Hepatitis A

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

Last reviewed: 21 Nov 2024

Last updated: 21 Feb 2024

Hepatitis A transmission usually precedes symptoms by 2 weeks, but can be up to 7 weeks, when stool viral 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, jaundice, dark urine or light-coloured stools, or diarrhoea.

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

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

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

Post-exposure prophylaxis may be with active or passive immunisation, depending on specific patient factors, and according to individual national guidelines.

Definition

Hepatitis A virus (HAV) is an RNA virus. Mode of transmission is faecal-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]

History and exam

Key diagnostic factors

presence of risk factors
fever
malaise
nausea and vomiting
jaundice
hepatomegaly
right upper quadrant pain
clay-coloured stools

Full details

Other diagnostic factors

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

Full details

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

Full details

Diagnostic investigations

1st investigations to order

serum transaminases
serum bilirubin
blood urea
serum creatinine
prothrombin time
IgM anti-hepatitis A virus (HAV)

Full details

Investigations to consider

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

Full details

Treatment algorithm

INITIAL

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

ACUTE

confirmed hepatitis A

Contributors

Authors

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

Disclosures

DYD receives grants from Roche, serves as guest director of hepatology for Tech University, and is a member of the Data and Safety Monitoring Board of the IQVIA.

Acknowledgements

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

Disclosures

MW and FAK declared that they have 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 information
Hepatitis B: should I have the vaccine?
Hepatitis C: what is it?
More Patient information
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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

Doan Y Dao, 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 information

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