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Hepatitis A - STDs Test Center

what is Hepatitis A?

is a communicable disease of the liver caused by the hepatitis A virus (HAV). Hepatitis A is a self-limited disease that does not result in chronic infection. Most adults with hepatitis A have symptoms, including fatigue, low appetite, stomach pain, nausea, and jaundice, that usually resolve within 2 months of infection; most children less than 6 years of age do not have symptoms or have an unrecognized infection. Antibodies produced in response to hepatitis A infection last for life and protect against reinfection. The best way to prevent hepatitis A infection is to get vaccinated.

How common is hepatitis A in the United States?

In 2017, a total of 3,366 cases of hepatitis A were reported in the United States, but due to underreporting, the actual number of cases is likely around 6,700 hepatitis A (1). Incidence rates decreased more than 95% from 1995 to 2011, then increased by 140% from 2011 to 2017. In 2017, large person-to-person outbreaks began occurring.

How is the hepatitis A virus (HAV) transmitted?

      • Person-to-person transmission through the fecal-oral route
      • Exposure to contaminated food or water can cause common-source outbreaks and sporadic cases of HAV infection.

 

 

 

 

Who is at increased risk for acquiring hepatitis A virus (HAV) infection?

      • persons with direct contact with persons who have hepatitis A
      • Travelers to countries with high or intermediate endemicity of HAV infection
      • Men who have sex with men
      • Users of injection and non-injection drugs
      • Persons with clotting factor disorders
      • Persons working with nonhuman primates
      • Household members and other close personal contacts of adopted children newly arriving from countries with high or intermediate hepatitis A endemicity

What is the incubation period for hepatitis A virus (HAV)?

The average incubation period for HAV is 28 days (range: 15–50 days) 

How long does hepatitis A virus (HAV) survive outside the body?

HAV can live outside the body for months, depending on the environmental conditions

Can hepatitis A become chronic?

No. Hepatitis A does not become chronic.

Can persons become re-infected with hepatitis A?

No. IgG antibodies to HAV, which appear early in the course of infection, provide lifelong protection against the disease 

How is HAV infection prevented?

Vaccination with the full, two-dose series of hepatitis A vaccine is the best way to prevent HAV infection. Hepatitis A vaccine has been licensed in the United States for use in persons 1 year of age and older. Immune globulin can provide short-term protection against hepatitis A, both pre- and post-exposure. Immune globulin must be administered within 2 weeks after exposure for maximum protection. Given that the virus is transmitted through the fecal-oral route, good hand hygiene—including handwashing after using the bathroom, changing diapers, and before preparing or eating food—is integral to hepatitis A prevention.

Who should be vaccinated against hepatitis A?

The Advisory Committee on Immunization Practices (ACIP) recommends that the following persons be vaccinated against hepatitis A:

      • All children at age 1 year,
      • People with unstable housing or experiencing homelessness
      • Persons who are at increased risk for infection,
      • Persons who are at increased risk for complications from hepatitis A, and
      • Any person wishing to obtain immunity (protection
      • Persons at Increased Risk for Hepatitis A Infection
      • Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A. Persons who travel to developing countries are at high risk for hepatitis A, even those traveling to urban areas, staying in luxury hotels, and those who report maintaining good hand hygiene and being careful about what they drink and eat
      • Men who have sex with men. Men who have sex with men should be vaccinated.
      • Users of injection and non-injection drugs. Persons who use injection and non-injection drugs should be vaccinated.
      • Persons who have occupational risk for infection. Persons who work with HAV-infected primates or with HAV in a research laboratory setting should be vaccinated. No other groups have been shown to be at increased risk for HAV infection because of occupational exposure.
      • Persons who have chronic liver disease. Persons with chronic liver disease who have never had hepatitis A should be vaccinated, as they have a higher likelihood of having fulminant hepatitis A (i.e., rapid onset of liver failure, often leading to death). Persons who are either awaiting or have received liver transplants also should be vaccinated.
      • Persons who have clotting-factor disorders. Persons who have never had hepatitis A and who are administered clotting-factor concentrates, especially solvent detergent-treated preparations, should be vaccinated.
      • Household members and other close personal contacts of adopted children newly arriving from countries with high or intermediate hepatitis A endemicity.  Previously unvaccinated persons who anticipate close personal contact (e.g., household contact or regular babysitting) with an international adoptee from a country of high or intermediate endemicity during the first 60 days following arrival of the adoptee in the United States should be vaccinated. The first dose of the 2-dose hepatitis A vaccine series should be administered as soon as adoption is planned, ideally 2 or more weeks before the arrival of the adoptee.
      • Persons with direct contact with persons who have hepatitis A. Persons who have been recently exposed to HAV and who have not previously received hepatitis A vaccine should be vaccinated.   

Can hepatitis A vaccine be given during pregnancy?

Yes. Hepatitis A vaccine is recommended for pregnant women with additional medical conditions or other indications for hepatitis A vaccine.

References

      1. Purcell RH. Relative infectivity of hepatitis A virus by the oral and intravenous routes in 2 species of nonhuman primates. The Journal of infectious diseases. 2002;185:1668-1771.1. Purcell RH. Relative infectivity of hepatitis A virus by the oral and intravenous routes in 2 species of nonhuman primates. The Journal of infectious diseases. 2002;185:1668-1771.
      2. Tassopoulos NC, Papaevangelou GJ, Ticehurst JR, Purcell RH. Fecal excretion of Greek strains of hepatitis A virus in patients with hepatitis A and in experimentally infected chimpanzees. The Journal of infectious diseases. 1986;154(2):231-237.
      3. Fiore AE. Hepatitis A transmitted by food. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2004;38(5):705-715.
      4. Carl M, Francis DP, Maynard JE. Food-borne hepatitis A: recommendations for control. The Journal of infectious diseases. 1983;148(6):1133-1135.
      5. Millard J, Appleton H, Parry JV. Studies on heat inactivation of hepatitis A virus with special reference to shellfish. Part 1. Procedures for infection and recovery of virus from laboratory-maintained cockles. Epidemiol Infect. 1987;98(3):397-414.
      6. Halliday ML, Kang LY, Zhou TK, et al. An epidemic of hepatitis A attributable to the ingestion of raw clams in Shanghai, China. The Journal of infectious diseases. 1991;164(5):852-859.
      7.  Hadler SC, Webster HM, Erben JJ, Swanson JE, Maynard JE. Hepatitis A in day-care centers. A community-wide assessment. The New England journal of medicine. 1980;302(22):1222-1227.
      8.  Lednar WM, Lemon SM, Kirkpatrick JW, Redfield RR, Fields ML, Kelley PW. Frequency of illness associated with epidemic hepatitis A virus infections in adults. American journal of epidemiology. 1985;122(2):226-233.
      9. Tong MJ, el-Farra NS, Grew MI. Clinical manifestations of hepatitis A: recent experience in a community teaching hospital. The Journal of infectious diseases. 1995;171 Suppl 1:S15-18.
      10. Koff RS. Clinical manifestations and diagnosis of hepatitis A virus infection. Vaccine. 1992;10 Suppl 1:S15-17.