What is hepatitis A?

Hepatitis A is a virus which causes inflammation of the liver. Hepatitis A is mainly spread through poor hygiene, contaminated food or close contact with an infected person (including sexual contact). Hepatitis A does not usually cause lasting damage to the liver, though some people may have a more severe infection. Vaccination against hepatitis A virus is often advised for people whose occupations or lifestyle put them more at risk, and for travellers, especially if going to developing countries.

How is the hepatitis A virus spread?

Hepatitis A is spread most often from person to person by oral/faecal contact, ie, by putting something in the mouth that has been contaminated with infected faeces. This can occur in the following ways:

Infected raw food supply
Occasionally in New Zealand, and often overseas, the food supply can become infected. This sometimes occurs in shellfish growing in water contaminated with faeces (raw sewage).

Poor hygiene habits
Forgetting to wash your hands with soap and water after having a bowel motion, or before eating or preparing food. It is thought the virus can also be passed on from contact with an infected surface, such as a nappy change table or kitchen workbench.

Having sex
Infection is more likely when practicing anal/oral sex or when fingers have been in contact with the anus then the mouth. Sexual infection is more common in men.

What are the symptoms of hepatitis A?

Children infected with the hepatitis A virus usually have no symptoms. Adults who are infected may become quite ill suddenly. Their skin may turn a yellowish/brown colour, they feel very tired and sick, and some will vomit. They may have tummy pain, dark urine and/or light coloured bowel movements and fever.

These symptoms usually do not occur until about a month after infection has occurred. Unfortunately, an infected person can pass the virus on to others as early as two weeks before their symptoms appear.

Treatment for hepatitis A 

For most people infected by hepatitis A virus (HAV) there is no specific treatment and the virus will disappear by itself over a few months. The person is then immune to the virus and cannot be reinfected.

Some people, however, can be treated with immunoglobulin (Ig). This drug needs to be given quickly (up to two weeks following infection with HAV) and may provide temporary immunity.

About one in 100 people infected with HAV suffer from a more sudden, severe infection that may require a liver transplant.

Prevention of hepatitis A 

The best way to prevent infection with HAV is to have very good personal hygiene habits and practise safe sex.

Hand washing
Hand washing with hot, soapy water before eating or preparing food and after having a bowel motion will reduce your risk of being infected or infecting somebody else.

Workbenches
If you are working in a service industry, such as a day care centre or hospital, make sure workbenches that may become contaminated are washed with your workplace's recommended cleaning solution on a regular basis.

Food handlers should wash down workbenches with hot, soapy water regularly and take extra care to wash their hands thoroughly after having a bowel motion.

Immunoglobulin (Ig)
Immunoglobulin can provide a temporary immunity to the virus for two to three months if given prior to getting HAV, or within two weeks of infection. There is also a vaccine available to protect against hepatitis A (below). 

Immunisation against hepatitis A

Vaccines are medicines that protect a person from developing a disease. The hepatitis A vaccine is made from inactive hepatitis A virus (synthetic). The vaccine gives protection four weeks after the first injection. A second booster injection given six to 18 months later results in long-lasting protection, possibly around 20 years.

The vaccine is recommended for men who have sex with other men, and people two years of age and older who:

• have chronic liver disease or clotting factor disorders
• travel or work in developing countries (this includes all countries except those in northern and western Europe, Japan, Australia, New Zealand and North America, but not Mexico)
• live in communities with high rates of hepatitis A
• work in laboratories that deal with the hepatitis A virus
• inject and reuse IV needles.

The hepatitis A vaccine can be given alone or as a combined vaccination for hepatitis A and hepatitis B. The combined vaccine is given over six months, but can also be given in a rapid-dose schedule (eg, if limited time before travel) - talk to your doctor or travel health centre for details. If you are travelling to developing countries, you might want to check whether you have had these vaccinations.

The hepatitis A vaccine may also be used in certain outbreak situations where ongoing infection is occurring. Although studies of certain occupational groups (for example, food service workers, healthcare workers, child care workers, sewage workers) have not shown an increased risk, such people may consider vaccination if they wish to further reduce their risk or are in communities where ongoing outbreaks are occurring.

Original material provided by Auckland Sexual Health Service. Reviewed by everybody, March 2011.