Hepatitis A

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 24 Jul 2025

Last updated: 20 May 2025

Hepatitis A is one of the most frequently reported infectious diseases in the US.

Hepatitis A is not a chronic disease.

Transmission usually precedes symptoms by 2 weeks, but can be up to 7 weeks, when stool viral concentrations are highest. Patients are considered noninfectious 1 week after onset of jaundice.

Symptomatic patients may present with abrupt-onset fever, abdominal pain, malaise, jaundice, dark urine or light-colored stools, or diarrhea.

Immunoglobulin M antihepatitis A virus test should be ordered when a patient is symptomatic or hepatitis A virus (HAV) virus is suspected.

Common exam findings are hepatomegaly and clinical jaundice with marked elevation of serum aminotransferases (usually >1000 units/L).

No specific therapy is available, and treatment is usually supportive.

Postexposure prophylaxis may be with active or passive immunization, depending on specific patient factors, and according to individual national guidelines.

Definition

HAV is an RNA virus. Mode of transmission is fecal-oral. Most infections in adults and older children are symptomatic; 70% develop jaundice. The majority of infections in children younger than 6 years are asymptomatic.[1] Average incubation period is 28 days (range 15-50 days).[1]

Unlike hepatitis B and C infections, hepatitis A infection is not associated with chronic liver disease.[1][2]

História e exame físico

Principais fatores diagnósticos

fever
malaise
nausea and vomiting
jaundice
hepatomegaly
right upper quadrant pain
clay-colored stools

Detalhes completos

Outros fatores diagnósticos

fatigue
headache
dark urine
pruritus
arthralgias and myalgias
cough
diarrhea
constipation
splenomegaly
posterior cervical lymphadenopathy
evanescent rash
bradycardia

Detalhes completos

Fatores de risco

living in endemic region
travel to endemic region
close personal contact with an infected person
men who have sex with men
known foodborne outbreak
illegal drug use
homelessness
occupational exposure

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

serum aminotransferases
serum bilirubin
BUN
serum creatinine
prothrombin time
immunoglobulin M (IgM) antihepatitis A virus (HAV)

Detalhes completos

Investigações a serem consideradas

immunoglobulin G (IgG) antihepatitis A virus (HAV)
hepatitis A virus RNA detection

Detalhes completos

Algoritmo de tratamento

Inicial

unvaccinated people with recent exposure to hepatitis A (<2 weeks)

AGUDA

confirmed hepatitis A

Colaboradores

Autores

Doan Y Dao, MD

Assistant Professor of Medicine

Director, Center of Excellence for Liver Disease in Vietnam

Johns Hopkins School of Medicine

Department of Medicine

Division of GI and Hepatology

Baltimore MD

Declarações

DYD receives grants from Roche Diagnostics International Ltd and Gilead Sciences.

Agradecimentos

Dr Doan Dao would like to gratefully acknowledge Dr Musaddiq Waheed and the late Dr Fida A. Khan, the previous contributors to this topic.

Declarações

MW and FAK declared that they have no competing interests.

Revisores

Howard J. Worman, MD

Professor of Medicine and Cell Biology

Columbia University College of Physicians and Surgeons

New York

Declarações

HJW declares that he has no competing interests.

Srikrishna Nagri, MD

Gastroenterologist

Dartmouth-Hitchcock Nashua

Nashua

Declarações

SN declares that he has no competing interests.

George Y. Wu, MD, PhD

Professor of Medicine

University of Connecticut Health Center

Farmington

Declarações

GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.

Kittichai Promrat, MD

Assistant Professor

Division of Gastroenterology

Department of Medicine

Brown University

Declarações

KP declares that he has no competing interests.

Pierre Van Damme, MD, PhD

Professor

Director of Vaccine & Infectious Disease Institute

University of Antwerp

Antwerp

Belgium

Declarações

PVD has been and still is principal investigator of vaccine trials for several vaccine manufacturing companies, from which the university obtained and obtains research contracts and funds for conducting such vaccine trials.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Centers for Disease Control and Prevention. Hepatitis A. [internet publication].Texto completo

Kemmer NM, Miskovsky EP. Hepatitis A. Infect Dis Clin North Am. 2000 Sep;14(3):605-15. Resumo

Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Acute hepatitis B
- Hepatitis E
- Acute hepatitis C
Mais Diagnósticos diferenciais
Diretrizes
- Hepatitis A
- Child and adolescent immunization schedule by age: recommendations for ages 18 years or younger, United States, 2025
Mais Diretrizes
Conectar-se ou assinar para acessar todo o BMJ Best Practice

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Hepatitis A

Summary

Definition

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

unvaccinated people with recent exposure to hepatitis A (<2 weeks)

confirmed hepatitis A

Colaboradores

Autores

Doan Y Dao, MD

Declarações

Agradecimentos

Declarações

Revisores

Howard J. Worman, MD

Declarações

Srikrishna Nagri, MD

Declarações

George Y. Wu, MD, PhD

Declarações

Kittichai Promrat, MD

Declarações

Pierre Van Damme, MD, PhD

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice