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JAMA Patient Page
December 19, 2017

Hepatitis A

JAMA. 2017;318(23):2393. doi:10.1001/jama.2017.17244

Hepatitis A is an infection that causes inflammation of the liver.

This disease is caused by the hepatitis A virus (HAV). This virus can be transmitted (passed on to other people) through contact with the feces of people infected with HAV. Transmission can occur from directly touching feces or by consuming food or water that has been contaminated by fecal matter.

Common symptoms of hepatitis A infection include fever, fatigue, abdominal pain, nausea, vomiting, and jaundice (yellowing of the skin and eyes). Symptoms usually appear 2 to 6 weeks after exposure. Blood tests can show inflammation of the liver. Some people have mild symptoms or no symptoms and may not even realize they are ill.

There is no special treatment for this infection and symptoms usually go away within 2 months. Once someone has had this infection, the body produces antibodies that prevent reinfection. In rare cases, hepatitis A infection can lead to liver failure, especially in people who have other reasons for liver disease.

Outbreaks

Hepatitis A has been spread through numerous outbreaks, especially related to contaminated fruits and vegetables both fresh and frozen. Hepatitis A virus can survive on the surface of produce and is not killed unless food is heated to at least 185°F (85°C) for 1-2 minutes. Hepatitis A can also be spread through sexual activity (particularly in men who have sex with other men) and is associated with injection drug use. Some large outbreaks of HAV infection have recently been reported among homeless people in the United States.

Prevention

The most important way to prevent hepatitis A is to get vaccinated. Vaccination is recommended for all children at age 1 year and for people at high risk of hepatitis infection (including people who travel frequently to countries where HAV is common). Men who have sex with men, those who use injection drugs, and people with other forms of liver disease should also be vaccinated.

There are 2 forms of vaccine to protect people from hepatitis A infection. One vaccine protects against hepatitis A only and should be given as 2 injections at least 6 months apart. A second vaccine prevents infection with both HAV and hepatitis B virus, another virus that also causes liver inflammation. This vaccine needs to be given as 3 injections over a period of 6 months. Hepatitis A vaccine can also be given to patients who have been exposed to HAV to prevent infection if done within 2 weeks of exposure to the virus.

Another type of medication given by injection, immune globulin (a substance made from human plasma containing antibodies to disease), is sometimes used along with hepatitis A vaccine in patients with certain medical conditions (for example, compromised immune system, liver disease) who are traveling within 2 weeks. Immune globulin can be considered in travelers who cannot get the hepatitis A vaccine either because they are too young or are allergic to components of the vaccine.

Regardless of vaccination status, everyone should wash their hands often to help prevent hepatitis A.

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The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Article Information

Published Online: November 1, 2017. doi:10.1001/jama.2017.17244

Conflict of Interest Disclosures: Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: Viral hepatitis. Centers for Disease Control and Prevention website. https://www.cdc.gov/hepatitis/hav/index.htm. Accessed October 20, 2017.

Topic: Infectious Diseases

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