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.
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. Average incubation period is 28 days.
History and exam
Key diagnostic factors
- nausea and vomiting
- right upper quadrant pain
- clay-colored stools
Other diagnostic factors
- dark urine
- arthralgias and myalgias
- posterior cervical lymphadenopathy
- evanescent rash
- 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
- occupational exposure
1st investigations to order
- serum aminotransferases
- serum bilirubin
- serum creatinine
- prothrombin time
- IgM anti-hepatitis A virus (HAV)
Investigations to consider
- IgG anti-hepatitis A virus (HAV)
- hepatitis A virus RNA detection
unvaccinated people with recent exposure to hepatitis A (<2 weeks)
confirmed hepatitis A
- Acute hepatitis B
- Hepatitis E
- Acute hepatitis C
- Recommended immunization schedule for adults aged 19 years or older
- Recommended immunization schedule for children and adolescents aged 18 years or younger
Hepatitis B: should I have the vaccine?
Hepatitis C: what is it?More Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer