Hepatitis A: How It Spreads, Symptoms and Who Should Get the Vaccine

Hepatitis A is one of the most common travel infections, and one of the easiest to prevent. A safe, highly effective vaccine protects you for many years. Unlike hepatitis B and C, it doesn’t cause long-term liver disease, but it can make adults very unwell for weeks.

Imagine coming home from a fantastic holiday. Three weeks later you feel exhausted, lose your appetite, and have a dull ache under your right ribs. Then your urine turns dark and the whites of your eyes look yellow. A blood test confirms hepatitis A, probably from a salad or ice cube on the trip. A vaccine at the travel clinic would almost certainly have prevented it.

How hepatitis A spreads

• Eating food or drinking water contaminated with the faeces of an infected person
• Raw or undercooked shellfish from contaminated water
• Close contact with an infected person, including in households, nurseries and some sexual contact

It’s most common where sanitation and safe water are limited, but outbreaks also happen in wealthy countries, for example from contaminated frozen berries.

Symptoms

Symptoms usually appear two to four weeks after infection. Young children often have none. Adults may have:

• Fever, tiredness and feeling generally unwell
• Loss of appetite, nausea and vomiting
• Pain in the upper right tummy
• Dark urine, pale poo and itchy skin
• Yellow skin and eyes (jaundice)

Treatment and recovery

There’s no specific medicine. Most people recover fully within a few weeks to a couple of months with rest, fluids and avoiding alcohol. Check with a doctor or pharmacist before taking any medicines, including paracetamol, because the liver is inflamed. Rarely, especially in older adults or people with existing liver disease, it can cause liver failure, so get urgent help for confusion, severe drowsiness, bleeding or bruising easily.

People are most infectious in the two weeks before symptoms start. Stay off work, school or nursery until your doctor or public health team says it’s safe, usually at least a week after jaundice begins, and don’t prepare food for others.

But who should get the vaccine?

• Travellers to countries where hepatitis A is common
• People with long-term liver disease
• Men who have sex with men, and people who inject drugs
• Some workers, such as sewage workers and some laboratory staff
• Close contacts of someone with hepatitis A, if given soon after exposure
• Children, in countries such as the US where it’s part of the routine schedule

Sources: World Health Organization (Hepatitis A fact sheet), US Centers for Disease Control and Prevention (Hepatitis A), NHS (Hepatitis A). This guide is for general information and does not replace advice from your own nurse, doctor or pharmacist.