Hepatitis A

Hep A | HAV |

Overview

  • Hepatitis A is an acute infection of the liver.
  • Most infections are from contaminated food or water but sexual transmission can occur, especially in men who have sex with men (MSM).
  • Does not cause chronic hepatitis, care is usually symptomatic.

Cause

Hepatitis A virus (HAV), a small single-stranded RNA virus.

Clinical presentation

Symptoms

Incubation period 15-50 days, mean of 28 days

Acute hepatitis: lethargy, nausea, fever, anorexia for a few days then jaundice, pale stools and dark urine

Usually asymptomatic in children, more severe illness in elderly and pregnant women, usually resolves in 1 month

Complications

Liver failure is rare

Diagnosis

TestSite/SpecimenConsideration
AST, ALT, bilirubin

Blood

Raised in acute hepatitis
Anti-HAV IgM

Blood

Acute HAV infection, persists for 3-6 months
Anti-HAV Ig-total

Blood

Previous infection or vaccination

AST – Aspartate aminotransferase
ALT – Alanine aminotransferase
Anti-HAV IgM – Hepatitis A virus IgM antibodies
Anti-HAV Ig-total – Total antibody count (includes IgM, IgG and IgA)

Investigations

Exclude other causes of acute hepatitis, including hepatitis B and hepatitis C.

Management

Principle treatment option
SituationRecommended
Symptomatic infection Supportive care. Hospitalisation if severe illness or clinical deterioration.

Other immediate management

  • Advise no sexual contact during the acute illness and for at least 1 week after the onset of jaundice.
  • Contact tracing
  • Provide patient with factsheet
  • Notify the state/territory health department
  • Comprehensive STI testing may be appropriate, depending on the patient’s history.

Special treatment situations

Special considerations

Consider seeking specialist advice before treating any complicated presentation.

SituationRecommended
Complicated infection Severe hepatitis may require hospital admission.
Pregnant women 
pregnancy
Seek specialist advice. Severe hepatitis can be more severe in pregnant women.

Contact tracing

  • Notifiable condition
  • Trace back 50 days from onset of symptoms
  • Infectivity for 2 weeks before the onset of jaundice to 1 week after
  • Passive immunisation with human immunoglobulin within 2 weeks of exposure and commence active vaccination course.

See Australasian Contract Tracing Manual – Hepatitis A for more information.

Follow up

Review in 1 week provides an opportunity to:

  • Confirm contact tracing procedures have been undertaken or offer more contact tracing support
  • If high risk e.g. men who have sex with men (MSM), provide further sexual health education and prevention counselling.

Auditable outcomes

  • 100% of HIV positive men who have sex with men (MSM) are vaccinated or immune
  • 100% of close contacts receive vaccination if susceptible.
Last Updated: Friday, 20 May 2016