Summary

• Transmission primarily occurs via faecal-oral route.
• After ingestion and absorption, the virus replicates in the liver and is excreted in bile, reaching extremely high concentrations in the stool.
• Transmission usually precedes symptoms by 2 weeks when stool concentrations are highest. Patients are considered non-infectious 1 week after onset of jaundice.
• Symptomatic patients may present with abrupt-onset fever, abdominal pain, malaise, and jaundice. Common examination findings are hepatomegaly and clinical jaundice with marked elevation of serum transaminases (usually >1000 units/L). IgM anti-hepatitis A virus serology is the test of choice for diagnosis.
• No specific therapy is available and treatment is supportive. Personal hygiene is the key to prevention. Post-exposure prophylaxis may be with active or passive immunisation, depending on specific patient factors, and according to individual national guidelines.