After years of decline, hepatitis A outbreaks and infections have dramatically increased throughout the United States in recent years: From 2016 to 2018, the CDC reported a nearly 300% increase in HAV infections. Many of these new infections are the result of contaminated food, but there have also been increases among men who have sex with men (MSM), people who inject drugs (PWID), and those who are homeless. Hepatitis A is normally not fatal, but for individuals with pre-existing liver disease, it can lead to death. Consequently, these recent outbreaks have led to a significant number of deaths. This page is designed to give you very basic information about HAV, including ways to prevent it, so we can avoid unnecessary loss of life from a disease that is preventable with a vaccine.
What is hepatitis A?
Hepatitis A is A type of viral hepatitis. It is a virus that infects the liver, but it differs from hepatitis B (HBV) and C (HCV), in that it doesn’t become chronic: Once infected, people will likely feel symptoms for around 2 months, with some people experiencing them for as long as 6 months. Like HBV, HAV is vaccine preventable.
Hepatitis A is transmitted from fecal to oral contact—when poop (fecal matter) is inadvertently eaten. It is commonly a food-borne illness, where someone eats something that has not been properly cleaned or cooked, or the preparer hasn’t properly washed their hands, but it can also be sexually transmitted through oral to anal contact.
What are the symptoms of hepatitis A?
Once infected with HAV, it usually takes about 2–6 weeks for symptoms to develop. Whereas hepatitis B and C are usually asymptomatic (no symptoms), hepatitis A almost always has symptoms, some that can feel quite severe:
• Jaundice (yellowing of skin and eyes)
• Fever
• Fatigue
• Loss of appetite
• Nausea and/or vomiting
• Abdominal pain
• Joint pain
• Dark urine
• Clay-colored stools (shit or poop)
These symptoms can last 2–3 months, with some people experiencing them as long as 6 months. There is no treatment for hep A to get rid of these symptoms, but there are ways to help manage them. Don’t take any medications—either over-the-counter or prescribed—to deal with your symptoms without consulting your medical provider. You don’t want to put any added pressure on your liver, and some medications can do that.
How is hepatitis A prevented?
There are two ways to absolutely prevent HAV: Get vaccinated or do post-exposure prophylaxis after getting exposed to it (if you have not been vaccinated).
The HAV vaccine is a safe and effective way to prevent infection. The vaccine is a two-shot sequence—and you need them both to ensure long-lasting protection: You get the first shot, and then followup with the second one 6 months later. Depending upon the brand of vaccine used, the second dose can be given as long as 12–18 months after the first one.
There are also vaccines that prevent both HAV and HBV.
If a person misses the vaccination within the allotted time period, it’s safe to start over as extra doses are not harmful. The HAV vaccine is safe for people living with HIV, as well as those with HBV or HCV. Indeed, people living with any of these infections should be vaccinated against HAV.
If you have not been vaccinated, but think you’ve been exposed, call your medical provider immediately. You can get immune globulin (a medication) or the HAV vaccine. It has to be administered within the first two weeks of an exposure.
Other ways to prevent HAV include good hand washing, thoroughly cooking food, and boiling water (note, drinking water in the U.S. is treated to kill HAV), and minimizing oral-to-fecal contact during sex.
Once a person has been infected with HAV, they will have natural immunity and will not need to worry about future infections.
Who should get vaccinated?
In the U.S., all children have been vaccinated since 2005. Some states started earlier. There are no recommendations to vaccinate all adults, so don’t assume that you’ve gotten the vaccine at a later date. The following people should get vaccinated against HAV:
• All children at age 1 year
• People traveling to countries where hepatitis A is common
• Family and caregivers of adoptees from countries where hepatitis A is common
• Men who have sex with men
• People who use drugs, either injected or non-injected
• Homeless persons
• People with chronic or long-term liver disease, including hepatitis B or hepatitis C
• People living with HIV
• People with clotting-factor disorders
• People with direct contact with others who have hepatitis A
• Any person wishing to obtain protection from the virus
Hepatitis A is a preventable disease. Don’t assume you’ve been vaccinated: Talk with a medical provider to determine if you need to be vaccinated.
FOR MORE INFORMATION, check out the CDC’s website on hepatitis A: cdc.gov/hepatitis/hav/afaq.htm.