Liver Disease | Liver India | Alcoholic Liver Disease

Viral Hepatitis A

Hepatitis (HEP-ah-TY-tis) makes your liver swell and stops it from working right. You need a healthy liver. The liver does many things to keep you alive. The liver fights infections and stops bleeding. It removes drugs and other poisons from your blood. The liver also stores energy for when you need it.

What are the signs and symptoms of hepatitis A?

Persons with hepatitis A virus infection may not have any signs or symptoms of the disease. Older persons are more likely to have symptoms than children. If symptoms are present, they usually occur abruptly and may include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and eyes). Symptoms usually last less than 2 months; a few persons are ill for as long as 6 months. The average incubation period for hepatitis A is 28 days (range: 15–50 days). In less than 2% severe liver failure may lead to death unless an emergency liver transplant is done.

Hepatitis A can make you feel like you have the flu.

You might

Some people have

Some people don't have any symptoms.

If you have symptoms, or think you might have hepatitis A, go to a doctor. The doctor will test your blood.

How is hepatitis A diagnosed?

A blood test (IgM anti-HAV) is needed to diagnose hepatitis A. Talk to your doctor or someone from your local health department if you suspect that you have been exposed to hepatitis A or any type of viral hepatitis.

Most people who have hepatitis A get well on their own after a few weeks.

You may need to rest in bed for several days or weeks, and you won't be able to drink alcohol until you are well. The doctor may give you medicine for your symptoms.

How can I protect myself?

You can get the hepatitis A vaccine.

A vaccine is a drug that you take when you are healthy that keeps you from getting sick. Vaccines teach your body to attack certain viruses, like the hepatitis A virus.

The hepatitis A vaccine is given through a shot. Children can get the vaccine after they turn 2 years old. Children aged 2 to 18 will need three shots. The shots are spread out over a year. Adults get two or three shots over 6 to 12 months.

You need all of the shots to be protected. If you miss a shot, call your doctor or clinic right away to set up a new appointment.

You can protect yourself and others from hepatitis A in these ways, too:

Who can get hepatitis A?

Anyone can get hepatitis A.

But some people are more likely to than others:

How is hepatitis A virus transmitted?

Hepatitis A virus is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A. This type of transmission is called "fecal-oral." For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed.

Most infections result from contact with a household member or sex partner who has hepatitis A. Casual contact, as in the usual office, factory, or school setting, does not spread the virus.

What products are available to prevent hepatitis A virus infection?

Two products are used to prevent hepatitis A virus infection: immune globulin and hepatitis A vaccine.

How are hepatitis A vaccines made?

There is no live virus in hepatitis A vaccines. The virus is inactivated during production of the vaccines, similar to Salk-type inactivated polio vaccine.

Is hepatitis A vaccine safe?

Yes, hepatitis A vaccine has an excellent safety profile. No serious adverse events have been attributed definitively to hepatitis A vaccine. Soreness at the injection site is the most frequently reported side effect.

Any adverse event suspected to be associated with hepatitis A vaccination should be reported to the Vaccine Adverse Events Reporting System (VAERS). VAERS forms can be obtained by calling 1-800-822-7967.

Is immune globulin safe?

Yes. No instance of transmission of HIV (the virus that causes AIDS) or other viruses has been observed with the use of immune globulin administered by the intramuscular route. Immune globulin can be administered during pregnancy and breast-feeding.

Can other vaccines be given at the same time that hepatitis A vaccine is given?

Yes. Hepatitis B, diphtheria, poliovirus (oral and inactivated), tetanus, oral typhoid, cholera, Japanese encephalitis, rabies, yellow fever vaccine or immune globulin can be given at the same time that hepatitis A vaccine is given, but at a different injection site.

How long does immunity last after hepatitis A vaccination?

Although data on long-term protection are limited, estimates based on modeling techniques suggest that protection will last for at least 20 years.

When are persons protected after receiving hepatitis A vaccine?

One month after receiving the first dose of hepatitis A vaccine, 94-100% of adults and children will have protective antibodies. Many persons will have protective antibodies by 2 weeks after the first vaccine dose. However, to receive optimal protection, the first dose of hepatitis A vaccine should be given 4 weeks prior to time of desired protection. Those who need optimal protection earlier than 4 weeks after the first dose of vaccine should also receive immune globulin. The second dose of vaccine in 6-18 months is necessary to assure long term protection. Check with your doctor for when the next dose is due.

Can hepatitis A vaccine be given after exposure to hepatitis A virus?

No, hepatitis A vaccine is not licensed for use after exposure to hepatitis A virus. In this situation, immune globulin should be used.

Should pre-vaccination testing be done?

Pre-vaccination testing is done only in specific instances to control cost (e.g., persons who were likely to have had hepatitis A in the past). This includes persons who were born in countries with high levels of hepatitis A virus infection, elderly persons, and persons who have clotting factor disorders and may have received factor concentrates in the past.

Should post-vaccination testing be done?


Can a patient receive the first dose of hepatitis A vaccine from one manufacturer and the second (last) dose from another manufacturer?

Yes. Although studies have not been done to look at this issue, there is no reason to believe that this would be a problem.

What should be done if the second dose of hepatitis A vaccine is delayed?

The second dose should be administered as soon as possible. There is no need to repeat the first dose.

Can hepatitis A vaccine be given during pregnancy or lactation?

We don't know for sure, but because vaccine is produced from inactivated hepatitis A virus, the theoretical risk to the developing fetus is expected to be low. The risk associated with vaccination, however, should be weighed against the risk for hepatitis A in women who may be at high risk for exposure to hepatitis A virus.

Can hepatitis A vaccine be given to immunocompromised persons? (e.g., persons on hemodialysis or persons with AIDS)



Hepatitis A vaccination provides protection before one is exposed to hepatitis A virus. Hepatitis A vaccination is recommended for the following groups who are at increased risk for infection and for any person wishing to obtain immunity.

Persons traveling to or working in countries that have high or intermediate rates of hepatitis A.

All susceptible persons traveling to or working in countries that have high or intermediate rates of hepatitis A should be vaccinated or receive immune globulin before traveling. Persons from developed countries who travel to developing countries are at high risk for hepatitis A. Such persons include tourists, military personnel, missionaries, and others who work or study abroad in countries that have high or intermediate levels of of hepatitis A. The risk for hepatitis A exists even for travelers to urban areas, those who stay in luxury hotels, and those who report that they have good hygiene and that they are careful about what they drink and eat.

Children in states, counties, and communities that have consistently increased rates of hepatitis A and periodic hepatitis A outbreaks.

Children living in states, counties, and communities that have consistently increased rates of hepatitis A and periodic outbreaks should be routinely vaccinated beginning at 2 years of age. High rates of hepatitis A can be found in these populations, both in urban and rural settings. In addition, to effectively prevent epidemics of hepatitis A, vaccination of previously unvaccinated older children is recommended within 5 years of initiation of routine childhood vaccination programs. Although rates differ among areas, available data indicate that a reasonable cutoff age in many areas is 10-15 years of age because older persons have often already had hepatitis A. Vaccination of children before they enter school should receive highest priority, followed by vaccination of older children who have not been vaccinated.

Men who have sex with men

Sexually active men (both adolescents and adults) who have sex with men should be vaccinated.

Hepatitis A outbreaks among men who have sex with men have been reported frequently. Recent outbreaks have occurred in urban areas in the United States, Canada, and Australia.

Illegal-drug users

Vaccination is recommended for injecting and non-injecting illegal-drug users if local health authorities have noted current or past outbreaks among such persons.

During the past decade, outbreaks have been reported among injecting-drug users in the United States and in Europe.

Persons who have occupational risk for infection.

Persons who work with hepatitis A virus-infected primates or with hepatitis A virus in a research laboratory setting should be vaccinated. No other groups have been shown to be at increased risk for hepatitis A virus infection because of occupational exposure.

Outbreaks of hepatitis A have been reported among persons working with non-human primates that are susceptible to hepatitis A virus infection, including several Old World and New World species. Primates that were infected were those that had been born in the wild, not those that had been born and raised in captivity.

Persons who have chronic liver disease.

Persons with chronic liver disease who have never had hepatitis A should be vaccinated, as there is a higher rate of fulminant (rapid onset of liver failure, often leading to death) hepatitis A among persons with chronic liver disease. Persons who are either awaiting or have received liver transplants also should be vaccinated.

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