Hepatitis A

Key messages for primary care practitioners

Hepatitis A is a vaccine preventable disease; ensure that at risk groups, including those travelling to endemic areas, are immunised.
Acute infectious hepatitis is a notifiable disease.
Post-exposure prophylaxis should be given to contacts of cases of hepatitis A [1].

Background information

Testing

Treatment

Prevention and control

Patient information (English only)

Patient information (English and other languages)

Other useful resources

References

Background information

Globally, about 1.4 million cases of hepatitis A occur annually [2]. Areas of high endemicity include parts of Africa, Asia, and Central and South America [3].
In 2009, there were 351 laboratory reports of hepatitis A to the HPA (provisional data) [4]. Specific studies have shown that higher rates occur in people of South Asian ethnicity and that travelling home to the Indian sub-continent to visit friends and relatives may be a significant risk factor [5].
The hepatitis A virus (HAV) causes hepatitis (inflammation of the liver) and infection can be prevented by immunisation.
Symptoms and severity of illness vary but generally increase with age. Symptoms can include:
- flu-like illness (fever, sore throat, fatigue, joint pains, loss of appetite)
- nausea
- vomiting and diarrhoea (particularly in children)
- abdominal pain
- jaundice (may be absent in children), with dark urine
- complete liver failure is rare (less than 1%), but can occur
HAV is normally spread by the faecal-oral route but can also be spread occasionally through blood. Transmission routes can include:
- Person to person (close personal contact or sexual transmission)
- Contaminated food or drink
- Injecting drug use
The average incubation period ranges from 15-50 days [1].
Symptoms usually last less than two months, although 10%-15% of symptomatic persons have prolonged or relapsing disease for up to six months [6].
Chronic persistent infection does not occur with HAV, and once infected people develop lifelong immunity [1].
For further background information please see the HPA hepatitis A web pages.

Testing

Sample required for diagnosis: clotted blood sample (2-6ml) sent to the local laboratory.

Always include the travel history in the information provided on the test request form.

Treatment

There is no specific treatment for hepatitis A infection. Treatment of symptoms may make the patient more comfortable. Hospital admission may be required if very unwell. Liaise with your local infectious disease or hepatology specialist as necessary.

The patient should be advised not to take alcohol, and hepatotoxic drugs should be avoided for up to a year after acute illness.

Prevention and control

Hepatitis A vaccine should be offered to those at risk of infection. Risk groups include those who have been in contact with someone else who has the infection, travellers to countries where the infection is common, and other groups such as injecting drug users.

For further information see Chapter 17 of Immunisation against Infectious Disease (more commonly referred to as the "The Green Book" [external link]). Note that a second dose of hep A vaccine should be given 6-12 months after the initial dose and confers immunity for approximately ten years.

Ask about future travel plans as patients who visit friends and relatives in countries where the infection is endemic are at increased risk of acquiring infection. For country specific travel advice please consult the National Travel Health Network and Centre [external link] (NaTHNaC).

Acute hepatitis A is a notifiable disease in the UK. If a case is diagnosed it should be notified to your local Health Protection Unit.

Patients are infectious for two weeks before and about a week after development of jaundice. Measures to prevent transmission should be taken including hand washing, attention to personal hygiene and use of hepatitis A vaccine and human normal immunoglobulin (HNIG) when indicated. Please seek advice from your local Health Protection Unit.

Guidance for the prevention and control of hepatitis A infection

Guidance on Infection Control in Schools and other Child Care Settings

Patient information (English only)

British Liver Trust hepatitis A leaflet [external link]

Patient UK hepatitis A information [external link]

NaTHNaC hepatitis A factsheet for travellers [external link]

Patient information (English and other languages)

Viral hepatitis (including hepatitis A) information for female sex workers [external link] is available in a range of languages from TAMPEP (European Network for HIV/STI Prevention and Health Promotion among Migrant Sex Workers)

Other useful resources [external links]

The British Liver Trust [external link] a charity which provides resources including a website, helpline and publications for people with liver disease.

National Travel Health Network and Centre [external link] (NaTHNaC) - for country specific travel advice.

NaTHNaC prevention of food and water-borne diseases [external link] information for health professionals

NaTHNaC Hepatitis A information for health professionals [external link]

References

Health Protection Agency. Guidance for the prevention and control of hepatitis A infection
World Health Organization. Hepatitis A factsheet [external link]
Health Protection Agency. Foreign travel-associated illness, England, Wales, and Northern Ireland. Annual Report 2005
HPA hepatitis A website: Epidemiological data
Health Protection Agency. Foreign travel-associated illness - a focus on those who visiting friends and relatives: 2008 report
Centers for Disease Control and Prevention. Hepatitis A information for Health Professionals [external link]