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Hepatitis A Information

Michigan Outbreak

Hepatitis A Questions and Answers for the Public

Overview

Transmission / Exposure

Symptoms

Diagnosis / Treatment

Prevention / Vaccination

Hepatitis A Vaccine and International Travel

Overview

What is hepatitis?
Hepatitis means inflammation of the liver. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis but a virus often causes hepatitis. In the United States, the most common hepatitis viruses are hepatitis A virus, hepatitis B virus, and hepatitis C virus.

What is hepatitis A?
Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. It can range from a mild illness lasting a few weeks to a severe illness lasting several months. Although rare, hepatitis A can cause death in some people. Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person.

What is the difference between hepatitis A, hepatitis B, and hepatitis C?
Hepatitis A, hepatitis B, and hepatitis C are liver infections caused by three different viruses. Although each can cause similar symptoms, they have different modes of transmission and can affect the liver differently. Hepatitis A is usually a short-term infection and does not become chronic. Hepatitis B and hepatitis C can also begin as short-term, acute infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. There are vaccines to prevent hepatitis A and hepatitis B; however, there is no vaccine for hepatitis C.

How serious is hepatitis A?
Most people who get hepatitis A feel sick for several weeks, but they usually recover completely and do not have lasting liver damage. In rare cases, hepatitis A can cause liver failure and death; this is more common in people older than 50 and in people with other liver diseases.

How common is hepatitis A in the United States?
In 2016, there were an estimated 4,000 hepatitis A cases in the United States. Hepatitis A rates have declined by more than 95% since the hepatitis A vaccine first became available in 1995.

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Transmission / Exposure

How is hepatitis A spread?
Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. Hepatitis A can also spread from close personal contact with an infected person such as through sex or caring for someone who is ill.

Contamination of food (this can include frozen and undercooked food) by hepatitis A can happen at any point: growing, harvesting, processing, handling, and even after cooking. Contamination of food or water is more likely to occur in countries where hepatitis A is common and in areas where there are poor sanitary conditions or poor personal hygiene. In the United States, chlorination of water kills hepatitis A virus that enters the water supply. The Food and Drug Administration (FDA) routinely monitors natural bodies of water used for recreation for fecal contamination so there is no need for monitoring for hepatitis A virus specifically.

Who is at risk for hepatitis A?
Although anyone can get hepatitis A, in the United States, certain groups of people are at higher risk, such as:

  • People with direct contact with someone who has hepatitis A
  • Travelers to countries where hepatitis A is common
  • Men who have sexual contact with men
  • People who use drugs, both injection and non-injection drugs
  • Household members or caregivers of a recent adoptee from countries where hepatitis A is common
  • People with clotting factor disorders, such as hemophilia
  • People working with nonhuman primates

I think I have been exposed to hepatitis A. What should I do?
If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department. If you were recently exposed to hepatitis A virus and have not been vaccinated against hepatitis A, you might benefit from an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective if given within the first 2 weeks after exposure. A health professional can decide what is best based on your age and overall health.

What is postexposure prophylaxis (PEP)?
Postexposure prophylaxis (PEP) refers to trying to prevent or treat a disease after an exposure. For hepatitis A, postexposure prophylaxis is an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective in preventing hepatitis A if given within the first 2 weeks after exposure.

If I have had hepatitis A in the past, can I get it again?
No. Once you recover from hepatitis A, you develop antibodies that protect you from the virus for life. An antibody is a substance found in the blood that the body produces in response to a virus. Antibodies protect the body from disease by attaching to the virus and destroying it.

How long does hepatitis A virus survive outside the body?
The hepatitis A virus is able to survive outside the body for months. High temperatures, such as boiling or cooking food or liquids for at least 1 minute at 185°F (85°C), kill the virus, although freezing temperatures do not.

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Symptoms

What are the symptoms of hepatitis A?
Older children and adults typically have symptoms. If symptoms develop, they can appear abruptly and can include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay-colored stools
  • Joint pain
  • Jaundice (yellowing of the skin and eyes)
  • Most children younger than age 6 do not have symptoms when they have hepatitis A. When symptoms are present, young children typically do not have jaundice but most older children and adults with hepatitis A have jaundice.

How soon after exposure to hepatitis A will symptoms appear?
If symptoms occur, they usually start appearing 4 weeks after exposure, but can occur as early as 2 and as late as 7 weeks after exposure. Symptoms usually develop over a period of several days.

How long do hepatitis A symptoms last?
Symptoms usually last less than 2 months, although some people (10%–15%) with hepatitis A can have symptoms for as long as 6 months.

Can a person spread hepatitis A without having symptoms?
Yes. Many people, especially children, have no symptoms. In addition, a person can transmit the virus to others up to 2 weeks before symptoms appear.

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Diagnosis / Treatment

How will I know if I have hepatitis A? How is hepatitis A diagnosed?
A doctor can determine if you have hepatitis A by discussing your symptoms and taking a blood sample.

How is hepatitis A treated?
Unvaccinated people who have been exposed recently (within 2 weeks) to the hepatitis A virus should get the hepatitis A vaccine or a shot of immune globulin to prevent severe illness. To treat the symptoms of hepatitis A, doctors usually recommend rest, adequate nutrition, and fluids. Some people will need medical care in a hospital. It can take a few months before people with hepatitis A begin to feel better.

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Prevention / Vaccination

Can hepatitis A be prevented?
Yes. The best way to prevent hepatitis A is through vaccination with the hepatitis A vaccine. To get the full benefit of the hepatitis A vaccine, more than one shot is needed. The number and timing of these shots depends on the type of vaccine you are given. Practicing good hand hygiene – including thoroughly washing hands after using the bathroom, changing diapers, and before preparing or eating food – plays an important role in preventing the spread of hepatitis A.

Who should get vaccinated against hepatitis A?
The Advisory Committee on Immunization Practices (ACIP) recommends hepatitis A vaccination for the following people:

  • All children at age 1 year
  • Travelers to countries where hepatitis A is common
  • Family and caregivers of ad
  • optees from countries where hepatitis A is common
  • Men who have sexual encounters with other men
  • Users of recreational drugs, whether injected or not
  • People with chronic or long-term liver disease, including hepatitis B or hepatitis C
  • People with clotting-factor disorders
  • People with direct contact with others who have hepatitis A
  • Any person wishing to obtain immunity (protection)

How is the hepatitis A vaccine given?
The hepatitis A vaccine is safe and effective and given as 2 shots, 6 months apart. Both shots are needed for long-term protection. The hepatitis A vaccine also comes in a combination form, containing both hepatitis A and B vaccine, that can be given to anyone 18 years of age and older. This combination vaccine is given as 3 shots, over 6 months. All three shots are needed for long-term protection for both hepatitis A and B.

Is the hepatitis A vaccine effective?
Yes, the hepatitis A vaccine is highly effective in preventing hepatitis A virus infection. A second hepatitis A shot results in long-term protection.

Is the hepatitis A vaccine safe?
Yes, the hepatitis A vaccine is safe. No serious side effects have been reported from the hepatitis A vaccine. Soreness at the injection site is the most common side effect reported. As with any medicine, there is always a small risk that a serious problem could occur after someone gets the vaccine. However, the potential risks associated with hepatitis A are much greater than the potential risks associated with the hepatitis A vaccine. Since the licensure of the first hepatitis A vaccine in 1995, millions of doses of hepatitis A vaccine have been given in the United States and worldwide.

Who should not receive the hepatitis A vaccine?
People who have ever had a serious allergic reaction to the hepatitis A vaccine or who are known to be allergic to any part of the hepatitis A vaccine should not receive the vaccine. Tell your doctor if you have any severe allergies. Also, the vaccine is not licensed for use in infants under age 1 year.

What is immune globulin (IG)?
Immune globulin (IG) is a substance made from human blood plasma that contains antibodies that protect against infection. Immune globulin is a shot and provides short-term protection against hepatitis A for up to 2 months depending on the dosage given. IG is sometimes used before travel to a country where hepatitis A is common. IG is also used to prevent infection after exposure to the hepatitis A virus but must be given within 2 weeks after exposure for the best protection.

Will the hepatitis A vaccine protect me from other forms of hepatitis?
No, the hepatitis A vaccine will only protect you against hepatitis A. There is a separate vaccine available for hepatitis B. There is also a combination hepatitis A and hepatitis B vaccine that offers protection for both viruses. There is no vaccine for hepatitis C at this time.

Can hepatitis A vaccine be given to people with compromised immune systems, such as hemodialysis patients or people with AIDS?
Yes. The hepatitis A vaccine is inactivated (not “live”), so it can be given to people with compromised immune systems.

Is it harmful to have an extra dose of hepatitis A vaccine or to repeat the entire hepatitis A vaccine series?
No, getting extra doses of hepatitis A vaccine is not harmful.

What should be done if the last dose of hepatitis A vaccine is delayed? If the second dose has been delayed (more than 6 months since the first dose was given), the second, or last dose, should be given as soon as possible. The first dose does not need to be given again.

Where can I get the hepatitis A vaccine? Speak with your health professional or call your local public health department, where free or low-cost vaccines for adults may be offered. For children, check the Vaccines for Children Program.

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Hepatitis A Vaccine and International Travel

Who should get the hepatitis A vaccine before traveling internationally?
Anyone who is susceptible (unvaccinated or never had hepatitis A) and planning to travel to countries where hepatitis A is common should be vaccinated with the hepatitis A vaccine or immune globulin (IG) before traveling. Even travelers to urban areas, resorts, and luxury hotels in countries where hepatitis A is common are at high risk. Even travelers reporting that they maintained good hand hygiene and were careful about what they drank and ate have been infected when traveling to countries where hepatitis A is common. Click here for more information on international travel and HAV.

How soon before travel should I get the hepatitis A vaccine?
You should get the first dose of hepatitis A vaccine as soon as you plan international travel to a country where hepatitis A is common. Two weeks or more before departure is ideal, but getting the vaccine any time before travel will provide some protection.

For optimal protection, older adults, people who are immunocompromised, and people with chronic liver disease or other chronic medical conditions who are planning to depart in less than 2 weeks should receive the first dose of vaccine and can get a shot of immune globulin at the same time, at a separate injection site.

I’m leaving for my trip in a few days, can I still get the hepatitis A vaccine?
Experts say that the first dose of hepatitis A vaccine can be given any time before departure. This will provide some protection for most healthy people.

What should I do if I am traveling internationally but cannot receive hepatitis A vaccine?
Travelers who are allergic to a vaccine component or who are younger than 12 months should receive a single dose of immune globulin (IG). Immune globulin provides effective protection against hepatitis A virus infection for up to 2 months, depending on the dosage given. If you are staying longer than two months, you can get another dose of IG for continued protection.

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