Hepatitis A
hepatitis; A; hepatitis-A; infectious; jaundice; immunise; immunisation; vaccine; vaccination; diseases ;
Contents
Five viruses are known which cause hepatitis (infection of the liver) as their main effect. They are called Hepatitis A, B, C, D, and E. Many other viruses can cause hepatitis as part of other illnesses.
What is hepatitis A?
- The hepatitis A virus causes an infection of the liver. Hepatitis A infections cause illness in every country of the world.
How does it spread?
- The virus grows within the liver, and passes into the intestine.
- The main way it is spread is through poo (faeces), when the poo gets onto the hands of other people, and then is moved from hands to mouth.
- It is often spread through contaminated water, or sometimes food (when poo gets into the water supply or onto food).
- In developing countries with poor hygiene and sanitation, hepatitis A is very common, with most people having it before the age of five, and then becoming immune to it.
- Hepatitis A is not a sexually transmitted infection.
Who is at risk?
- In countries such as Australia, where there is clean water and good management of waste, less than 30% of adults have been infected by hepatitis A.
- This means that when Australians go as travellers to developing countries (where virtually all people have hepatitis A in childhood), and which do not have reliable water and sanitation, they are at relatively high risk of getting hepatitis A.
- There are also other groups of people at increased risk including people living in remote areas (especially north Queensland), aboriginal communities without reliable water and sanitation, people who live in areas where there is flooding, injecting drug users, men who have sex with men, child care workers, residents and workers in institutional care, and plumbers.
- Having hepatitis A, even without symptoms, protects the person for life.
How long it takes to develop
- It takes from 15 to 40 days, (average 28 days) for hepatitis A to develop after the person has been in contact with the virus.
How long is it infectious?
- The person is most infectious in the 2 weeks before the jaundice appears. The virus is in their faeces.
- The person is mildly infectious during the first week of the jaundice and is usually no longer infectious a week after the jaundice appears.
Signs and symptoms
- Symptoms can appear suddenly or slowly.
- Common early symptoms include loss of appetite, feeling sick, vomiting, abdominal pains and mild fever.
- Many children have an infection without showing any signs of being unwell.
- Jaundice (yellowing of the skin and eyes) occurs in at least 75% of adults, but in only 5% of children under 4 years of age, and less than 10% of children aged 4 to 6 years. Children and adults who do not get jaundice can still pass the virus on to other people (be contagious).
- People can also have swelling of the liver, dark wee (urine) and pale coloured poo.
- Jaundice and other symptoms can last from 1 to 10 weeks, but most people are becoming well by 4 weeks after the jaundice appeared.
- Most people will recover fully within 6 weeks, and the rest by 6 months.
- There is a slight risk of serious illness, usually in people over 50 years, but deaths are very rare.
- Three months after the beginning of the illness, the liver is almost always completely back to normal. Hepatitis A never causes lasting liver disease.
- Having the infection gives the person immunity for life. (A few people get several episodes of jaundice and feeling unwell over the few months after the illness starts to happen, but this is unusual.)
What you can do
- There is no specific treatment for hepatitis A.
- Rest and extra drinks are important.
- Some medicines that the person usually takes may need to be changed because hepatitis A may affect how the liver acts on the medicine (check this with your doctor).
- Avoid alcohol.
- A few people may need to go to hospital if the sickness and vomiting make it difficult for them to eat and drink.
The topic 'Feeling sick' has suggestions for caring for a sick child.
Preventing the spread of hepatitis A
- Children, especially those who are not fully toilet trained, should be kept away from child care or preschool for a week after the jaundice appears.
- Since most young children with hepatitis A do not get jaundice, and many have no signs of the infection, or may be only mildly unwell, keeping children who are jaundiced out of child care is important, but it will not be enough to prevent the spread of hepatitis A at child care or preschool.
- Careful hygiene practices must always be followed at child care in particular. If a child has an infection (not only hepatitis A) which is not causing the child to be unwell, it can still be passed on to staff and make them unwell, or spread from one child to another, and then to the adults and older children of another family.
- In South Australia it is recommended that older children and adults are also excluded for a week after becoming jaundiced, although other sources suggest this is not needed because adults and older children are able to follow hygiene guidelines.
- Any person who handles food should always be very strict about hand washing and other hygiene practices, such as cleaning surfaces and cutlery.
Immunisation
- Immunisation against hepatitis A is a very effective way of protecting people from infection. The vaccine contains viruses which have been killed by formaldehyde.
- A single dose of the vaccine will begin to give effective protection from about 2 weeks after the dose, and this protection lasts about 12 months. A second dose 6 to 18 months after the first dose will give long term protection (at least 10 years).
- Because hepatitis A is not common in Australia, the vaccine is not recommended for all Australians, but it is recommended for specific groups (the vaccine may not be free for people in these groups).
- Travellers from low risk areas (most of Australia) to high risk areas (which means virtually to all developing countries). Hepatitis A occurs throughout the world, but the risk is highest in areas where there is not a safe water supply.
- All Aboriginal and Torres Strait Islander children in north Queensland between 18 months and 6 years, and people working in rural and remote Indigenous communities.
- Child care and pre-school workers who are likely to come in contact with hepatitis A in their work place. The NHMRC recommend that this immunisation is a standard occupational health practice.
- Care providers in institutional care, and disabled people.
- Health care workers (even though they still need to practice strict infection control procedures).
- Sewerage workers
- Men who have sex with men.
- Injecting drug users.
- People with chronic liver disease.
- People with haemophilia who may need blood products.
- Groups of people at special risk (eg in areas which have been flooded).
Note: if immediate protection is needed - eg for an unplanned visit to a high risk area, or to control an outbreak - immunoglobulin may be given, but this does not give long lasting protection. Immunisation with the hepatitis A vaccine is usually given at the same time.
Protecting your family from hepatitis A
- Person-to-person is the usual way hepatitis A is spread.
- Personal cleanliness is important, including hand washing before food preparation and eating.
- A safe water supply and sewerage system are vital.
- Outbreaks have occurred from raw shellfish which have been in contact with the virus.
Travel advice
For information about health risks and recommended immunisations when travelling, see:
Center for Disease Control and Prevention (USA):
http://www.cdc.gov/ncidod/diseases/hepatitis/a/index.htm
Emmick J. 'Hepatitis A', in Mosby's Pediatric Clinical Advisor, Mosby 2002.
Immunise Australia Internet site:
http://www.immunise.health.gov.au/
NHMRC. 'The Australian Immunisation Handbook, 9th Ed', 2008:
South Australian Department of Health, 'Hepatitis A':
http://www.dh.sa.gov.au/pehs/ygw/hepa-pehs-sahealth-2009.pdf
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your
child's sex.