Hepatitis A

What does the liver do?

The liver is in the upper right part of the abdomen. It has many functions which include:

• 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 medicines.
• Helping to remove or process alcohol, poisons and toxins from the body.
• Making bile which passes from the liver to the gut and helps to digest fats.

What is hepatitis and hepatitis A?

Hepatitis means inflammation of the liver. There are many causes of hepatitis, some more serious than others. For example, alcohol excess and several different viruses can cause hepatitis. One type of virus which causes hepatitis is called the hepatitis A virus. This leaflet is only about hepatitis A. See other leaflets for information about hepatitis B and C which are different.

Who gets hepatitis A and how common is it?

Anyone at any age can develop hepatitis A. The virus is passed out in the faeces (motions). In areas of poor sanitation and poor water supplies, hepatitis A can become common due to contaminated water and food. For example, you may become infected with the virus by eating uncooked food prepared or washed in contaminated water, or by drinking contaminated water. Shellfish caught in contaminated water can carry the hepatitis A virus. The highest risk areas of the world include: Africa, Asia, and 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 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.

The incubation period is 2-6 weeks. This means that it takes 2-6 weeks to develop symptoms after first being infected. (However, during this time you will be passing out the virus in your faeces, and so can infect others 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.
• 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 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.

A blood test can confirm the diagnosis. 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.

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?

• Immunisation. This is recommended before traveling to certain countries where it 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 leaflet called 'Hepatitis A immunisation' for details.
• Avoid the following when traveling 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?

No specific treatment is available. The immune system will usually clear away the infection. Bedrest whilst feeling ill is traditionally recommended, but whether it hastens recovery is not proven. Avoiding fatty foods may help to reduce the feeling of sickness. Do not drink alcohol whilst you are ill. Try not to pass the virus on to others. That is, have good hygiene including washing your hands after using the toilet. Also, whilst ill with this infection it is sensible not to share towels, flannels and cups, and not to kiss anyone.

© EMIS and PIP 2005   Updated: June 2006

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest.

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