Hepatitis A: What you need to know about symptoms and treatment

In extreme conditions — hostilities, frequent displacement, lack of stable access to clean water — the human body becomes especially vulnerable. It is then that diseases that we have almost forgotten about return. Hepatitis A is one of them. It was also called "disease of dirty hands", and today this infection is once again a threat. Despite its relatively mild course, the virus seriously affects the body and requires attention. How to recognize hepatitis A and protect yourself from it — we will tell you further.

Anastasiya Lishnevska, an infectious disease specialist, immunologist, candidate of medical sciences, and founder of the “House of Immunity and Prevention of Infectious Diseases,” provided a comment for the article.

Anastasia Lishnevska

infectious disease specialist

• immunologist
• Candidate of Medical Sciences
• founder of the "House of Immunity and Prevention of Infectious Diseases"

What is hepatitis A, and how is it different from other types of viruses?

Hepatitis A is an acute viral infection caused by the hepatitis A virus of the Picornaviridae family. Unlike hepatitis B and C, HAV does not cause chronic hepatitis, but it affects the liver and can lead to a fulminant, severe course and/or complications. It is transmitted by the fecal-oral route, and after infection, a person acquires lifelong immunity.

How is hepatitis A transmitted?

The hepatitis A virus is transmitted through the following routes:

• direct contact with a sick person (household or sexual),
• contaminated water, products, or surfaces (the virus survives on them for a long time),
• unwashed hands. That is, we can say, the fecal-oral way.

The virus can remain infectious:

• on hands—up to several hours,
• on food—several days,
• in feces, frozen products—up to several months.

This makes infection very likely if hygiene is not observed, especially in places with poor sanitation.

What are the symptoms of hepatitis A? How to distinguish it from a cold or poisoning?

Hepatitis A in adults causes symptomatic disease in 70% or more cases, and is characterized by the sudden onset of anorexia, nausea, vomiting, fever, and abdominal pain. After 1–2 days—dark urine, light stool; later—jaundice and itching (in 40–70%).

In 80%—hepatomegaly, arthralgias, rashes, and splenomegaly are also possible.

• Hepatomegaly — liver enlargement, is the main sign of liver damage.
• Arthralgias — joint pain without signs of inflammation. It may appear in the early stages of the disease.
• Rashes — skin manifestations (spots, papules), which may accompany the immune response to the virus.
• Splenomegaly — spleen enlargement. It occurs less frequently, but is possible with a complicated or severe course.

These symptoms indicate a systemic reaction of the body to a viral infection, in particular, an immune response to the hepatitis virus.

Unlike a cold, there are no symptoms from the respiratory system (runny nose, cough, etc.). Unlike poisoning — jaundice, biochemical changes in liver enzymes, prolonged course.

How long is the incubation period, and when do the first signs appear?

The incubation period is an average of 28 days (range 15 to 50 days).

The first symptoms (anorexia, nausea, fever) appear towards the end of the incubation period.

The patient becomes contagious 2–3 weeks before the onset of symptoms, and remains contagious for about a week after the onset of jaundice.

How is viral hepatitis A confirmed?

Main diagnostic criteria:

Symptoms: jaundice, general weakness, abdominal pain.

Blood biochemistry:

• ALT >1000 IU/l,
• increased bilirubin,
• increased alkaline phosphatase.

Serology:

• IgM to HAV—confirms acute infection (appears with the onset of symptoms, persists for up to 6 months).
• IgG—appears later, indicates a previous disease or vaccination.

There is a PCR method for hepatitis A virus RNA in feces, although this method is not approved by some professional organizations.

What is the treatment for hepatitis A?

There are no effective antiviral drugs, so treatment is mostly symptomatic. It is worth avoiding drugs that can strain the liver and limit physical activity. In case of a sudden and severe course, immediate hospitalization is necessary.

85% of patients recover completely in 2–3 months, almost 100%—up to 6 months. Relapses may occur, but they are short-lived, the infection does not become chronic, although it can lead to complications.

Is it worth getting vaccinated during an outbreak?

Yes, vaccination is the main and most effective means of protection against hepatitis A. It is best to get vaccinated in advance, before the outbreak begins, but during an outbreak, it also makes sense and can stop the deterioration of the infection.

Vaccination schemes:

Inactivated hepatitis A vaccine (e.g., Havrix): 2 doses.

• For children—720 U,
• for adults—1440 U.

Combined hepatitis A and B vaccine (Twinrix): 3 doses.

⚠️ Consult an infectious disease physician about vaccination, and if there are any doubts about the effect of the vaccine on immunity, consult an immunologist-infectious disease specialist.

Features during an outbreak:

• The vaccine can be administered even after contact with a patient, if no more than 14 days have passed.
• Vaccination is carried out in high-risk areas—kindergartens, schools, and groups.
• For people over 40 years of age, as well as people with liver diseases or weakened immunity, combined protection is recommended: vaccine + immunoglobulin (in different parts of the body).

What are the most effective prevention measures right now?

1. Vaccination:

• The most reliable method of prevention.
• Provides long-term immunity (over 20 years).

2. Hygiene:

• Washing hands thoroughly after using the toilet and before eating.
• Thermal processing of food products (HAV virus dies at a temperature >85 °C for 1 minute).
• Avoiding raw water and products in regions with low sanitary standards.
• Disinfecting surfaces, in particular with a 1:100 chlorine solution.

What to do after contact with a patient with hepatitis A?

Post-exposure prophylaxis is recommended for the following categories:

• If there has been close household or sexual contact with a laboratory-confirmed case of hepatitis A.
• In kindergartens, if there is ≥1 case of hepatitis A in children/staff or ≥2 cases in families.
• For food workers who work with raw foods.

⚠️ Post-exposure prophylaxis is not required if there was a single case of hepatitis A in a school, office, or hospital, if there is no close contact. In such situations, compliance with hygiene standards is sufficient.

Hepatitis A is a preventable disease. Simple hygiene measures, careful attention to the quality of water and food, and most importantly — vaccination — reliably protect against this infection. Don’t wait for symptoms to appear—take care of yourself and your loved ones today.