Hepatitis A

What is hepatitis A?

Hepatitis A is a viral disease that affects the liver. The hepatitis A virus is highly infectious and is spread when traces of faeces/stools (poo) containing the virus contaminate hands, objects, water or food.

Anyone can be at risk of hepatitis A through ingesting food or drinks containing traces of the virus contaminated by a person with hepatitis A.

Hepatitis A outbreaks

There have been outbreaks of hepatitis A associated with eating contaminated farmed and distributed foods (for example shellfish), and among particular groups (people experiencing homelessness, people who inject drugs and men who have sex with men).

Hepatitis A is more common in low socioeconomic countries with reduced access to clean water supplies and sanitation (sewerage) facilities.

Hepatitis A outbreaks can occur in childcare centres. Children under 5 years of age often don’t show any symptoms, but can infect childcare workers or other children (for example during nappy changes). The first sign of an outbreak is usually when a parent or childcare worker becomes sick.

Symptoms of hepatitis A

You can become ill any time between 2 and 4 weeks after coming into contact with the hepatitis A virus.

The average incubation period (the time between infection taking place and symptoms appearing) for the virus is 28 days.

Many infected people, particularly children less than 5 years old, show few or no symptoms.

For older children and adults, the symptoms of hepatitis A include:

• fever
• nausea
• abdominal discomfort and pain
• dark urine
• yellow skin and eyes (jaundice).

Symptoms may last for several weeks. Most people fully recover from hepatitis A infection.

A single infection of hepatitis A leads to lifelong immunity. Prior infection with hepatitis B or hepatitis C does not offer immunity for hepatitis A.

Complications of hepatitis A

Around 10% of people who have had hepatitis A experience a relapse (become unwell again with hepatitis A). Most people who have a relapse fully recover.

Hepatitis A does not cause chronic (long-lasting) liver disease.

The severity of the disease is more severe in older age groups and for people with existing liver fibrosis and cirrhosis.

Complications of hepatitis A are rare, but the infection can lead to fulminant hepatitis. This is an acute form of hepatitis that can cause liver failure. The risk of death from fulminant hepatitis increases with age.

Causes of hepatitis A

Hepatitis A is caused by a virus. The virus can survive for several hours outside the body but persists on the hands and in food for even longer. It is resistant to heating and freezing.

The virus is spread when it enters the mouth, which can happen when hands, foods or other items are contaminated with the faeces of a person with hepatitis A. The disease can also be spread sexually by oral or anal contact.

A person with hepatitis A is infectious from 2 weeks before they show symptoms to one week after they become jaundiced (have yellow skin and eyes).

If an infected person has no jaundice, they may pass on the virus up to 2 weeks after they first have symptoms (about 4 weeks in total). Caution is advised beyond this period as the virus can still be shed in stools (faeces) for longer periods.

Reducing the risk of hepatitis A

Protecting yourself from hepatitis A

The most important action you can take to protect yourself against hepatitis A is to get vaccinated.

Practising strict personal hygiene is also essential to reducing the risk of hepatitis A. Steps you can take include:

• Wash your hands with soap and hot running water before handling food, after going to the toilet and after handling used condoms or having contact with nappies or the anal area of another person. Use a clean towel to dry your hands.
• Use barrier protection (dental dams) when engaging in oral-anal sex and avoid sex with someone who has hepatitis A virus.
• Vaccination may prevent illness if given within 2 weeks of contact with an infectious person.
• Clean bathrooms and toilets often, paying attention to toilet seats, handles, taps and nappy change tables.
• Boil your drinking water if it comes from an untreated source, such as a river.
• If you are travelling overseas, particularly to countries where hepatitis A is widespread, take special care to avoid hepatitis A. Before travelling, talk to your doctor about immunisation for protection.

Protecting others from hepatitis A

If you have hepatitis A:

• Do not prepare food or drink for other people.
• Do not share eating or drinking utensils with other people.
• Do not share linen and towels with other people.
• Do not have sex.
• Wash eating utensils in soapy water, and machine wash linen and towels.

Household contacts and sexual partners of an infectious person may need to be immunised.

All people who have hepatitis A should check with their doctor before returning to work or school.

The following people have increased risk of passing hepatitis A on to others and must check with their doctor before returning to work or school:

• People who handle food or drink.
• People whose work involves close personal contact, such as child carers and health workers.
• Children who attend child-care facilities.

Protecting yourself from hepatitis A when overseas

Careful selection and preparation of food and drink in countries where hepatitis A is widespread is vital. Suggestions include:

• Only drink bottled water with an unbroken seal.
• Avoid unpackaged drinks or ice.
• Avoid eating raw food such as fruit or salad that has been (or may have been) cleaned or prepared with contaminated water.
• Avoid uncooked foods, particularly vegetables and fruit that you have not peeled, prepared or boiled yourself.
• Avoid raw or undercooked meat and fish.
• Make sure cooked food is hot and eat it right away.
• Avoid shellfish and unpasteurised dairy products.
• Avoid eating food from street vendors.

Diagnosis of hepatitis A

Tests used to diagnose hepatitis A may include:

• medical history – plus immunisation status and travel history
• physical examination
• blood test – a sample of your blood will be sent to a laboratory to confirm the diagnosis.

Treatment for hepatitis A

There is no specific treatment for hepatitis A. In most cases, your immune system will clear the infection and your liver will completely heal. Treatment aims to ease symptoms and reduce the risk of complications. Options may include:

• Rest – hepatitis A can make you tired and lacking in energy for day-to-day life, so rest when you can.
• Eat small meals more often – nausea can affect your ability to eat and can contribute to tiredness, so eat small amounts of high-calorie foods often if nausea is a problem.
• Drink fluids.
• Protect your liver – the liver processes medication and alcohol, so avoid alcohol and review any medication with your doctor.

Exposure to hepatitis A

If you’ve been in contact with someone with hepatitis A and you are not immune (have not been immunised or have never had a hepatitis A infection), speak with your doctor about your treatment options.

Immunisation against hepatitis A

Immunisation is the best protection against hepatitis A infection and is recommended for people in high-risk groups, and for unvaccinated people who have been in close contact with someone who has hepatitis A.

Immunisation against hepatitis A includes a course of injections over a 6 to 12-month period. Healthy people 12 months of age and over receive 2 doses of hepatitis A vaccine, or 3 doses if the hepatitis A and hepatitis B vaccines are given as a combination.

You can complete any missed vaccine doses, even if the recommended time frame has passed. You do not need to start the vaccine course again.

If you are in close contact with someone who has hepatitis A be sure to have the hepatitis A vaccine if you have not already completed a vaccine course.

Babies under 12 months of age and people who have a weakened immune system who are also in close contact with a person with hepatitis A can have an injection of normal human immunoglobulin (also called passive immunisation) instead of the hepatitis A vaccine.

Protection against hepatitis A is available free of charge under the National Immunisation Program Schedule for Aboriginal and Torres Strait Islander children (between 12 and 24 months) who live in high-risk areas (Queensland, Northern Territory, Western Australia and South Australia). (It is also recommended for people who work with Aboriginal and Torres Strait Islander children and communities in these areas.)

Hepatitis A immunisation is recommended for high-risk groups

In Victoria, the vaccine is recommended (but not free) for:

• people (12 months of age and over) travelling to places where hepatitis A is common (endemic)
• people whose work puts them at increased risk of infection including:
  • plumbers and sewage workers
  • people who work with children
  • people who work with people with developmental disabilities
• people with developmental disabilities
• people with liver disease or people who have had a liver transplant or have chronic hepatitis B or hepatitis C
• people who have anal intercourse (including men who have sex with men, and workers in the sex industry)
• people who inject drugs
• inmates of correctional facilities (prisons).

Remember that immunisation against hepatitis A does not protect you against hepatitis B or hepatitis C.

Pregnancy and hepatitis A immunisation

Hepatitis A immunisation is not usually recommended for women who are pregnant although vaccination might be recommended in some situations.

Speak with your doctor if you are not immune to hepatitis A and you are at increased risk of infection or if you have a pre-existing medical condition such as liver disease.

Pre-immunisation checklist

Before receiving the vaccine, tell your doctor or nurse if you (or your child):

• are unwell (temperature over 38.5 ˚C)
• have allergies to any other medications or substances
• have had a serious reaction to any vaccine
• have had a serious reaction to any component of the vaccine
• have had a severe allergy to anything
• have a disease, or are having treatment, that causes low immunity
• are taking any prescription or over-the-counter medications
• are pregnant or intend to become pregnant.

Side effects of immunisation against hepatitis A

Immunisations against hepatitis A are effective and safe. All medications can have side effects.

For most people, the chance of a serious side effect from a vaccine is much lower than the chance of serious harm if you catch the disease.

Common side effects from the hepatitis A vaccine include:

• localised pain, redness and swelling at the injection site
• low-grade temperature (fever)
• headache.

Managing fever after immunisation

Common side effects following immunisation are usually mild and temporary (occurring in the first few days after vaccination). Specific treatment is not usually required.

There are a number of treatment options that can reduce the side effects of the vaccine including:

• Drink extra fluids and do not overdress if you have a fever.
• Although routine use of paracetamol after vaccination is not recommended, if fever is present, paracetamol can be taken – check the label for the correct dose or speak with your pharmacist (especially when giving paracetamol to children).

Managing injection site discomfort

Many vaccine injections may result in soreness, redness, itching, swelling or burning at the injection site for one to 2 days. Paracetamol might be required to ease the discomfort.

Sometimes a small, hard lump (nodule) at the injection site may persist for some weeks or months. This should not be of concern and requires no treatment.

Concerns about immunisation side effects

If a side effect following immunisation is unexpected, persistent or severe, or if you are worried about yourself or your child’s condition after a vaccination, see your doctor or immunisation nurse as soon as possible or go directly to a hospital.

Immunisation side effects may be reported to SAEFVIC, the Victorian vaccine safety and central reporting service. Adverse events in other states or territories can be reported through SAEFVAC.

It is important to seek medical advice if you (or your child) are unwell, as this may be due to other illness rather than because of the vaccination.

Rare side effects of hepatitis A immunisation

There is a very small risk of a serious allergic reaction (anaphylaxis) to any vaccine. This is why you are advised to stay at the clinic or medical surgery for at least 15 minutes following immunisation in case further treatment is required.

Where to get help

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital
• Your GP (doctor)
• Local government immunisation service
• LiverWELL Tel. 1800 703 003
• Maternal and Child Health Line (24 hours, 7 days) Tel. 13 22 29
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• Immunisation Unit, Department of Health, Victorian Government Email: immunisation@health.vic.gov.au
• National Immunisation Information Hotline Tel. 1800 671 811
• Pharmacist
• Community Pharmacist Pilot – receive some treatments at a local pharmacy without needing to see a doctor for a prescription in Victoria
• SAEFVIC Tel. 1300 882 924