for Veterans and the Public
Hepatitis A: Entire Lesson
What is hepatitis A?
Hepatitis A is a result of infection with the hepatitis A virus. Hepatitis A is a contagious liver disease that can range in severity from a mild illness lasting a few weeks to a severe illness causing liver failure. Most people infected with the virus get well within six months. However, hepatitis A can be serious for older people and people who already have liver disease such as hepatitis B or C.
How is hepatitis A spread?
The hepatitis A virus is usually spread by putting something in your mouth that is contaminated with the virus. The virus is found in the stool of people with hepatitis A and is spread when someone's stool accidentally contaminates food or water. This can happen when an infected person does not adequately wash his or her hands after using the bathroom then touches other things such as food. When other people eat that food, they can get infected with hepatitis A. Usually the transmission is between people in very close personal contact.
Foods themselves can be contaminated with hepatitis A virus, such as raw oysters harvested from sewage-contaminated water. When people eat food contaminated with hepatitis A virus, they can get infected with the virus.
Hepatitis A is usually spread through
- household contact with an infected person
- sexual contact with an infected person
- eating or drinking contaminated food or water
- sharing eating utensils that are contaminated
- touching contaminated surfaces and then placing your hands near or in the mouth
Who is at risk for hepatitis A?
Anyone can acquire hepatitis A under the conditions described in the previous section. However, rates of infection are particularly high among certain groups, and people in these groups can be considered at high risk. These include the following:
- Men who have sex with men
- People who use illicit drugs
- People, especially children, living in or traveling to areas that have high rates of hepatitis A, particularly Africa, Asia, and Latin America
How will I know if I have hepatitis A?
Your doctor can tell you if you have hepatitis A by taking a sample of your blood. A blood test for a specific antibody called an IgM antibody can tell if you are infected with hepatitis A. Your doctor will also talk to you about your symptoms, which may include the following:
- Yellowing of the skin or eyes (called jaundice)
- Feeling very tired
- Stomach pain
- Not feeling very hungry
- Dark urine
- Low-grade fever
Though some people do not have any symptoms, hepatitis A usually makes people feel sick:
- Adults with hepatitis A are often too ill to work for up to a month.
- People with hepatitis A sometimes have to be hospitalized (up to 1 person in 5).
- In rare cases, people die as a result of hepatitis A (about 3 to 6 deaths per 1,000 cases).
What treatments are available for hepatitis A?
There are no special treatments for hepatitis A. Most people with hepatitis A recover without treatment within a few months by getting a lot of rest and drinking plenty of fluids.
What can I do to prevent hepatitis A?
Practice good personal hygiene
Because so many cases of hepatitis A are due to close contact with an infected person, you should always practice good personal hygiene, especially by washing your hands.
Be careful in high-risk situation
- Boil water or drink bottled water in areas where there is a risk for hepatitis A contamination.
- Eat cooked foods and fruits that you can peel and avoid eating vegetables or fruits that could have been washed with contaminated water, such as lettuce.
- Avoid eating raw or steamed shellfish, such as oysters, that live in contaminated waters.
- Use condoms correctly and every time you have sex. (See Tips for Using Condoms, on the VA HIV/AIDS website.)
The best way to prevent hepatitis A is to get vaccinated. The vaccine is very effective and can keep you from ever getting hepatitis A. You will not get hepatitis A from the vaccine.
Ask your VA medical care provider about vaccination if:
- you are in one of the high risk groups listed in "Who is at risk for hepatitis A?"
- you have any other type of chronic liver disease
More on the hepatitis A vaccine follows.
What is the hepatitis A vaccine?
The hepatitis A vaccine is a dose of inactive virus that stimulates your natural immune system. After the hepatitis A vaccine is given, your body makes antibodies that will protect you against the hepatitis A virus.
Vaccination for hepatitis A requires 2 shots, 6 months apart. The vaccine is given with an injection, into the muscle of the upper arm. If for some reason the second injection doesn't take place at 6 months, you can receive the second dose at a later time.
If you need hepatitis B vaccination in addition to hepatitis A, you can do these individually or as a combined vaccine that covers both. The combination vaccine is given as 3 injections over a 6-month period--an initial dose, followed by a second dose 1 month later, and then a third dose 5 months after the second.
Should I get the hepatitis A vaccine?
You may need the vaccination against hepatitis A if you have not previously been vaccinated against hepatitis A and you have any of the following reasons for receiving the vaccination:
- Chronic hepatitis C
- Chronic hepatitis B
- Alcoholic hepatitis
- Cirrhosis or liver fibrosis
- Other chronic liver disease
- Findings consistent with liver disease (such as esophageal varices)
- Clotting factor disorder
- HIV infection
- Use of injection drugs
- Use of non-injection street or illicit drugs
- Are a man who has sex with other men
- Are awaiting or have received a liver transplant
- Work with primates that are infected with hepatitis A or work in a research laboratory where the virus is present
- Travel, work, or live in areas or communities where there are high or moderate rates of hepatitis A infection (these tend to be developing countries such as certain parts of Africa, Asia, and Central and South America)
- Are planning to adopt, care for, or live in a household with a child from a country where hepatitis A is common
Health care personnel and patients with the following conditions should discuss the hepatitis A vaccination with their health care provider: pregnancy, immunocompromising conditions, HIV infection, heart disease, chronic lung disease, chronic alcoholism, asplenia, kidney failure.
You should NOT get the hepatitis A vaccination or you should wait, if you:
- Had a serious allergic reaction to a previous hepatitis A vaccination
- Are moderately or severely ill, with or without fever, at the time the vaccination is scheduled (if you are just mildly ill, ask your doctor or nurse if it is OK for you to receive the vaccine)
Speak with your VA health care provider to see if you should be vaccinated against hepatitis A.
Should pregnant or breast-feeding women receive the hepatitis A vaccination?
The safety of hepatitis A vaccination during pregnancy has not been determined; however, because hepatitis A vaccine is produced from inactivated virus, the risk to the developing fetus is probably low. The risk associated with hepatitis A vaccine should be discussed with your health care provider to determine if vaccination is right for you.
Do I need to be tested for hepatitis A before getting the vaccination?
Your provider may decide to test your blood for antibodies to hepatitis A but this is not mandatory for everyone. If you have antibodies to hepatitis A already, it means either that you were infected with hepatitis A in the past or that you were previously vaccinated against hepatitis A. Either way, you don't need to get the hepatitis A vaccination if you already have antibodies to hepatitis A.
What are the side effects of the hepatitis A vaccine?
The hepatitis A vaccine is made from inactive virus and is quite safe. In general, there are very few side effects. The most common potential side effect is soreness at or around the injection site. Other potential side effects include mild headache, loss of appetite among children, and feeling tired. These side effects usually last 1 or 2 days. However, like any medicine, the vaccine could cause serious problems, such as an allergic reaction, which may appear within a few minutes or hours after getting the shot. This occurs very rarely, but if you believe you are having a reaction to the vaccine, you should call your doctor or nurse right away. Some warning signs of a serious allergic reaction include the following:
- High fever
- Behavior changes
- Difficulty breathing
- Hoarse voice or wheezing
- Pale skin
- Weakness or dizziness
- A fast heart beat
You will NOT get hepatitis A from the vaccine, and receiving the vaccine is much safer than getting the disease itself.
What vaccines are available for hepatitis A?
There are 2 vaccines for hepatitis A on the market. There is 1 combination vaccine on the market for hepatitis A and B together.
Products and Publications
- The ABCs of Hepatitis
Two-page guide to the symptoms, treatment, and prevention of hepatitis A, B, and C.
- ABCs of Hepatitis (video)
This 15-minute video was created for general education on hepatitis A, B, and C in substance use disorder programs.Transcript included.
Definitions of terms commonly used with viral hepatitis and related conditions.
- American Liver Foundation
A national nonprofit organization dedicated to the prevention, treatment, and cure of hepatitis and other liver diseases through research, education, and advocacy. Web site features a database directory of hepatitis clinical trials, lay-oriented facts sheets, and links to additional resources.
- Centers for Disease Control and Prevention: Viral Hepatitis
Information on all types of viral hepatitis from the CDC's National Center for Infectious Diseases. Site features related CDC guidelines and recommendations as well as training materials, slide sets, fact sheets, and key CDC hepatitis documents.
- NATAP: Hepatitis
Recogizing that coinfection with viral hepatitis among people with HIV is a growing problem, the National AIDS Treatment Advocacy Project (NATAP) has developed an extensive amount of information on hepatitis, both in the context of HIV coinfection and as a separate illness. NATAP provides coverage of key conferences, maintains a selection of hepatitis articles, and features an ask-the-expert forum on hepatitis C.