It’s not normally fatal, but hep A can lead to death for someone with liver disease

After years of decline, hepatitis A (HAV) outbreaks and infections have dramatically increased throughout the United States in recent years: From 2016 to 2018, the CDC reported a nearly 300% rise in HAV infections, with continued outbreaks reported in the years since. Many of these new infections are the result of contaminated food, but there have also been increases among men who have sex with men (MSM), people who inject drugs (PWID), and people who are homeless. Hepatitis A is not normally fatal, but for individuals with pre-existing liver disease, it can lead to death. Consequently, these recent outbreaks have led to a significant number of deaths. This page is designed to give you very basic information about HAV, including ways to prevent it so we can avoid this unnecessary loss of life from a vaccine-preventable disease.

What is hepatitis A?

Hepatitis A is a type of viral hepatitis. It is a virus that infects the liver, but it differs from hepatitis B (HBV) and C (HCV), in that it doesn’t become chronic: Once infected, people will likely feel symptoms for around two months, with some people experiencing them for as long as six months. Like HBV, HAV is vaccine preventable.

Hepatitis A is transmitted from fecal to oral contact: When traces of poop (feces) are inadvertently eaten. It is commonly a food-borne illness, where someone eats something that has not been properly cleaned or cooked or hands have not been properly washed, but it can be sexually transmitted as well through oral to anal contact.

What are the symptoms of hepatitis A?

Once infected with HAV, it usually takes about 2–7 weeks for symptoms to appear. Whereas hepatitis B and C are usually asymptomatic (no symptoms), hepatitis A almost always has symptoms, some of which can feel quite severe:

•     jaundice (yellowing of skin and eyes)

•     fever

•     fatigue

•     loss of appetite

•     nausea and/or vomiting

•     abdominal pain

•     diarrhea

•     joint pain

•     dark urine

•     clay-colored stools (shit or poop)

These symptoms can last for 2–3 months, with some people experiencing them as long as six months. There is no treatment for hep A, but your symptoms may be treatable. However, don’t take any medications—either over-the-counter or prescribed—to deal with symptoms without first consulting your medical provider. You don’t want to put any added pressure on your liver, and some medications can do that.

How is hepatitis A prevented?

There are two ways to completely prevent HAV: Get vaccinated, or take post-exposure prophylaxis after having been exposed (if you have not been vaccinated).

The HAV vaccine is a safe and effective way to prevent infection. The vaccine is a two-shot sequence, and you need them both to ensure long-lasting protection: You get the first one, and then follow up with the second shot six months later. Depending upon the brand of vaccine used, the second dose can happen as long as 12–18 months later. There are also vaccines that have both HAV and HBV in them. If a person misses the vaccination within the allotted time period, it’s safe to start over as extra doses are not harmful. The HAV vaccine is safe for people with HIV, as well as those with HBV or HCV. Indeed, people living with any of these infections should be vaccinated against HAV.

If you have not been vaccinated, but think you’ve been exposed, call your medical provider immediately. You can take immune globulin or the HAV vaccine. It must be administered within the first two weeks of an exposure to be effective.

Other ways to prevent HAV include good hand washing, cooking food, and boiling water (Note: in the U.S., drinking water is treated to kill HAV), and minimizing oral to fecal contact during sex.

Once a person has been infected with HAV, they will have natural immunity and need not worry about future infections.

Who should get vaccinated?

In the U.S., all children have been vaccinated since 2005. Some states started earlier. There are no recommendations to vaccinate all adults, so don’t assume that you received the vaccine. The following should be vaccinated:

•     all children at age 1 year

•     people traveling to countries where hepatitis A is common

•     family and caregivers of adoptees from countries where hepatitis A is common

•     men who have sex with men

•     people who use drugs, either injected or non-injected

•     homeless persons

•     people with chronic or long-term liver disease, including hepatitis B or hepatitis C

•     people living with HIV

•     people with clotting-factor disorders

•     people with direct contact with others who have hepatitis A

•     any person wishing to obtain protection from the virus

Hepatitis A is preventable. Don’t assume you’ve been vaccinated—talk with a medical provider.

Check out the CDC’s website on hepatitis A: Track hepatitis A outbreaks, with this interactive map from Hep Mag: