What is hepatitis?
What is hepatits A?
Who gets hepatitis A?
How does it cause disease?
What are the common findings?
How is hepatitis A diagnosed?
How is hepatitis A treated?
What are the complications?
How can hepatitis A be prevented?
What research is being done?
Links to other information
Michael R. Narkewicz, M.D.
Hewit-Andrews Chair in Pediatric Liver Disease
Associate Professor of Pediatrics, Medical Director,
The Pediatric Liver Center
University of Colorado School of Medicine and The Children's Hospital
The term "hepatitis" is used to describe inflammation, swelling, or soreness of
the liver. Hepatitis can have many different causes, including the hepatitis A,
B, and C viruses; the delta and hepatitis E viruses; the Epstein-Barr virus (the
mono virus); the cytomegalovirus (CMV); the herpes simplex virus; and varicella
Other causes of hepatitis include toxins, such as drugs or alcohol. More rarely,
autoimmune diseases, bacterial infections, fungal infections, and parasitic infections
can cause hepatitis. The three most common causes of hepatitis are the hepatitis
A, B, and C viruses.
The hepatitis A virus (an RNA virus) causes hepatitis A. This virus infects the
liver and causes liver injury. Hepatitis A is the most common cause of acute viral
hepatitis in the world.
Hepatitis A commonly is spread from person-to-person by contact with a stool from
an infected person, or from water or food that has been contaminated by infected
stool. Hepatitis A also can be found in shellfish from certain waters where raw
sewage may drain. It often can pass from caregivers to children or adults in settings
where there is close contact.
Most commonly, adults are exposed in small epidemics due to contaminated food or
water sources. However, in 40% of people, no known risk factor can be identified.
In the United States, approximately 10% to 20% of children have been exposed to
hepatitis A by five years of age. Most of these children do not have symptoms when
infected. In developing countries, the hepatitis A infection is very common in children
Hepatitis A generally is ingested in contaminated food or water. It is absorbed
by the body, and then is taken into the liver cells. Following an incubation period
of 15 to 50 days (average of 30 days), the liver cells are injured during the process
of the body trying to eliminate the virus.
The incubation period for hepatitis A is about four weeks (i.e., after being exposed
to the virus, a patient will not have any symptoms for about four weeks). Then,
the patient usually will have flu-like symptoms, including malaise, vomiting, diarrhea,
and fatigue. Jaundice (yellow eyes) often develops as the flu-like symptoms lessen;
however, many times, particularly in children, jaundice will not be apparent. Liver
blood tests, particularly AST and ALT, are abnormal.
After a period of illness, from one to four weeks, the jaundice will clear, the
liver blood tests will normalize, and almost all patients will recover. Rarely,
patients can have a relapse of jaundice for over six months. Very rarely, hepatitis
A can lead to liver failure (less than 1 out of 10,000 cases).
Hepatitis A can be diagnosed by a blood test, which looks for an antibody (anti-hepatitis
A IgM) that is produced to the virus. If a patient has abnormal liver blood tests
(e.g., bilirubin, AST, or ALT), a physician will suspect hepatitis A.
No medications have been shown to be effective in treating hepatitis A. In fact,
most individuals recover from it without any specific treatment. In patients who
are deeply jaundiced, a low-fat diet may reduce diarrhea. A Vitamin K supplement
may help reduce the risk of bleeding in patients who are jaundiced for a long period
of time. In the rare case of liver failure, a liver transplant may be the only treatment
The most feared complication is liver failure; however, it very rarely occurs. Other
complications, while rare, include pancreatitis, rashes, myocarditis, and relapsing
hepatitis for up to six months. Cholestatic hepatitis, with itching as a major symptom,
is another rare complication of hepatitis A. It may be treated with corticosteroids.
The primary prevention against hepatitis A is good handwashing and sanitation practices.
Post-exposure prophylaxis with immunoglobulin has been the standard method of preventing
hepatitis after an individual has been exposed to hepatitis A. Immunoglobulin may
not be effective if given more than two weeks after an exposure. However, since
hepatitis A can be prevented by vaccination with the hepatitis A vaccine, the use
of immunoglobulin is declining. Several inactivated hepatitis A vaccines are available.
The hepatitis A vaccination is recommended for those individuals (older than two
Other high-risk groups include certain Native American populations where hepatitis
A may be very prevalent, laboratory workers handling the virus, sewage workers,
health care workers, and individuals who work with primates.
Recent research has suggested that the hepatitis A vaccination early in the course
of a hepatitis A epidemic may prevent the development of hepatitis A among individuals
who are exposed to the virus. After exposure to the virus, gamma globulin can prevent
the development of hepatitis A.
Current research efforts have resulted in the licensing of two vaccines. Additional
work is concentrated on developing a live, attenuated vaccine that would be useful
in third-world countries. Ongoing research also is focused on the use of these vaccines
as prophylaxis in epidemics and the development of combination vaccines.
For more information on hepatitis A, log on to the following Web sites:
Innis BL, Snitbhan R, Kunasol, et al. Protection against hepatitis A by an inactivated
vaccine. JAMA 1994;271:1328-34.
Katkov WN. Hepatitis vaccines. Med Clin North Am 1996;80:1189-1200.
Keefe EB, Iwarson S, McMahon BJ, et al. Safety and immunogenicity of hepatitis A
vaccine in patients with chronic liver disease. Hepatology 1998;27:881-6.
Lemon SM, Thomas DL. Vaccines to prevent viral hepatitis. N Engl J Med 1997;336:196-204.
Koff RS. Hepatitis A. Lancet 1998;341:1643-9.
About the Author
Dr. Narkewicz graduated from the University of Vermont School of Medicine and completed
his training in Pediatrics and Pediatric Gastroenterology at the University of Colorado.
He holds the Hewit-Andrews Chair in Pediatric Liver Disease and is Associate Professor
of Pediatrics at the University of Colorado and the Medical Director of the Pediatric
Liver Center and Liver Transplantation at The Children's Hospital, Denver, Colorado.
Copyright 2012 Michael R. Narkewicz, M.D., All Rights Reserved
The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.
By using this website, you accept the information provided herein "AS IS." Neither RemedyConnect nor the providers of the information contained herein will have any liability to you arising out of your use of the information contained herein or make any express or implied warranty regarding the accuracy, content, completeness, reliability, or efficacy of the information contained within this website.
RemedyConnect, Inc. has created this privacy statement in order to demonstrate our firm commitment to your privacy. The following discloses our information gathering and dissemination practices for this website: http://www.remedyconnect.com.
We do not acquire any more information about website visitors than is required by law or is otherwise necessary to provide a high level of service efficiently and securely. Our site's registration form requires users to give us contact information (e.g., their name and e-mail address) and demographic information (e.g., children's birth months, but not birth dates). We use customer contact information from the registration form to (1) send the user pertinent medical and parenting information and (2) allow your local health provider lists of who is registering on that provider's site as a parent/guardian, staff member, doctor, or visitor. Users may opt-out of receiving future mailings; see the choice/opt-out section below.
We use your IP address to help diagnose problems with our server and to administer our Website. Your IP address is used to help identify you and to gather broad demographic information.
Demographic and profile data is also collected at our site. We may use this data to tailor the visitor's experience at our site, showing them content that we think they might be interested in, and displaying the content according to their preferences.
Our site may use order forms to allow users to request information, products, and services.
We will respect your doctor's right to privacy. A doctor typically does not give his/her e-mail address to the parents/guardians of patients. We will not provide the e-mail addresses of doctor(s) in the local practice to users of their site without the doctor(s)' permission. Their site is restricted to use by whomever they wish, and they may deny access to their site to one or more prior users. In unusual cases, doctors may change their private site's access code and arrange for us to e-mail the new access code to approved users.
This site contains links to other sites. RemedyConnect.com is not responsible for the privacy practices or the content of such Websites. See Disclaimers.
We will provide individually-identifiable information about website users to third parties only if we are compelled to do so by order of a duly-empowered governmental authority, we have the express permission of the visitor, or it is necessary to process transactions and provide you services from our affiliates: Live Agent Answering Service, Digital Answering Service, Medical Answering Service and Pediatric Answering Service.
This site may make chat rooms, forums, message boards, and/or news groups available to its users. Please remember that any information that is disclosed in these areas becomes public information and you should exercise caution when deciding to disclose your personal information.
This site has security measures in place to protect the loss, misuse and alteration of the information under our control. For further information regarding our security, please contact us at firstname.lastname@example.org. If you have any concerns regarding the security of information, please do not provide any information to RemedyConnect, Inc. until you are comfortable with our security measures.
You may correct or update your User Registration information at any time, by visiting the User Registration section and providing your personal password that you set at registration. If need be, please email us at email@example.com.
Our site provides users the opportunity to opt-out of receiving e-mail communications from our partners or us, except communications approved by your doctor's practice office. To so opt-out, please email us at firstname.lastname@example.org. To be removed as a user, please email us at the same address. If need be, you may mail requests to us at RemedyConnect, Inc., 9200 E. Mineral Avenue, Suite 100, Centennial, CO 80112. Our telephone number is 303-793-0703.
If you have any questions about this privacy statement, the practices of this site, or your dealings with this Website, you can contact us by email at email@example.com or by mail at our address above.