Hepatitis A: Sorting the Evidence From the Noise

Key takeaways

• Childhood vaccine: 2 doses, starting at 12 to 23 months, given 6 months apart
• Adults who should be vaccinated: travelers to many countries, people at higher risk, and any adult who wants protection
• Most useful single change: Check whether you and your children have had both doses.
• Commonest mistake: Preparing food for others while you have symptoms.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

What it is

A liver infection caused by the hepatitis A virus, spread when tiny amounts of stool from an infected person get into food, water or onto hands. It sits within Infectious Diseases. Below are the published figures, in one place.

The numbers, in one place

What helps

What follows is the practical part: the things guidance actually asks of you.

• Check whether you and your children have had both doses
• Ask about the vaccine at least a few weeks before international travel
• Wash hands with soap and water after using the toilet or changing diapers and before handling food
• Call your doctor or health department quickly after a known exposure

What to avoid

The common mistakes, including the ones that sound sensible.

• Preparing food for others while you have symptoms
• Drinking alcohol or taking extra acetaminophen (Tylenol) while your liver is inflamed, unless your doctor agrees
• Drinking untreated water or eating raw shellfish where hepatitis A is common

In depth

Hepatitis A virus enters through the mouth, passes through the gut and travels to the liver, where it multiplies inside liver cells. It is the immune system's attack on those infected cells, rather than the virus itself, that causes most of the inflammation and symptoms. The virus is shed into bile and passed in stool, often for a couple of weeks before symptoms appear, which is why people spread it before they know they are ill.

How sick someone gets depends a lot on age. Many young children have no symptoms or only a mild illness, so they can quietly pass the virus to others at home or in child care. Most adults do develop symptoms, which can last for weeks, and a small number have a relapse during recovery. Older adults and people with existing liver disease have the highest risk of serious illness.

Unlike hepatitis B and C, hepatitis A never becomes a long-term infection, and recovery brings lifelong immunity. Rarely, it causes sudden liver failure. In recent years, large US outbreaks have spread person to person among people who use drugs and people experiencing homelessness, which is why vaccination is now recommended for these groups as well as for travelers and children.

Signs and symptoms

• Tiredness and loss of appetite, often the first symptoms
• Nausea, vomiting and pain in the upper right part of the belly
• Fever and joint aches
• Dark, tea-colored urine and pale or clay-colored stool
• Yellowing of the skin or the whites of the eyes (jaundice)
• Itchy skin as the illness goes on

Causes and risk factors

• Eating food or drinking water contaminated with tiny amounts of stool
• Close household or sexual contact with someone who has hepatitis A
• Travel to countries where hepatitis A is common
• Using drugs, whether injected or not
• Experiencing homelessness or unstable housing
• Men who have sex with men, and anyone with poor access to hand washing and sanitation

How it is checked

Because many infections cause similar symptoms, hepatitis A is confirmed with a blood test for a specific antibody called IgM anti-HAV, which appears early in the illness. Your doctor will also order liver function tests to see how inflamed the liver is and a clotting test to check how well the liver is working.

Doctors are required to report cases to the health department. Public health staff will ask about recent travel, food and contacts, and they may contact people you live with or have had close contact with so they can get vaccine or immune globulin in time. If you work with food, the health department will advise when you can return.

Treatment and support options

Rest and nutrition at home

There is no antiviral treatment, so care supports the liver while it heals. Rest when you are tired, eat small meals when your appetite allows, and drink enough fluids, especially if you are vomiting. Many people find they can eat more earlier in the day, when nausea is often less. Most adults recover fully over weeks to a few months.

Being careful with medicines and alcohol

An inflamed liver handles some medicines and alcohol less well. Avoid alcohol until your doctor says your liver has recovered, and check before taking acetaminophen (Tylenol), herbal products or supplements. Tell your doctor about every prescription you take, since some doses may need to change while you are ill.

Hospital care

A small number of people need hospital care because they cannot keep fluids down, become very jaundiced or show signs of liver failure such as confusion or bleeding. Specialist liver teams monitor these patients closely, and in rare cases a liver transplant is needed. Older adults and people with chronic liver disease are at the most risk.

Protecting your contacts

People you live with, have sex with or share food or drugs with may be offered the hepatitis A vaccine or immune globulin. These are most effective when given within 2 weeks of exposure. The health department or your doctor can help decide who needs which option based on their age and health.

Prevention

• Make sure children get both doses of the hepatitis A vaccine
• Ask about the vaccine if you are an adult in a higher-risk group or simply want protection
• Wash hands with soap and water after using the toilet or changing diapers and before handling food
• When traveling, drink bottled or treated water and avoid raw shellfish and unpeeled raw produce
• Do not share towels, toothbrushes, eating utensils or drug equipment

Day to day

Recovery often feels slower than people expect. Plan for several weeks of lower energy, ask for help with work and family tasks, and return to activity gradually. Keep follow-up appointments so your doctor can check that liver tests are returning to normal, and report any new yellowing or worsening symptoms, since relapses can happen.

While you are contagious, protect the people around you. Wash your hands thoroughly after using the bathroom, keep your own towel, and do not prepare food for others until your doctor or health department says it is safe. Clean bathroom surfaces regularly with a bleach-based or EPA-registered disinfectant.

For specific groups

People with chronic liver disease

If you have hepatitis B or C, fatty liver disease or cirrhosis, hepatitis A can be much more serious. Vaccination is recommended. Ask your doctor to check your vaccine record at your next visit.

International travelers

Hepatitis A is common in many parts of the world, even in high-end resorts. Vaccination is recommended before travel to these areas. One dose before departure provides good protection for most healthy travelers; finish the series later for lasting protection.

Pregnancy

The hepatitis A vaccine can be given during pregnancy when there is a risk of infection, such as travel or an outbreak. If you are exposed while pregnant, contact your provider promptly about vaccine or immune globulin.

Questions to ask your doctor

• Have I or my children had both doses of the hepatitis A vaccine?
• Do I need the vaccine because of travel, work or my health?
• I was exposed; should I get vaccine or immune globulin?
• Which pain relievers are safe while my liver is inflamed?
• When will my liver tests return to normal?
• When can I go back to work or handle food?

More questions, answered

How long does hepatitis A last?

Most people feel sick for less than 2 months, though some have symptoms that come and go for up to 6 months. Tiredness is often the last symptom to fade. Your doctor can track recovery with blood tests of liver function.

Can I get hepatitis A twice?

No. Once you recover from hepatitis A, you are protected for life. A past infection does not protect you against hepatitis B or C, which are caused by different viruses.

Is the hepatitis A vaccine safe?

Yes. It has been used widely for decades. Side effects are usually mild, such as soreness where the shot was given, headache or tiredness. Serious allergic reactions are rare.

Do I need a blood test before getting the vaccine?

Usually not. In most cases you can simply be vaccinated. Testing for immunity first is sometimes considered for people likely to have had hepatitis A in the past, such as those who grew up where it is common.

Does cooking kill the hepatitis A virus?

Thorough cooking kills it, which is why fully cooked shellfish is safer than raw. Foods that are not cooked after handling, such as salads, sandwiches and fresh fruit, are the usual route when an infected food worker spreads it.

Does hand sanitizer kill hepatitis A?

Alcohol-based sanitizer is less effective against hepatitis A than washing with soap and warm running water. Scrub for at least 20 seconds, especially after using the toilet, after changing diapers and before preparing or eating food.

Related topics

• Hepatitis B and C: What the Evidence Actually Says (Liver Health)
• The Evidence on Liver Health, Without the Hype (Digestive Health)
• Returning Traveler Illness: What Published Guidance Supports (Travel Health)
• The Evidence on Adult Vaccination, Without the Hype (Preventive Care)

Where to go next

• Hepatitis A: A Practical Checklist
• Myths About Hepatitis A, Checked Against the Guidance
• Hepatitis A — the reference entry
• Infectious Diseases: The Complete Guide
• The Evidence on Tuberculosis Basics, Without the Hype
• RSV (Respiratory Syncytial Virus): Sorting the Evidence From the Noise

When to speak to a doctor

See your doctor for yellowing of the skin or eyes, dark urine, pale stools, loss of appetite or pain on the right side of the belly. Call 911 for confusion, extreme sleepiness, vomiting blood or easy bleeding or bruising, which can signal liver failure.

Where this comes from

• CDC — Hepatitis A Basics
• CDC — Hepatitis A Vaccination

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.