Hepatitis A for health professionals
Hepatitis A is a viral infection that causes inflammation of the liver. Most people who contract hepatitis A recover fully after 1 to 2 weeks or in severe cases, several months. Asymptomatic infection is common, particularly in young children. Symptoms include:
- abdominal pain
- nausea and vomiting
- dark urine
- pale stools
Natural hepatitis A infection confers lifelong immunity.
Transmission of hepatitis A occurs via the faecal-oral route through exposure to food, drink or objects contaminated with the faeces of another person infected with hepatitis A. In Australia, most cases of hepatitis A are associated with:
- overseas travel to high-risk countries
- day care centres enrolling children not yet toilet trained
- sexual and household contacts of people infected with hepatitis A
- illicit drug use.
Outbreaks have also been reported as a result of drinking or bathing in water contaminated by sewage, or by consumption of contaminated foods such as shellfish.
The incubation period is generally 15 to 50 days, usually 28 to 30 days.
Cases are considered infectious from 2 weeks prior to the onset of prodromal symptoms, to 2 weeks after symptom onset (or 1 week after the onset of jaundice, if it occurs).
On clinical suspicion of hepatitis A, request serology for hepatitis A IgM and IgG, and liver function tests (LFTs).
There is no test to detect hepatitis A during the incubation period and therefore testing of asymptomatic patients is not recommended.
Hepatitis A infection is a notifiable condition under the South Australian Public Health Act 2011. Notify any suspected or confirmed cases to the South Australian Communicable Disease Control Branch on 1300 232 282 (24 hours/7 days).
There is no specific antiviral treatment for hepatitis A. Rest, good fluid intake and alteration in diet may decrease symptoms. Severely ill people may require admission to hospital for supportive treatment.
- Exclude the case from child care, preschool, school or work for at least 7 days after jaundice onset (or if no jaundice, 14 days after the onset of illness)
- encourage good personal hygiene practices, especially thorough hand washing and safe food handling procedures
- offer hepatitis A vaccine to non-immune household and/or sexual contacts of all cases of hepatitis A.
The hepatitis A vaccine provides 6 to 12 months of protection against hepatitis A infection within two weeks of administration, and lifelong protection if a booster dose is administered at least 6 months after the first dose.
Vaccination is unlikely to protect against infection from a possible source of hepatitis A if more than 14 days have elapsed since exposure.Normal human immunoglobulin (NHIG) is not routinely recommended but may be indicated in close contacts of a confirmed case for whom vaccination is contraindicated.