Hepatitis A

Last reviewed: 21 Apr 2022

Last updated: 19 May 2022

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

Transmission usually precedes symptoms by 2 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, and jaundice.

Immunoglobulin M anti-hepatitis A virus serology is the test of choice for diagnosis.

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 supportive.

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

Definition

Hepatitis A virus (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.[1]

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

History and exam

Key diagnostic factors

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

More key diagnostic factors

Other diagnostic factors

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

Other diagnostic factors

Risk factors

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

More risk factors

Diagnostic investigations

1st investigations to order

serum aminotransferases
serum bilirubin
BUN
serum creatinine
prothrombin time
IgM anti-hepatitis A virus (HAV)

More 1st investigations to order

Investigations to consider

IgG anti-hepatitis A virus (HAV)
hepatitis A virus RNA detection

More investigations to consider

Treatment algorithm

INITIAL

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

ACUTE

confirmed hepatitis A

Contributors

Authors

Musaddiq Waheed, MD

Hospitalist Physician

Archbold Memorial Hospital

Thomasville

Assistant Clinical Professor

Florida State University School of Medicine

Tallahassee

Disclosures

MW declares that he has no competing interests.

Acknowledgements

Dr Musaddiq Waheed would like to gratefully acknowledge the late Dr Fida A. Khan for his contribution to this topic.

Disclosures

FAK declared that he has no competing interests.

Peer reviewers

Howard J. Worman, MD

Professor of Medicine and Cell Biology

Columbia University College of Physicians and Surgeons

New York

Disclosures

HJW declares that he has no competing interests.

Srikrishna Nagri, MD

Gastroenterologist

Dartmouth-Hitchcock Nashua

Nashua

Disclosures

SN declares that he has no competing interests.

George Y. Wu, MD, PhD

Professor of Medicine

University of Connecticut Health Center

Farmington

Disclosures

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

Disclosures

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

Disclosures

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.

Differentials
- Acute hepatitis B
- Hepatitis E
- Acute hepatitis C
More Differentials
Guidelines
- Recommended immunization schedule for adults aged 19 years or older
- Recommended immunization schedule for children and adolescents aged 18 years or younger
More Guidelines
Patient leaflets
Hepatitis B: should I have the vaccine?
Hepatitis C: what is it?
More Patient leaflets
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Hepatitis A

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

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

confirmed hepatitis A

Contributors

Authors

Musaddiq Waheed, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Howard J. Worman, MD

Disclosures

Srikrishna Nagri, MD

Disclosures

George Y. Wu, MD, PhD

Disclosures

Kittichai Promrat, MD

Disclosures

Pierre Van Damme, MD, PhD

Disclosures

Differentials

Guidelines

Patient leaflets

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

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