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

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 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
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

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.