What is hepatitis A?

'Hepatitis' means inflammation or swelling of the liver. It can be caused by chemicals or drugs, or by different kinds of viral infections.

Hepatitis A virus is one type of hepatitis. Infection with one type of hepatitis virus does not give protection against infection with other hepatitis viruses. Hepatitis A is not common in Australia, most people acquire their infection when travelling overseas.

What are the symptoms of hepatitis A?

Symptoms of hepatitis A include:

• feeling unwell
• tiredness
• fever
• nausea
• lack of appetite
• abdominal discomfort
• joint pain (occasionally)
• dark urine, pale stools and jaundice (yellowing of the eyeballs and skin). Jaundice, dark urine and pale stools do not occur in all cases.

Symptoms of hepatitis usually show about four weeks after contact with the virus. Sometimes symptoms will appear between two and seven weeks.

Illness is usually mild and lasts one to three weeks. Almost all people recover completely.

Some people, particularly people with chronic liver disease, may experience more severe symptoms.

Small children who become infected usually have no symptoms.

Hepatitis A does not cause long-term liver disease and deaths caused by hepatitis A do occur but are very rare. Occasionally people are hospitalised for the disease and can have relapsing symptoms after the disease has seemed to clear.

How is hepatitis A spread?

Large amounts of the hepatitis A virus are found in the faeces (poo) of an infected person. The virus can survive in the environment for several weeks in the right conditions.

Hepatitis A is usually transmitted when virus from an infected person is swallowed by another person through:

• eating contaminated raw, frozen or undercooked food
• drinking contaminated water
• touching dirty nappies, linen or towels of a person with hepatitis
• sharing personal items such as toothbrushes
  
• direct contact (including sexual) with a person with hepatitis

Outbreaks of hepatitis A have been traced to:

• person-to-person spread
• sexual contact especially among men who have sex with men
• consumption of imported frozen fruits
• drinking water contaminated with sewage
• eating food that has been contaminated at its source such as vegetables, berries and shellfish
• eating contaminated food
  
• child-care centres, nursing homes and prisons.

Infected people may pass on the virus to others typically from two weeks before they develop symptoms until one week after they have jaundice (yellowing of the eyeballs and skin). If they do not develop jaundice, they may pass the virus on for two weeks after they develop symptoms. People should be careful after this as the virus can be shed in faeces for longer periods.

Infection with hepatitis A continues to be a problem for people travelling overseas, especially people visiting developing countries where hepatitis A is common.

Who is at risk of hepatitis A?

Those who have not had hepatitis A and who have not been vaccinated against it are at risk of catching the disease.

How is hepatitis A prevented?

Vaccination

A safe and effective vaccine is available against hepatitis A.

The vaccine may take two weeks or more to provide the best protection. Two doses taken six months apart is recommended for long-lasting protection.

The vaccine can protect someone exposed to the virus if given within two weeks of contact.

Vaccination is recommended for the following higher-risk groups:

• travellers to countries where hepatitis A is common (most developing countries)
• frequent visitors to rural and remote indigenous communities
• some health care workers who work in or with indigenous communities
• sewerage workers
• plumbers
• men who have sex with men
• childcare and pre-school workers
• the intellectually disabled and their carers
• people who use/inject illicit drugs
• patients with chronic liver disease
• people with haemophilia needing regular blood products.
  

What else can be done to avoid hepatitis A?

Everyone should always wash their hands thoroughly with soap and running water for at least 10 seconds and dry them with a clean towel:

• after going to the toilet
• before eating
• before preparing food or drink
• after handling objects that may have been contaminated such as nappies and condoms.
  

Imported frozen fruit products have been the source of numerous outbreaks of hepatitis A. Cooking these products prior to consuming eliminates the risk of hepatitis A and other potential foodborne infections.

What can be done to avoid giving hepatitis A to others?

If you have hepatitis A:

• wash your hands thoroughly with soap and warm water, dry on a clean towel
• 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.
  

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.

How is hepatitis A diagnosed?

A doctor will diagnose hepatitis A based on the patient's symptoms and will do a blood test for hepatitis A antibodies to confirm. Occasionally, hepatitis A DNA testing (PCR) may also be used for diagnosis on blood or faeces samples.

How is hepatitis A treated?

There is no specific treatment for hepatitis A.

Vaccination or an injection of immunoglobulin may prevent illness if given within two weeks of contact with the infectious person. Household contacts and sexual partners of an infectious person may need to be vaccinated or given immunoglobulin.

Rest, drinking a lot of fluid, and eating well are recommended for people with hepatitis A.

Avoiding alcohol will also reduce the stress on the liver.

What is the public health response?

• Doctors, hospitals and laboratories must confidentially notify cases of hepatitis A infection to the local public health unit.
• Public health unit staff will work with the doctor, the patient or the patient's family to identify close contacts at risk of infection and arrange for those at risk to receive information about the disease and if necessary preventative treatment.
• Public Health Unit staff follow special guidelines for managing cases of hepatitis A in people who attend or work at a child care centre, and in people who handle food for sale.
• Public health unit staff also investigate outbreaks of hepatitis A to identify the cause of the outbreak, control its spread and prevent further infections.

For further information please call your local Public Health Unit on 1300 066 055.