Hepatitis A

What does the liver do?

• Storing glycogen (fuel for the body) which is made from sugars. When required, glycogen is broken down into glucose which is released into the bloodstream.
• Helping to process fats and proteins from digested food.
• Making proteins that are essential for blood to clot (clotting factors).
• Processing many medicines which you may take.
• Helping to remove or process alcohol, poisons and toxins from the body.
• Making bile which passes from the liver to the gut down the bile duct. Bile breaks down the fats in food so that they can be absorbed from the bowel.

What is hepatitis and hepatitis A?

Hepatitis means inflammation of the liver. For example, drinking too much alcohol, various drugs and chemicals, and also several different viruses can cause hepatitis. One virus that causes hepatitis is called the hepatitis A virus. This leaflet is only about hepatitis A. For more information see separate leaflets called 'Hepatitis B' and 'Hepatitis C', which are caused by different viruses.

Hepatitis A is a virus which is carried in the bloodstream to the liver. It can then affect your liver to cause hepatitis.

Who gets hepatitis A and how common is it?

Hepatitis A can affect anyone. The virus is passed out in faeces (motions) of infected people. In areas of poor sanitation, hepatitis A can become common due to contaminated water and food. This means you may become infected by eating uncooked food prepared or washed in contaminated water or by drinking contaminated water. Shellfish caught in contaminated water can also carry the hepatitis A virus. The highest risk areas of the world include: Africa, Asia, parts of eastern Europe and parts of the middle East.

Hepatitis A has become uncommon in parts of the world where sanitation is generally good, such as the UK. However, outbreaks in schools and families can sometimes occur in the UK as the virus is quite easily passed on from person to person if personal hygiene is not good. For example, if infected people do not wash their hands after going to the toilet.

What are the symptoms of hepatitis A?

Symptoms may develop shortly after you first become infected with the virus (within 2-6 weeks, which is the 'incubation period'). Some people, particularly young children, may only have a mild illness.

You may not know you are infected during the incubation period. However, you can pass on the virus to others in this time if your standard of hygiene is not good. For example, if you do not wash your hands after going to the toilet, and then prepare food.

Following the incubation period, symptoms that may develop include:

• Flu-like symptoms. For example fever, general aches and headaches. These are the most common symptoms.
• Tiredness, feeling sick, sometimes vomiting and diarrhoea.
• Jaundice. This is a yellow colour of the skin and whites of the eyes. This may turn the urine dark and the faeces a pale colour. This is due to pigments in the blood not being properly cleared by the inflamed liver. Jaundice can cause itching.
• An ache over the liver (the upper part of the right side of the abdomen below the ribs).

The length of the illness is variable. The flu-like symptoms usually last a week or so with the jaundice then gradually fading. A feeling of tiredness may last a few weeks. Most people fully recover. In a very small number of people the illness can be more severe and last longer. Complications are rare (see below).

In some cases the infection causes only mild symptoms, and no jaundice. In some cases, no symptoms at all develop (a subclinical infection).

Hepatitis A infection does not become persistent (chronic). This is unlike some other forms of hepatitis such as hepatitis B and C which can cause a chronic (persistent) infection of the liver.

How is hepatitis A diagnosed?

A simple blood test can detect if you are infected with the hepatitis A virus. The test detects an antibody against the virus which you make when you are first infected.

A different antibody persists long-term after the infection has cleared. This antibody keeps you immune from future infection. A blood test can detect this second antibody which shows if you have had hepatitis A in the past, and that you are now immune.

You may also have other blood tests called liver function tests. These measure the activity of enzymes (chemicals) and other substances made in the liver. This gives a general guide as to whether the liver is inflamed, and how well it is working. See separate leaflet called 'Blood Test - Liver Function Tests'.

Are there any possible complications?

Serious illness is rare with hepatitis A infection. The illness can be unpleasant and make you feel quite ill, but most people make a full recovery.

However, in a small number of cases, the infection can cause severe liver inflammation leading to liver failure. This is more common in older people who develop this infection. A small number of people die from severe hepatitis A infection. A liver transplant can be life-saving if liver failure develops.

How can I prevent catching hepatitis A?

You can avoid catching hepatitis A by:

• Immunisation. This is recommended before travelling to certain countries where hepatitis A is common. See your doctor or practice nurse 4-6 weeks before the date of travel. Also, immunisation is sometimes advised for contacts of people who develop the illness and in certain other circumstances. See separate leaflet called 'Hepatitis A Immunisation' for details.
• Avoid eating and drinking the following when travelling to high risk countries: raw or inadequately cooked shellfish, raw salads and vegetables, untreated drinking water, ice cubes made from untreated water and unpasteurised milk.

What is the treatment for hepatitis A?

There is no specific treatment for hepatitis A. It is usually a self-limiting illness which means it usually goes away on its own. The immune system will usually clear away the infection. It is common to feel more tired that usual when you have hepatitis A so you may need to have plenty of rest.

Avoiding fatty foods may help to reduce the feeling of sickness. You should not drink alcohol whilst you are ill. It is important to have excellent personal hygiene to reduce the risk of passing the virus on to others. You should also avoid handling food and having unprotected sex when you are infected with the virus.

You will be immune from further bouts of hepatitis A once you have recovered from an infection with this virus.

Further help and information

British Liver Trust

2 Southampton Road, Ringwood BH24 1HY
Tel: 0800 652 7330 Web: www.britishlivertrust.org.uk