Hepatitis A
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
Test | Site/Specimen | Consideration |
---|---|---|
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 |
Investigations
Exclude other causes of acute hepatitis, including hepatitis B and hepatitis C.
Management
Principle treatment option | |
---|---|
Situation | Recommended |
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.
Situation | Recommended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Complicated infection | Severe hepatitis may require hospital admission. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pregnant women
For more information go to the Therapeutic Goods Association's Prescribing medicines in pregnancy database and/or seek specialist advice. ![]() |
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.