes away on its own in almost all cases. Hepatitis A does not lead to long-term liver problems.

Other forms of the virus (hepatitis B and hepatitis C) also cause hepatitis. Hepatitis A is the most common type.

How is hepatitis A spread?

The disease is caused by the hepatitis A virus. The virus is found in the stool of an infected person. It is spread when a person eats food or drinks water that has come in contact with infected stool.

Sometimes a group of people who eat at the same restaurant can get hepatitis A. This can happen when an employee with hepatitis A doesn't wash his or her hands well after using the bathroom and then prepares food.

The disease can also spread in day care centers. Workers can spread the virus if they don't wash their hands well after changing a diaper.

Some things can raise your risk of getting hepatitis A, such as eating raw oysters or undercooked clams. If you're traveling in a country where hepatitis A is common, you can lower your chances of getting the disease by avoiding uncooked foods and untreated tap water.

What are the symptoms?

After you have been exposed to the virus, it can take from 2 to 7 weeks before you see any signs of it. Symptoms usually last for about 2 months.

Common symptoms are:

• Feeling very tired.
• Feeling sick to your stomach.
• Not feeling hungry.
• Losing weight without trying.
• Pain on the right side of the belly, under the rib cage (where your liver is).
• A fever.
• Sore muscles.

Older people with hepatitis A may get yellow skin (jaundice), along with dark urine and clay-colored stools.

All forms of hepatitis have similar symptoms. Only a blood test can tell if you have hepatitis A or another form of the disease.

Call your doctor right away if:

• You have any signs of hepatitis A.
• Someone you live with has hepatitis A.
• You have eaten in a restaurant that has had an outbreak of the virus.
• Your child goes to a day care center where hepatitis A has been reported.

How is hepatitis A diagnosed?

Your doctor will ask questions about your symptoms and where you have eaten or traveled. You may have blood tests if your doctor thinks you have the virus. These tests can tell if your liver is inflamed and whether you have antibodies to the hepatitis A virus. These antibodies prove that you have been exposed to the virus.

Take steps to avoid passing hepatitis A on to others. Tell people you live with or have sex with that you have hepatitis A. Wash your hands with soap and hot water right after you use the bathroom or change a diaper and before you prepare food.

How is it treated?

Hepatitis A goes away on its own in most cases. You can help yourself get better faster by drinking lots of water and eating a healthy mix of foods.

Unlike other forms of hepatitis, the hepatitis A virus does not lead to long-term illness or serious liver damage. Most people get well within a few months.

While you have hepatitis A, cut back on daily activities until all of your energy returns. As you start to feel better, take your time in getting back to your regular activities. If you try to meet your regular pace too soon, you may get sick again.

You can only get the hepatitis A virus once. After that, your body builds up a defense against it.

Can hepatitis A be prevented?

You can protect yourself from hepatitis A by getting a vaccine (Havrix or Vaqta). You will get it in a series of two shots. It is usually 100% effective if you get both shots before you are exposed to the virus. A combination vaccine (Twinrix) that protects against hepatitis A and hepatitis B also is available.

The U.S. Centers for Disease Control and Prevention advises that all children get the hepatitis A vaccine when they are at least 1 year old.

If you have been around someone who you know has hepatitis A, the hepatitis A vaccine or an injection of immune globulin (IG) may prevent you from getting the disease. It’s important for you to get the shot within 2 weeks of being exposed to the virus.

Frequently Asked Questions

Cause

Hepatitis A is caused by a virus (hepatitis A virus, or HAV) that multiplies in liver cells and is shed in stool.

How HAV is spread

Hepatitis A virus is found in the stool (feces) of a person who has hepatitis A. The virus is spread most commonly when people put food or objects contaminated with stool containing HAV into their mouths.

Large numbers of people get the virus after drinking contaminated water because, in many parts of the world, drinking water is contaminated with raw sewage. The virus also may be spread by eating uncooked food (such as raw shellfish) and unpeeled fruits and vegetables washed in contaminated water. Hepatitis A outbreaks caused by contaminated drinking water are rare in the United States because water supplies are treated to destroy the virus and other harmful organisms.

In the U.S., HAV is spread mainly among people who have close contact with someone who has the virus. You can become infected with HAV if you:

• Eat food prepared by someone who does not wash his or her hands well after using the bathroom or changing a diaper.
• Don't wash your hands after changing a diaper.
• Eat raw or undercooked shellfish that was harvested from waters contaminated with raw sewage.
• Are a man and have sex with men.

Outbreaks of hepatitis A among children in day care facilities occur because children, especially those who wear diapers, may get stool on their hands and then touch objects that other children put into their mouths. Caregivers in day care centers can spread the virus if they do not wash their hands thoroughly after changing a child's diaper.

It is very rare for hepatitis A virus to be spread by infected blood or blood products. It is not known to be spread through saliva or urine.

Some people fear that hepatitis A infection is related to or increases the risk of contracting acquired immunodeficiency syndrome (AIDS). This is not true. The hepatitis A virus is not related to the human immunodeficiency virus (HIV), which causes AIDS, nor does it increase your risk of HIV infection. A person can be infected with both hepatitis A and HIV, but the two infections have nothing to do with each other.

Incubation and contagious periods

After the hepatitis A virus enters your body, the amount of virus grows for 2 to 7 weeks. The average incubation period is about 4 weeks.

Your stools and body fluids contain the highest levels of the virus 2 weeks before symptoms start. This is the time when you are most contagious, but you still may spread the virus after symptoms appear.

Symptoms

Symptoms usually appear 15 to 50 days (2 to 7 weeks) after you have been exposed to the hepatitis A virus (HAV). The average time is 4 weeks. Symptoms usually are mild and may not be noticed in children younger than 6 years of age. In older children and adults, early symptoms are often similar to those of a stomach virus. Possible symptoms include:

• Extreme tiredness (fatigue).
• Fever.
• Sore muscles.
• Headache.
• Pain on the right side of the abdomen, under the rib cage (where the liver is located).
• Nausea.
• Loss of appetite and weight loss.
• Yellowing of the skin and the white part of the eyes (jaundice), sometimes accompanied by dark urine and clay-colored (whitish) stools. Jaundice is less common in children and younger adults.

About 15% of people who have hepatitis A have symptoms of HAV infection that return or last for 6 to 9 months after infection first occurred.¹ The infection is usually not any more severe than it was the first time, but arthritis can occur with it. After the infection goes away, the person usually returns to normal health. In rare cases, cholestatic hepatitis occurs, which can cause itching and can last throughout the infection.

In general, by the time symptoms appear, the amount of virus being shed in your stools is declining. You still may spread the virus, but you are less likely to do so after symptoms appear.

Symptoms of hepatitis A usually last less than 2 months.

What Happens

After the hepatitis A virus (HAV) enters your body, the amount of virus grows for 2 to 7 weeks. The average incubation period is about 4 weeks.

• Your stools (feces) and body fluids contain the highest levels of the virus 2 weeks before symptoms start (if there are any symptoms). This is the time when you are most contagious. However, you still may pass the virus to another person until all of your symptoms have gone away.
• From 5 to 10 days after you become infected with HAV, your body usually starts to make HAV antibodies.
• Between 3 and 6 months after you become infected with the virus, antibodies develop that will give you lifelong protection (immunity) against HAV infection. The antibodies can always be detected in your blood, indicating that you were infected with the hepatitis A virus some time in the past.

Symptoms of hepatitis A usually last less than 2 months. More than 99% of people who have hepatitis A recover fully. Within 1 to 2 months after your symptoms go away, your liver will be completely healed.

Possible complications of hepatitis A include the following:

• About 15% of people with HAV have a temporary return (relapse) of symptoms or prolonged symptoms of HAV infection 6 to 9 months after infection first occurred.¹
• A rare condition called cholestatic hepatitis may develop and is associated with severe itching. In some people, the illness lasts weeks or months.
• Problems with other organs, including sudden gallbladder inflammation (acute cholecystitis) and inflammation of the pancreas (pancreatitis), may occur, but these complications are uncommon.
• A very small number of people, most often older adults or those with long-term (chronic) liver disease, rapidly develop severe liver failure when they become infected with HAV. This condition is called fulminant hepatitis. Up to 70% of people with fulminant hepatitis A recover without major treatment. But some people may require a liver transplant to avoid liver failure and death.²

Hepatitis A during pregnancy

Hepatitis A does not increase the risk of stillbirth, miscarriage, or birth defects.

Preventive treatment with immune globulin, which contains hepatitis A antibodies, is safe for pregnant women who have been exposed to the virus.

What Increases Your Risk

People who practice certain behaviors or have certain jobs are at higher risk for hepatitis A. If you are a member of a high-risk group, you should receive the hepatitis A vaccine (What is a PDF document?).

Risk factors for hepatitis A include:

• Eating food that has been prepared by someone who is infected with the hepatitis A virus and who has poor hygiene.
• Eating raw or undercooked shellfish (such as oysters or clams).
• Eating uncooked food (such as unpeeled fruits or vegetables) or drinking tap water or well water while traveling in countries where hepatitis A is common.
• Living in a community where hepatitis A is common and outbreaks occur (largely a risk factor for young children).
• Living in a household with someone who has hepatitis A.

Lifestyle factors that increase your risk for hepatitis A include:

• Traveling to countries where hepatitis A is common.
• Being a man who has sex with men.

When To Call a Doctor

Contact a doctor immediately if a person diagnosed with hepatitis A develops severe dehydration (caused by vomiting and an inability to hold down fluids) or any signs of rapidly developing liver failure, which include:

• Extreme irritability (greater than would be expected when a person is ill).
• Impaired ability to think clearly or reason.
• Extreme drowsiness.
• Loss of consciousness.
• Swelling of the face, hands, feet, ankles, legs, arms, or abdomen (edema).
• Bleeding from the nose, mouth, or rectum (including blood in stools), or under the skin.

Call a doctor today if:

• Any of the signs or symptoms of hepatitis A develop. For more information, see the Symptoms section of this topic.
• Someone in your household has been diagnosed with hepatitis A.
• You have eaten in a restaurant or any other dining facility known to be the source of an outbreak of hepatitis A.
• A child or another family member has been in a day care center or another institution where a hepatitis A outbreak has occurred.
• Your sex partner has been diagnosed with hepatitis A.
• You are planning a trip to a foreign country or have any other reason to believe you should be vaccinated against hepatitis A. Plan for vaccination 6 months before travel, if possible. If time is running short, getting vaccinated at least 1 month before travel offers some protection, and 2 weeks before travel may also be helpful.³

Watchful Waiting

Watchful waiting, or surveillance, is not advised if you think you have been exposed to the hepatitis A virus (HAV) or if you have symptoms of the illness.

It is important to see a doctor when symptoms develop, because all forms of viral hepatitis have similar symptoms. Only a blood test can determine whether you have hepatitis A or another hepatitis virus. A doctor also can advise you about how to prevent the spread of hepatitis A.

Who To See

Most of the time, the following health professionals can diagnose and treat hepatitis A:

• Family medicine doctor
• Pediatrician
• Internist
• Nurse practitioner
• Physician assistant

If complications develop, you may need care from:

• A gastroenterologist.
• A liver specialist (hepatologist).
• An infectious disease specialist.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

A thorough medical history and physical examination provide valuable information about your symptoms and whether it is likely that you have been exposed to the hepatitis A virus (HAV).

While taking a medical history, your doctor usually will ask where you have traveled, if you work in or have a child in a day care center, and if you live with someone known to have hepatitis A.

If you may have been exposed to hepatitis A, you will have blood tests to study liver function and to see whether your liver is damaged or inflamed. Blood tests to study liver function include:

• Bilirubin. When bilirubin builds up in the blood, it may indicate hepatitis.
• Albumin. Lower than normal levels may indicate hepatitis or other liver problems.
• Prothrombin time, a blood test that measures how long it takes blood to clot. An abnormal prothrombin time can be caused by liver disease or injury.

Blood tests that may be done to determine whether the liver is damaged or inflamed include:

• Alanine aminotransferase (ALT). When the liver is damaged or diseased, ALT is released into the bloodstream, causing levels of the enzyme to rise.
• Aspartate aminotransferase (AST). When body tissues or organs such as the heart or liver are damaged, AST is released into the bloodstream. The amount of AST in the blood is directly related to the extent of the tissue damage.
• Alkaline phosphatase (ALP). Large amounts of ALP in the bloodstream may indicate liver damage.
• Lactic dehydrogenase (LDH). Many diseases can cause elevations in LDH levels. In addition to the LDH test, your doctor will usually run other tests to confirm a diagnosis of hepatitis A.

If tests show your liver is inflamed, you will have an antibody (anti-HAV) test on a sample of your blood. The presence of HAV antibodies means that HAV infection is the most likely cause of your hepatitis.

If the results of the anti-HAV test show that HAV is not multiplying in your body, your doctor may do other hepatitis blood tests to find out whether hepatitis B virus, hepatitis C virus, or Epstein-Barr virus (which causes infectious mononucleosis, or “mono”) is causing your hepatitis.

Early Detection

If you are concerned that you have been exposed to the virus and you have not been previously infected or vaccinated, contact your doctor. If you get a shot of immune globulin (IG) within 2 weeks of being exposed to HAV, you probably will not develop symptoms of HAV infection.

Routine vaccination of hospital workers, food handlers, and child care center workers and attendees does not occur at this time because their chance of infection generally is no greater than that of the wider community. But some child care centers have workers get the shot because it works so well to prevent the disease. Plus there is very low chance of side effects from the vaccine. If outbreaks of HAV infection do occur in those settings, people who were exposed to the virus should receive a shot of immune globulin (IG).⁴

Treatment Overview

Hepatitis A goes away on its own in almost all cases. No medicines are used to treat the illness. Home treatment will usually help relieve your symptoms and help you prevent the spread of hepatitis A virus (HAV).

Slow down

Reduce your activity level to match your energy level. Do not stay in bed, because that may slow your recovery. Don't go to work or school unless your workload can be reduced to match your energy level. Avoid strenuous exercise, until you are fully recovered. As you start to feel better, go back to your regular activities gradually. If you try to meet your regular pace too soon, you may get sick again.

Eat right

Even though food may not appeal to you, it is important for you to get adequate nutrition. Try eating small, frequent meals instead of three large meals. For most people, nausea and loss of appetite don't set in until later in the day. Try eating more in the morning and less later in the day.

Doctors used to recommend a high-calorie, protein-rich diet to people who have hepatitis. This is no longer believed to be of any benefit, and such foods can be hard to eat when you feel nauseated. Try to maintain a balanced diet while eating foods that appeal to you.

Avoid dehydration

It is very important to keep your body well-hydrated when you have hepatitis A, especially if you have been vomiting. Drink plenty of water. If you can tolerate them, fruit juices and broth are other good choices because they provide additional calories. Many of the sports drinks available in grocery stores (such as Gatorade) can help replace essential electrolytes (salts) that are lost through vomiting.

Avoid alcohol and drugs

Hepatitis impairs your liver's ability to break down certain medicines and alcohol. If you take drugs (legal or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some medicines can make liver damage worse.

Make sure your doctor knows all the medicines you are taking, including herbal products. Do not take any new medicines or stop taking existing prescription medicines without your doctor's approval. Talk to your doctor about when it is safe to drink alcohol in moderation.

Try to control itching

People with hepatitis sometimes develop itchy skin. You can use nonprescription medicines, such as Benadryl or Chlor-Trimeton, to control the itching. Be sure to follow the instructions for use that are provided with the product, and stop using the product if you have any side effects. Tell your doctor before you start any new medicine.

Symptoms of hepatitis A usually begin to go away on their own in about 2 weeks. You can still spread the infection to others as long as you have symptoms, because your stools carry the virus.

Prevent hepatitis A infection after exposure (post-exposure prophylaxis)

If you have been around someone who you know has hepatitis A, the hepatitis A vaccine or an injection of immune globulin (IG) within 2 weeks of exposure may prevent you from getting hepatitis A.⁵

Prevention

The hepatitis A vaccine (What is a PDF document?) is the most effective means of preventing hepatitis A virus (HAV) infection. The vaccine provides 94% to 100% protection if you receive both of the shots in the vaccination series.⁶

Immunization with the hepatitis A vaccine is recommended for:

• All children beginning at 1 year of age. Two separate doses are given at least 6 months apart.⁷ The U.S. Centers for Disease Control and Prevention made this recommendation in early 2006. Many young children and adolescents have not had the hepatitis A vaccine.
• Anyone who will be in close contact with an adopted child from a country that has high rates of hepatitis A. This includes household contacts and babysitters. This recommendation only applies for the first 60 days the child is in the United States.⁸
• Children and adolescents who have not had the hepatitis A vaccine and who are in the following situations:⁹
  • A community outbreak of the disease has recently occurred.
  • They live in a state or community that has set up routine vaccination because the disease occurs there more often than in other areas.
• People whose travel, job, medical condition, or lifestyle puts them at risk of exposure to the virus. This includes:
  • People who are planning a trip to a foreign country where sanitary conditions are poor and hepatitis A is common.
  • People who use illegal drugs.
  • Men who have sex with men.
  • People who work with monkeys that are infected with the virus and those who work with the virus in a research setting.
  • People who have long-term (chronic) liver disease.
  • People who are awaiting or have had a liver transplant.
  • People with hemophilia or related blood-clotting disorders.

A combination vaccine (Twinrix) that prevents hepatitis A and hepatitis B is available for people 18 and older.

Considerations regarding the hepatitis A vaccine

Adults who are planning a trip to foreign countries where hepatitis A is common may want to be tested for HAV antibodies (anti-HAV test) before beginning a hepatitis A vaccination program. If you already have HAV antibodies in your blood, you are protected against infection, and you do not need to be vaccinated.

Consider the following before going through with anti-HAV testing before vaccination:

• Vaccination may be less expensive than anti-HAV testing. Testing costs include the cost of a doctor visit and lab tests. If the tests show that you need to be vaccinated, you will have to pay for the full vaccination series (two shots given at different times), including the expense of additional office visits.
• You can receive hepatitis A vaccine even if you already have HAV antibodies in your blood, and no harm will result.
• The hepatitis A vaccine is not fully effective until 4 weeks after the shot. But the vaccine does give some protection after 2 weeks.³ If you are going to be tested for anti-HAV, make sure to do so well in advance of your trip. People older than 60 might want to get the vaccine earlier than 4 weeks before departure, because evidence suggests that the immune response develops more slowly in older people.¹⁰

If you find out that you need the vaccine but you will be traveling in less than 4 weeks, you should receive the first shot in the vaccination series. One shot provides 90% protection from the disease and may reduce the severity of disease. If you want to be extremely careful, you can receive the first shot in the vaccination series and a shot of immune globulin (IG). This will ensure that you are protected against HAV. You can receive the second shot of hepatitis A vaccine 6 to 18 months (depending on the recommendations of the vaccine's manufacturer) after the first shot.

Other factors to consider regarding the HAV vaccine:

• Two shots of vaccine are needed to protect you best, so try to get your first shot at least 6 months before you go to a foreign country where hepatitis A is common.
• Routine vaccination of hospital workers, food handlers, and child care center workers and attendees does not occur at this time since their chance of infection generally is no greater than that of the wider community. But some child care centers have workers get the shot because it works so well to prevent the disease. Plus there is very low chance of side effects from the vaccine. If outbreaks of HAV infection do occur in those settings, people who were exposed to the virus should receive a shot of immune globulin (IG).⁴
• If you have had close personal contact with someone who has hepatitis A, you should get the hepatitis A vaccine or a shot of IG as soon as possible. If you get the vaccine or IG within 2 weeks of being exposed to HAV, you probably will not develop symptoms of HAV infection.⁵ For more information, see the Medications section of this topic.
• The hepatitis A vaccine will also provide some protection against infection if you are already exposed to the virus.¹¹

How to prevent HAV infection

• Get vaccinated against hepatitis A if your travel plans, job, medical condition, or lifestyle puts you at risk of exposure to the hepatitis A virus (HAV). For more information, see the What Increases Your Risk section of this topic.
• Develop good hygiene habits.
  • Make sure you and all members of your household always wash your hands thoroughly with soap and hot water after using the toilet and before preparing or eating food.
  • Wash dishes in hot, soapy water or in a dishwasher.
  • Discourage children from putting objects in their mouths, especially when sharing toys with other children.
  • Don't eat or drink anything that you think may have been prepared in unclean conditions.
• Protect yourself before you travel and while you're on your trip. If you plan to travel to a part of the world where sanitation is poor or where hepatitis A is a known problem, see your doctor about receiving the hepatitis A vaccine, immune globulin (IG), or the combination hepatitis A and B vaccine. Always drink bottled water or boil water before drinking it. Avoid untreated tap water or well water or beverages containing ice cubes. And do not eat raw foods (such as unpeeled fruits or vegetables).
• Do not eat uncooked or undercooked shellfish. If shellfish are living in water that has been contaminated with stool containing the hepatitis A virus, the shellfish may carry the virus.

Child care workers should receive frequent instruction on preventing the spread of hepatitis A. Even though children infected with HAV may have few or no symptoms, they can spread the infection to others, including child care workers and other adults who may develop more serious symptoms. To prevent the spread of HAV, child care workers should:

• Wear plastic (not latex because of the risk of allergic reaction) disposable gloves when changing diapers.
• Wash the child's hands, and then wear a fresh pair of gloves before changing another child's diapers.
• Clean the diaper-changing surface after each changing.
• Talk to their doctors about whether they should receive the HAV vaccine.

Home Treatment

Although no specific medical treatment is given for hepatitis A, home treatment can help relieve symptoms and prevent the spread of the virus.

Slow down

• Reduce your activity level to match your energy level. Do not stay in bed, because that may slow your recovery. Listen to your body, and slow down when you become tired.
• Don't go to work or school unless your workload can be decreased to match your energy level.
• Avoid strenuous exercise.
• As you start to feel better, go back to your regular activities gradually. If you try to meet your regular pace too soon, you may get sick again.

Eat right

• Even though food may not appeal to you, it is important for you to get adequate nutrition. Try eating small, frequent meals instead of three large meals. For most people, nausea and loss of appetite don't set in until later in the day. Try eating more in the morning and less later in the day.
• Doctors used to recommend a high-calorie, protein-rich diet to people who have hepatitis. This is no longer believed to be of any benefit, and such foods can be hard to eat when you feel nauseated. Try to maintain a balanced diet while eating foods that appeal to you.

Avoid dehydration

It is very important to keep your body well hydrated when you have hepatitis A, especially if you have been vomiting. Contact your doctor immediately or go to the nearest emergency room if you have vomited more than two times in one day.

• Drink plenty of water.
• If you can tolerate them, fruit juices and broth are other good choices because they provide additional calories.
• Many of the sports drinks available in grocery stores (such as Gatorade) can help replace essential electrolytes that are lost through vomiting.

Avoid alcohol and drugs

Hepatitis impairs your liver's ability to break down certain medicines and alcohol. If you take drugs (legal or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some medicines can make liver damage worse.

Make sure your doctor knows all the medications you are taking, including herbal products. Do not take any new medicines or stop taking existing prescription medicines without your doctor's approval.

Talk to your doctor about when it is safe to drink alcohol in moderation.

Try to control itching

People with hepatitis sometimes develop itchy skin. You can use nonprescription medicines, such as Benadryl or Chlor-Trimeton, to control the itching. Be sure to follow the instructions for use that are provided with the product, and stop using the product if you have any side effects.

Tell your doctor before you start any new medicine.

Tips to prevent the spread of hepatitis A

If you have been infected with HAV, there are steps you can take to avoid infecting the people you are in close contact with.

• Inform those you live with or have sex with that you have hepatitis A. They should ask their doctor whether they need a shot of immune globulin. If given within 2 weeks of possible exposure to the virus, immune globulin (IG) is effective in preventing hepatitis A or reducing its symptoms. For more information, see the Medications section of this topic.
• Wash your hands with soap and hot water immediately after using the toilet or changing a diaper and before preparing food.
• Avoid any anal contact with a sex partner while you are infected.

Medications

Although no medicine can treat HAV symptoms after they develop, the hepatitis A vaccine is the most effective means of preventing hepatitis A virus (HAV) infection. The vaccine provides 94% to 100% protection if you receive both of the shots in the vaccination series.⁶ But the vaccine may not be as effective in those with weakened immune systems, such as people who have human immunodeficiency virus (HIV).⁶

If you have had close personal contact with someone who has hepatitis A, you should get the hepatitis A vaccine or a shot of immune globulin (IG). If you receive either the vaccine or IG within 2 weeks of being exposed to HAV, you probably will not develop symptoms of HAV infection.⁵

IG is also recommended for:

• People who are known to be allergic to other vaccines containing the same ingredients found in the hepatitis A vaccine.
• Children younger than age 1 who have not been immunized with the hepatitis A vaccine and have been exposed to HAV, particularly children who spend time in day care centers.

Medication Choices

hepatitis A vaccine (What is a PDF document?)

Immune globulin

For more information about the hepatitis A vaccines, see the Prevention section of this topic.

What To Think About

Immune globulin has been effective in controlling some outbreaks of the hepatitis A virus.

Surgery

Hepatitis A is a viral infection, so no surgical treatment is used.

A very small number of people, most often people with long-term (chronic) liver disease or older adults, develop liver failure when they become infected with the hepatitis A virus. This condition, called fulminant hepatitis, is life-threatening. For some people who have it, a liver transplant offers the only hope for survival.

Other Treatment

Some people with hepatitis A may develop severe nausea, vomiting, and dehydration. If this happens to you, you may need to be hospitalized so you can receive additional fluids by vein (intravenous, or IV, fluids) and medicines to control your symptoms.

Other Places To Get Help

Organizations

Related Information

• Hand-Washing
• Hepatitis B
• Hepatitis C
• Immunizations
• Travel Health
• Vaccine Information Statements

References

Citations

1. Centers for Disease Control and Prevention (2007). Viral Hepatitis A Fact Sheet. Available online: http://www.cdc.gov/ncidod/diseases/hepatitis/a/fact.htm.
2. Bell BP, et al. (2004). Hepatitis A virus. In RD Feigin et al., eds., Textbook of Pediatric Infectious Diseases, 5th ed., vol. 2, pp. 2069–2086. Philadelphia: Saunders.
3. Bell BP, et al. (2005). Hepatitis A virus. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 6th edition, vol. 2, pp. 2162–2185. Philadelphia: Elsevier.
4. Centers for Disease Control and Prevention (2006). Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 55 (RR-7): 1–23. Also available online: http://www.cdc.gov/mmwr/PDF/rr/rr5507.pdf.
5. Centers for Disease Control and Prevention (2007). Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 56(RR-41): 1080–1084. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5641a3.htm.
6. American Academy of Pediatrics (2006). Hepatitis A. In LK Pickering et al., eds., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 326–335. Elk Grove Village, IL: American Academy of Pediatrics.
7. Centers for Disease Control and Prevention (2009). Recommended immunization schedules for persons aged 0 through 18 years—United States, 2009. MMWR, 57(51 and 52): Q1–Q4. Also available online: http://www.cdc.gov/mmwr/PDF/wk/mm5751.pdf. [Erratum in MMWR, 57(53): 1419. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5753a5.htm?s_cid=mm5753a5_e.]
8. Centers for Disease Control and Prevention (2009). Updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for use of hepatitis A vaccine in close contacts of newly arriving international adoptees. MMWR, 58(36): 1006–1007. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5836a4.htm?s_cid=mm5836a4_e.
9. Centers for Disease Control and Prevention (2006). Hepatitis A vaccine: What you need to know. Vaccine Information Statement. Department of Health and Human Services, National Immunization Program (3/21/06). Available online: www.cdc.gov/vaccines/pubs/vis/downloads/vis-hep-a.pdf.
10. Leder K, et al. (2001). Travel vaccines and elderly persons: Review of vaccines available in the United States. Clinical Infectious Diseases, 33(9): 1553–1566.
11. Victor JC, et al. (2007). Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. New England Journal of Medicine, 357(17): 1685–1694.

Other Works Consulted

• Curry MP, Chopra S (2005). Acute viral hepatitis. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 6th ed., vol. 1, pp. 1426–1441. Philadelphia: Elsevier.
• Cuthbert JA (2001). Hepatitis A: Old and new. Clinical Microbiology Reviews, 14(1): 38–58.
• Weller PF (2005). Health advice for international travelers. In DC Dale, DD Federman, eds., ACP Medicine, Clinical Essentials, chap. 7. New York: WebMD.

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