Hepatitis A

Hepatitis A is a virus that infects the liver. The virus causes inflammation of the liver (hepatitis). Each year in the United States about 8,500 people become infected with hepatitis A virus, many of whom are children. Anyone can become infected with hepatitis A virus infection.

Typically, the virus is spread in households from person to person (horizontal transmission), and from contaminated food and water. Infected people excrete the virus in their stools (poop). When people come in contact with infected stool and do not wash their hands properly with soap and water, they can become infected.

Children can spread the gastrointestinal (GI) virus unsuspectingly from poor hand-washing. The virus can even survive on toys and be passed from child to child.

The virus is easily spread in areas that have poor sanitation or poor personal hygiene. In the U.S., hepatitis A virus is relatively uncommon because the water and sewage treatment facilities in this country are effective in killing most hepatitis A virus that may enter the water supply. However, many countries in the world do not have effective facilities to kill the virus. As a result, many people contract the infection.

If you or your child is traveling to areas in the world where there is a high prevalence of hepatitis A infection, you should take proper precautions — such as receiving the hepatitis A vaccine — before traveling.

Often, people who are infected with hepatitis A will not have any symptoms. Those who do have symptoms of infection may develop them over a period of several days.

Symptoms may include:

• Yellowing of the eyes and skin (jaundice)
• Loss of appetite
• Tiredness
• Dark urine
• Nausea
• Stomachache
• Vomiting

A person can contract the virus but not develop symptoms for almost 30 days. This is referred to as the incubation period. A person infected with hepatitis A virus can spread the virus to another person about one week before symptoms appear and while symptoms are present. Infected people without any symptoms can also transmit the virus. It is thought that children are less likely to develop symptoms as compared to adults.

If your child becomes infected with hepatitis A, he or she will experience an acute (short-term) infection. Unlike hepatitis B or C, hepatitis A virus does not cause long-term (chronic) infection and liver damage, like cirrhosis or liver cancer.

If your child becomes infected with hepatitis A virus after recovering from the infection, your child's body will produce antibodies which provide lifelong immunity to hepatitis A virus. Therefore your child cannot become re-infected with the hepatitis A virus.

Your child's doctor will confirm whether your child is or was infected with the hepatitis A virus by obtaining a blood sample for laboratory evaluation. The doctor will check to see if your child has the IgM antibody to hepatitis A (anti-HAV) positive, or will try to figure out if your child had contact with someone who has a confirmed diagnosis of hepatitis A virus infection.

There is no specific treatment for hepatitis A. Your child’s body will clear up the infection on its own. In most cases, your child’s liver will heal completely within a month or two, with no long-term damage.

Hepatitis A treatment generally focuses on dealing with side-effects of the infection, including:

• Rest more frequently. Many children with hepatitis A will have less energy as their bodies are fighting the infection. It may be more difficult to complete daily tasks. Encourage your child to rest when she needs to.
• Find ways to cope with nausea. Many children with hepatitis A feel queasy or may not be able to eat three large meals a day. Encourage your child to eat smaller portions more frequently through the day to get enough calories and maintain her energy level.
• Discuss medications and supplements with your child’s doctor. Your child’s liver will have difficulty processing medications, over-the-counter drugs and supplements as her body is fighting the hepatitis A infection. Your child’s doctor may recommend changing or stopping some medications until the injection is over.

It is important to encourage your child to always wash her hands with soap and water after using the bathroom, before preparing food and before eating food. You should also wash your hands after changing a diaper. Good personal hygiene and proper sanitation help prevent the spread of the virus. Learn how to properly clean your hands.

A vaccine is available that provides long-term protection against hepatitis A virus infection. The vaccine is administered in two shots, or three shots if administered with the hepatitis B vaccine.

The current recommendation from the U.S. Centers for Disease Control and Prevention is for all children to receive the first hepatitis A vaccine shot between 12 and 23 months of age, and the second shot six to 12 months later.

If you have questions about the hepatitis A vaccine, or if your child has not yet received the vaccine, please talk with your child's pediatrician.

Learn more about the hepatitis A vaccine at CHOP's Vaccine Education Center.