Hep A | HAV |
- 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.
Hepatitis A virus (HAV), a small single-stranded RNA virus.
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
Liver failure is rare
|AST, ALT, bilirubin
|Raised in acute hepatitis
|Acute HAV infection, persists for 3-6 months
|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)
Exclude other causes of acute hepatitis, including hepatitis B and hepatitis C.
|Principle treatment option|
||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
Consider seeking specialist advice before treating any complicated presentation.
||Severe hepatitis may require hospital admission.
||Seek specialist advice. Severe hepatitis can be more severe in pregnant women.
- 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.
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.
- 100% of HIV positive men who have sex with men (MSM) are vaccinated or immune
- 100% of close contacts receive vaccination if susceptible.