Hepatitis A

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

Situation	Recommended
Complicated infection	Severe hepatitis may require hospital admission.
Pregnant women  Aciclovir B3 Hydrocortisone A Amoxycillin A Imiquimod B1 Azithromycin B1 Itraconazole B3 Benzathine Penicillin A Ivermectin B3 Bioallethrin B2 Lignocaine A Cefotaxime B1 Metronidazole B2 Ceftriaxone B1 Permethrin B2 Ciprofloxacin B3 Piperonyl butoxide  B3 Clindamycin A Podophyllotoxin D Clotrimazole A Probenecid B2  Doxycycline D Procaine Penicillin  A Erythromycin A Tinidazole B3 Famciclovir B1 Valaciclovir B3 Fluconazole D     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.