<< Back to Infosheets

HEPATITIS A

What is Hepatitis A?

Hepatitis A is one of many viruses that cause inflammation of the liver. The Centers for Disease Control and Prevention estimate that 150,000 people in the U.S. are infected each year, a low rate compared to the underdeveloped countries. Most people recover from the hepatitis A virus within six months and do not have any serious health problems.

In the United States, there were an estimated 32,000 new hepatitis A virus infections in 2006. However, the official number of reported hepatitis A cases is much lower since many people who are infected never have symptoms and are never reported to public health officials, source Centers for Disease Control.

How is Hepatitis A Spread?

Infection is often caused by drinking water or eating food contaminated with fecal matter containing the virus. Different from the hepatitis B & C viruses, the hepatitis A virus remains stable when liver cells eliminate in into bile, which enters the digestive area. Fecal elements from an infected person have a high concentration of the virus, while saliva and other bodily fluids have a low concentration. The virus can survive in contaminated excrement on a person's hand, for instance, or on a surface for three to four hours at normal room temperatures. Consequently, an eating utensil contaminated with the virus could be a way of transmission to a person. Contaminated shellfish is also a frequent source of infection. Direct contact with an infected person is another way of transmission (kissing on the mouth and anal sex). It is suspected that sharing contaminated needles may be a way of infection. In over 40% of the reported cases, it is not known how these people were infected.

Who is At Risk for Hepatitis A?

The risk of being infected with the hepatitis A virus generally depends on the hygienic and sanitary conditions in an area. High-risk geographic areas are the Middle East, South America, Eastern Europe, Central America, Africa and Southeast Asia. There are also areas in the United States where poor sanitary circumstances have resulted in an outbreak of hepatitis A. Children at daycare centers spread the virus because of fecal-oral contamination through diaper changing. Outbreaks have been reported in the military and at centers for the disable. People using intravenous drugs with contaminated needles have also been infected with the virus. The Center for Disease Control and Prevention (CDC) lists households or sexual contact, daycare attendance or employment and recent international travel as the major know risk factors for the spread of hepatitis A. In about 42% of cases it is uncertain how the person became infected. The CDC estimates that a third of the U.S. population has been infected.

What Are The Symptoms for Hepatitis A Infection?

Like the other hepatitis viruses, a person infected with hepatitis A may not have any symptoms. Common symptoms simulate the flu. These might be fatigue, nausea, vomiting, pain in the liver area, dark urine or light colored stools and fever. Liver function tests are elevated, with many adults developing jaundice. Children under the age of two rarely have symptoms. Most people recover within six months.

Can Hepatitis A Result in Serious Complication?

A small amount of people infected with this virus may develop serious complications. These include people with alcoholic hepatitis, chronic hepatitis with cirrhosis or the elderly over 60 years old. These patients may suffer liver failure after being infected with hepatitis A. Federal mortality statistics for 1992 list hepatitis A as the primary cause of death for 82 individuals. In 1993 an estimated 121 people were hospitalized due to hepatitis A. Patients with this virus may show improvements in their symptoms and liver functions test only to suffer a relapse, often after four weeks. A relapse can happen more than once and there is no way to predict who will suffer a recurrence of acute symptoms. In rare cases, jaundice lasts for two or more months. Pregnant women infected with hepatitis A rarely suffer serious complications to themselves or their newborn.

How is Hepatitis A Diagnosed?

Hepatitis A is diagnosed by a blood test that is positive for the antibodies to the virus, which appears about four weeks after the infection. There are no false positives or negatives with this test. Liver functions tests (serum alanine aminotranferase (ALT), and aspirate aminotransferase (AST))are elevated above normal, often very high levels. Symptoms will normally appear during the first four weeks of infection.

How is Hepatitis A Treated?

There is no specific treatment for hepatitis A. Most patients are told to rest for one to four weeks after diagnosis, to avoid intimate contact, and to consume foods high in protein. People who have come into contact with the patients should be given temporary immunization with immune serum globulin within two weeks of exposure.

What is The Hepatitis A Vaccine?

The first hepatitis A vaccine became available in 1995 (HAVRIX®), followed by the second hepatitis A vaccine in 1996 (VAQTA®). They are equally safe and effective. The vaccines are made from an inactive hepatitis A virus that has been suspended in sterile solution. There are not made from infected blood. The body reacts with inactive virus to produce antibodies that protect against infection of the liver by hepatitis A virus. Clinical trials have proven that the vaccine is effective in preventing the infection in over 90% of people who where exposed. There are generally no known side effects, except for tenderness or irritation at the site of the injection. Less than 10% of those vaccinated become tired and nauseous. Two doses are recommended. The second dose is given no sooner than six months after the first dose.

Is there a vaccine that protects against both HAV and HBV infections?

Yes. Twinrix®, the hepatitis A and hepatitis B combination vaccine manufactured by GlaxoSmithKline, was licensed for use in the United States in 2001 for people 18 years of age and older. Three doses of Twinrix® are necessary for full protection against hepatitis A and hepatitis B virus infections. (Source, Immunization Action Coalition)

In April 2007, approval was received for an alternate 4-dose schedule for Twinrix®. Using this schedule, 3 doses of Twinrix® can be administered at 0, 7, and 21-30 days, followed by the 4th dose at 12 months. This schedule might benefit people needing rapid protection from both hepatitis A and hepatitis B virus infections. This includes people traveling to areas with high rates of hepatitis A and hepatitis B and emergency responders, especially those being deployed to disaster areas overseas. Again, this is available only for people 18 years of age and older. (Source, Immunization Action Coalition)

Is hepatitis A decreasing in the United States?

Yes. Rates of hepatitis A in the United States are the lowest they have been in 40 years. The hepatitis A vaccine was introduced in 1995 and health professionals now routinely vaccinate all children, travelers to certain countries, and persons at risk for the disease. Many experts believe hepatitis A vaccination has dramatically affected rates of the disease in the United States. (Source, Immunization Action Coalition).

© Copyright September 2001 - The Latino Organization for Liver Awareness / Revised: February 2009