Hepatitis A

The infection can be spread by:

• Eating food prepared by someone with the infection who hasn’t washed their hands properly
• Drinking contaminated water (including ice cubes) or eating food that is washed in contaminated water
• Eating raw or undercooked shellfish from contaminated water
• Close contact with someone who has hepatitis A
• Less commonly, having sex with someone who has the infection (this is particularly a risk for men who have sex with men) or injecting drugs using contaminated equipment

Someone with hepatitis A is most infectious from around 2 weeks before their symptoms appear until about a week after the symptoms first develop.²

Hepatitis A is found worldwide, but areas where it is most widespread include:

• Sub-Saharan and Northern Africa
• The Indian subcontinent (particularly India, Bangladesh, Pakistan and Nepal)
• Some parts of the Far East (excluding Japan)
• Middle East
• South and Central America²

The full list can be found here.³

The symptoms of hepatitis A develop, on average, around 4 weeks after becoming infected. Children often do not get any symptoms. Symptoms are common in adults and get worse with age. These can include:

• Fever
• Feeling tired and generally unwell
• Joint and muscle pain
• Headache
• Sore throat
• Cough
• Loss of appetite
• Nausea and vomiting
• Diarrhoea
• Stomach ache
• Jaundice – often causing itching
• Dark urine and pale stools⁴

In rare cases hepatitis A can cause the liver to stop working properly (liver failure).

In addition to the symptoms above, signs of liver failure can include:

• Sudden, severe vomiting
• Tendency to bruise and bleed easily (for example, frequent nosebleeds or bleeding gums)
• Irritability
• Problems with memory and concentration
• Drowsiness and confusion⁴

 Get medical advice as soon as possible if experiencing these symptoms. Liver failure can be life-threatening if not treated promptly.

Treatment for hepatitis A is symptomatic.

• Plenty of rest, especially during the initial stages of the infection
• Painkillers such as paracetamol or ibuprofen to help with aches and pains
• Reduce itching by maintaining a cool, well-ventilated environment, wearing loose clothing and avoiding hot baths or showers – your GP may recommend using an antihistamine in severe cases
• Eat smaller, lighter meals to help reduce nausea and vomiting
• Avoid alcohol – drinking alcohol can put additional strain on the liver⁵

For further information to help with treating symptoms speak to your pharmacist or GP.

The spread of hepatitis A can be minimised by:

• Being careful of what food is consumed and to wash hands thoroughly after using the toilet, before eating and before preparing food
• Only eat food that is freshly prepared, cooked and served piping hot, or fruit that has been peeled by yourself, such as a banana or mango
• Only drink bottled or cooled boiled water
• When drinking bottled water, ensure the seal is unbroken or choose sparkling water to ensure the bottle has not been refilled
• Only drink pasteurised milk
• Use bottled or boiled water to brush teeth. Do not use tap water⁶

Remember: BOIL IT, COOK IT, PEEL IT OR FORGET IT!

Vaccination is recommended for those traveling to countries where risk of hepatitis A infection is considered to be high.

In countries where there is a lower risk of hepatitis A infection, other factors need to be considered.

Travellers who may be at increased risk of hepatitis A infection include:

• Those going to areas of hepatitis A outbreaks who have limited access to safe water and medical care
• Frequent and/or long-stay travellers to areas where sanitation and food hygiene are likely to be poor
• Those with existing medical conditions such as liver disease or haemophilia
• Men who have sex with other men
• People who inject drugs
• Those who may be exposed to the virus through their work⁷

Vaccination is highly recommended if visiting areas where drinking water may be unsafe and where hygiene and sanitation is poor.

Hepatitis A is an inactivated vaccine. It is available for adults and children. The hepatitis A single vaccine is given as two doses:

• 1^st dose is ideally recommended 2 weeks before travel to develop immunity. It protects for about 1 year.
• 2^nd dose is recommended ideally 6-12 months after the first dose. It protects for about 25 years.
• A booster dose of hepatitis A vaccine after 25 years can be given to those at risk of infection

The vaccine stimulates the body to make antibodies against the virus. These antibodies protect against illness should infection with the virus occur.

Combination vaccines are also available:

• Hepatitis A and hepatitis B
• Hepatitis A and typhoid fever ⁸

The doses of the combined vaccines need to be given at slightly different time intervals. The travel clinic pharmacist will be able to provide further information.

This information is taken from trusted third party websites, NaTHNaC (Travel Health Pro) and EMIS (Patient info) and use of all information has been licenced under the Open Government Licence http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/.

Although the materials are being used/replicated under the provisions of the Open Government Licence this in no way represents endorsement of Traveljab.co.uk by NaTHNaC, Emis, Public Health England, the NHS or the Department of Health and Social Care.

1. Travel Health Pro: Hepatitis A factsheet
2. NHS: Hepatitis A causes
3. World Health Organisation (WHO): Hepatitis A, countries or areas at risk
4. NHS: Hepatitis A symptoms
5. NHS: Hepatitis A treatment
6. Patient.info: Hepatitis A
7. Center for disease control and prevention: Hepatitis A vaccine information statements
8. The Green Book: Chapter 17 Hepatitis A