Hepatitis A Dr Rob Hicks Inflammation of the liver - hepatitis - has many causes, including several viruses. The most common of these is hepatitis A.

In this article

What is it? Symptoms

Causes and risk factors Treatment and recovery

Hepatitis A is an infection of the liver caused by the hepatitis A virus.

According to the World Health Organisation, there are an estimated 1.5 million new cases of illness due to hepatitis A each year worldwide, and many more people become infected without developing symptoms. It's particularly common in less developed countries where poverty or poor sanitation are important factors. Africa, northern and southern Asia, parts of South America, and southern and eastern Europe all have high rates of the disease. In these countries almost every adult carries antibodies to hepatitis A suggesting that it is quite usual for people to be exposed to the infection, usually in childhood, and to develop immunity.

The infection isn't common in the UK, although it’s still the main type of infective hepatitis seen. (There are several other types of viral hepatitis such as hepatitis B and hepatitis C.) In 2005, for example, there were 457 laboratory reports of confirmed hepatitis A virus (HAV) infection in England and Wales.

The majority of people from the UK who become infected with hepatitis A contract it when abroad in a country where it is very common.

Hepatitis A is an acute infection, rather than chronic (long term). Rarely, it can cause life-threatening liver damage.

The incubation period of the virus before symptoms develop is between two and six weeks. How severely someone is affected varies from person to person. Some may not have any symptoms at all, while others may have just mild symptoms similar to those of a flu-like illness. This is particularly common among infants and young children.

The older someone is, the more severe the infection and symptoms are likely to be.

Possible symptoms include weakness, tiredness, headache, fever, loss of appetite, nausea and vomiting, abdominal pain and diarrhoea and dehydration. These may all occur for a week or more before jaundice appears.

Jaundice occurs in hepatitis infections because the liver becomes unable to remove a substance called bilirubin from the blood. This is a pigment that builds up in the body, causing the skin and whites of the eyes to turn yellow.

How to avoid infection

• Ensure high level of personal hygiene
• Avoid eating raw or inadequately cooked salads, vegetables and shellfish
• Check whether tap water is safe to drink before you go
• Get vaccinated against hepatitis A if visiting high-risk countries

The hepatitis A virus is found in the faeces of infected people. It's spread because of poor personal hygiene, such as when people don't wash their hands after using the toilet.

The most common causes of infection are contaminated food or water and person-to-person contact. In countries where sanitation and sewage disposal are poor, drinking water may become contaminated, causing major outbreaks of hepatitis A.

Food prepared or washed with contaminated water can also easily transmit the infection. Fruits, salads, raw vegetables and any uncooked foods are considered to be high risk, as are ice, iced drinks and ice cream. Food that comes into contact with contaminated seawater, for example, shellfish, can also transmit the infection.

There have also been outbreaks of hepatitis A among intravenous drug users although other types of hepatitis (B and C) are usually of more concern in this group.

There's no specific treatment for hepatitis A, but fortunately the majority of people recover within a few weeks. On average, around one in five people between the ages of 15 and 39 with hepatitis A is admitted to hospital for supportive treatment such as intravenous fluids, medication for pain and itching, and general nutritional support.

About 15% of people will have a prolonged or relapsing illness lasting up to 9 months. Tragically, a small number of people die when the infection overwhelms the body. This is more likely to happen to people over the age of 60.

A person with hepatitis A should avoid drinking alcohol until their liver is completely back to normal, as alcohol is toxic to liver cells and will slow its recovery.

Ensuring good personal hygiene practices - washing your hands after using the toilet and maintaining good food preparation - is essential in avoiding infection with hepatitis A, especially if you visit a high risk area.

When visiting high-risk countries, it's a good idea to avoid eating raw or inadequately cooked salads and vegetables, ice cream, unpeeled fruit and shellfish. Also avoid unpasteurised milk and drinks with ice, and check whether tap water is safe to drink before you go.

There's an effective vaccination to protect people from hepatitis A infection. It's available from your GP or high street travel centres, who will be able to advise you whether you need it for the country you are visiting. It's recommended for anyone travelling to the high-risk regions of the world.

Those people who have already had hepatitis A usually have life long immunity.

Advice and support

British Liver Trust

Helpline: 0800 652 7330
Email: info@britishlivertrust.org.uk
Website: www.britishlivertrust.org.uk

This article was last medically reviewed by Dr Trisha Macnair in February 2009.