Hepatitis A: Questions and Answers

i n f o r m at i o n a b o u t t h e d i s e a s e a n d vacc i n e s

What causes hepatitis A? How long does it take to show signs of illness
Hepatitis A is an infectious liver disease caused by after coming in close contact with a person
hepatitis A virus (HAV). who has hepatitis A virus infection?
It can take 15–50 days to develop symptoms (average
How does hepatitis A virus spread? 28 days). People with hepatitis A virus infection
Hepatitis A virus is spread from person to person might not have any signs or symptoms of the infection.
by putting something in the mouth that has been Adults are more likely to have symptoms than children.
contaminated with the stool (feces, poop) of a person About 7 out of 10 adults have symptoms, while
infected with hepatitis A virus. This type of spread children younger than age 6 years usually have no
is called “fecal-oral.” This can happen in a variety of symptoms. About 1 out of 8 people with symptoms
ways, such as when an infected person who prepares will have a prolonged or relapsing infectious illness
or handles food doesn’t wash his or her hands that lasts up to 6 months.
adequately after using the toilet and then touches
other people’s food. A person can also be infected How long do symptoms last?
by drinking water contaminated with hepatitis A Symptoms usually last less than 2 months; however,
virus or drinking beverages chilled with virus a few people are ill for as long as 6 months.
contaminated ice. Contaminated food, water, and
ice can be significant sources of infection for travelers How serious is hepatitis A?
to many areas of the world. For this reason, the virus
Hepatitis A can be quite serious. While most people
is more easily spread in areas where there are poor
fully recover within 2–3 months, older people, those
sanitary conditions or where good personal hygiene
with chronic liver disease or other health problems
is not observed.
may develop severe illness. A multi-state hepatitis A
Most hepatitis A viral infections in the United States outbreak that began in 2016 in the United States has
result from international travel to countries with primarily involved people who use drugs, people who
intermediate or high rates of hepatitis A virus infection, were homeless, and their close contacts. As of July
contact with a household member or sex partner 2020, more than 33,300 cases had been reported, of
who has hepatitis A, or sharing street drugs. Casual whom 61% had been hospitalized and about 1% died.
contact, as in the office, factory, or school setting,
does not spread the virus. Can people become chronically (life-long)
infected with hepatitis A virus?
Can hepatitis A virus be spread through sex?
No. Hepatitis A leads to a short-term infection, limited
Yes. Sex involves close, intimate contact (vaginal, to a few weeks or months, not a chronic infection.
anal, or oral sex) and increases the risk of exposure Relapsing hepatitis A, as described above, goes away
to hepatitis A virus in the feces of an infected person. and is NOT a chronic infection. Both hepatitis B and
hepatitis C viruses can cause chronic infection.
What are the symptoms of hepatitis A?
Not everyone infected with hepatitis A virus will How common is hepatitis A in the United
have symptoms; however, some infected people can States?
feel quite sick. If symptoms are present, they usually The incidence of hepatitis A in the U.S. increased
occur suddenly and can include fever, tiredness, loss more than 10-fold from 2015 to 2019, with over
of appetite, nausea, abdominal discomfort, vomiting, 18,800 cases reported to CDC in 2019. The number
joint pain, clay-colored stools, dark urine, and of reported cases declined by half to 9,952 in 2020.
jaundice (yellowing of the skin and eyes).
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This number is an underestimate of the actual hepatitis A virus becomes lower over time and can
number of infections: CDC estimates that about still be present 1 week or longer after symptoms
19,900 cases actually occurred in 2020. In recent develop. Infants are more likely to spread hepatitis A
years, large outbreaks have occurred among people virus for longer periods of time.
experiencing homelessness, people who use drugs,
and men who have sex with men. A smaller number If an unvaccinated person has had close
of cases are associated with international travel or personal contact with a person who is
eating imported food contaminated with HAV. infected with hepatitis A virus, what should
the person do?
How common is hepatitis A virus infection
If an unvaccinated person thinks that he or she might
throughout the world?
have been exposed to hepatitis A virus, the person
Hepatitis A occurs throughout the world. It is should call their healthcare provider immediately to
especially common in countries in Latin America, determine what to do. Vaccine or IG may be needed.
Africa, the Middle East, Asia, the Caribbean, and the IG is a concentrated dose of human antibodies that
Western Pacific. This means that people can become includes anti-HAV. In most cases, either of these
infected with the virus in many travel destinations, preparations can protect an exposed person from
even when using luxury tourist accommodations. developing hepatitis A virus infection. It’s important
The only destinations around the world for which to give vaccine and/or IG within 2 weeks following an
CDC does not recommend hepatitis A vaccination exposure (the sooner, the better) to prevent infection
or immune globulin (IG) for U.S. travelers before caused by the exposure. Vaccination provides long-
departure are Canada, Australia, New Zealand, Japan, lasting protection and should be done unless vaccine
and parts of Western Europe. is contraindicated. IG alone is used for children
younger than age 1 year or people who either refuse
How does a person know if he or she is or cannot be vaccinated. IG may be given, in addition
infected with hepatitis A virus? to vaccine, based upon a healthcare provider’s
To diagnose acute hepatitis A, a blood test called evaluation of people over 40, people who are immuno-
“IgM class antibody to hepatitis A virus” (IgM compromised, and people with chronic liver disease.
anti-HAV) is needed. There is also a blood test
available that shows if an unvaccinated person was Can a person be infected with hepatitis A virus
infected with hepatitis A virus in the past (total more than once?
hepatitis A antibody, also called anti-HAV). Talk to No. Once a person recovers from the infection, he or
your doctor or your local health department if you she develops life-long protection from future infection.
suspect that you have been exposed to the virus or
any other type of hepatitis virus. How does hepatitis A virus differ from
hepatitis B virus (HBV) and hepatitis C
Is there a treatment for hepatitis A? virus (HCV)?
No. There is no specific treatment for hepatitis A. • Hepatitis A, B, and C are three different viruses
Supportive care includes bed rest, fluids, and that injure the liver and cause similar symptoms in
fever-reducing medicines. Take fever-reducing people with acute (recently acquired) disease.
medicine only if your physician recommends it.
• Hepatitis A virus is spread by getting infected fecal
How long can a person with hepatitis A virus matter into a person’s mouth who has never had
infection spread the virus? hepatitis A virus infection (e.g., through unwashed
hands or sexual contact). Hepatitis B and hepatitis
The most likely time for an infected person to spread
C viruses are spread when an infected person’s
hepatitis A virus to others is during the 2 weeks
blood or blood-contaminated body fluids enter
before the infected person develops symptoms (e.g.,
another person’s bloodstream.
yellowing of skin and eyes). The risk of spreading
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• Hepatitis B and hepatitis C virus infections can • People who anticipate having close personal
cause chronic liver problems. Infection with contact with an international adoptee from a
hepatitis A virus does not. country of high or intermediate levels of hepatitis A
virus infection during the first 60 days following the
• There are vaccines that will protect people from
adoptee’s arrival in the United States
infection with hepatitis A and hepatitis B. Currently,
there is no vaccine to protect people from hepatitis • People who work with HAV-infected primates or
C virus infection. with hepatitis A virus in a research laboratory setting

• There are medications that are approved by the • People with any kind of chronic liver disease,
Food and Drug Administration (FDA) to treat including infection with hepatitis B or hepatitis C
chronic hepatitis B and chronic hepatitis C viral viruses, cirrhosis, fatty liver disease, alcoholic liver
infections. There is no specific treatment for disease, autoimmune hepatitis, or liver enzyme
hepatitis A virus infection. (See the question “Is tests (ALT or AST) persistently more than twice
there treatment for hepatitis A?”) normal levels.
• Any person who wishes to be protected from
• If a person has had one type of viral hepatitis in the
hepatitis A virus infection
past, it is still possible to get the other types.
Hepatitis A vaccine is not routinely recommended for
What kind of vaccine is hepatitis A vaccine? healthcare personnel, sewage workers, or day-care
Hepatitis A vaccine is an inactivated (killed) virus providers. Children who are not vaccinated by age 2
vaccine. years should be vaccinated as soon as possible.

How is hepatitis A vaccine administered? ACIP now recommends routine hepatitis A

vaccination for people who are homeless.
The vaccine is given by an injection into the muscle of
Can you provide a definition of “homeless”?
the upper arm for adults and older children and in the
thigh muscle of toddlers and younger children. CDC defines a homeless person as one who 1) lacks
housing, 2) is without permanent housing but may
Who should get this vaccine? stay in a shelter or transitional housing, or 3) “doubles
up” with a series of friends or extended family
Many people are recommended to receive hepatitis A
members. It can also include people previously
vaccine, including people at increased risk for
homeless who are being released from a prison
exposure to hepatitis A virus infection and people
or hospital if they do not have a stable housing
who are more likely to get seriously ill if infected
situation. The key to the definition is the instability
with the virus. According to CDC recommendations,
of the person’s living arrangement.
people who should be vaccinated include:
• All children starting at age 1 year (12–23 months)
How many doses of hepatitis A vaccine are
• All children age 2 through 18 years not previously recommended?
vaccinated
Two doses are recommended. The second dose is
• All people infected with HIV given no sooner than 6 months after the first dose.
• People age 6 months or older who are traveling to
or working in an area of the world except the United I’m not in a group for which hepatitis A vaccine
States, Canada, Japan, New Zealand, Australia, and is recommended. Can I still get vaccinated to
parts of Western Europe. Vaccine given to a child protect myself against infection?
age 6–11 months does not count toward the 2-dose Yes. Hepatitis A vaccine is safe and effective. Any
series given after the first birthday. person who wishes to be immune to infection with
• Men who have sex with men hepatitis A virus can receive the vaccine.
• Users of illicit drugs, injectable or non-injectable
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• People who are homeless or in temporary housing,
such as a shelter

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How long does hepatitis A vaccine protect you? How effective is hepatitis A vaccine?
Estimates for long-term protection for fully vaccinated Hepatitis A vaccine is very effective. It appears that
people (i.e., two-dose series) suggest that protection all adults, adolescents, and children become immune
from hepatitis A virus infection could last for at least to hepatitis A virus infection after getting two doses.
25 years in adults and at least 14–20 years in children. After one dose, at least 94 out of 100 people become
Protection after the first dose has been shown to immune for several years. It is important to get the
last more than a decade. Protection may be life-long, full two-dose series to ensure long-term protection.
similar to the immunity that follows natural infection,
but experts continue to evaluate the long-term Can I receive hepatitis A vaccine when I am
effectiveness of this vaccine. pregnant?
Yes. CDC recommends that a pregnant woman at risk
What organizations recommend hepatitis A of hepatitis A infection or at risk of a severe outcome
vaccine? of hepatitis A infection during pregnancy should be
The Centers for Disease Control and Prevention, the vaccinated.
American Academy of Pediatrics, the American
Academy of Family Physicians, the American College Can the vaccine cause hepatitis A virus infection?
of Obstetricians and Gynecologists, and the American No.
College of Physicians, recommend this vaccine.
Is there a vaccine that protects against both
Is hepatitis A vaccine safe? hepatitis A and hepatitis B virus infection?
Yes, hepatitis A vaccine is very safe. Since the Yes. Twinrix is a hepatitis A and hepatitis B combina-
licensure of the first hepatitis A vaccine in 1995, tion vaccine manufactured by GSK. It was licensed
millions of doses of hepatitis A vaccine have been for use in the United States in 2001 for people 18
administered worldwide, as well as in the United years of age and older. Three doses of Twinrix are
States. No serious adverse events have been necessary for full protection against hepatitis A and
attributed to the vaccine. hepatitis B virus infections.

What side effects have been reported with What is immune globulin (IG)?
this vaccine?
IG is a preparation of human antibodies that can be
The most common side effect is a sore arm, which given before exposure to hepatitis A virus for 1–2
happens to one out of two adults and one out of five months of protection against hepatitis A virus
children. Less common side effects include headache, infection and to people who have already been
loss of appetite, low-grade fever, or tiredness. When exposed to hepatitis A virus. IG must be given within
these problems happen, they usually start 3–5 days 2 weeks after exposure to the virus for maximum
after vaccination and usually last for 1–2 days. A protection.
very rare but serious side effect is a severe allergic
reaction. If this happens, it typically occurs within a What are the recommendations for the use of
few minutes to a few hours after the injection. hepatitis A vaccine and/or IG prior to travel?
(See the question on “Who should not receive
hepatitis A vaccine?”) All susceptible people (individuals who have never
had the infection or the vaccine) traveling to or
Who should not receive hepatitis A vaccine? working in countries except the United States,
Canada, Japan, New Zealand, Australia, and parts of
People who have had a serious allergic reaction to Western Europe should receive hepatitis A vaccine
hepatitis A vaccine in the past, or who are known or IG before departure. If traveling to the Caribbean,
to be allergic to any part of the hepatitis A vaccine, people should consider getting hepatitis A vaccine or
should not receive it. People with moderate or severe IG if travel is to areas of unreliable sanitation.
acute illness should wait to receive hepatitis A
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Infants age 6 through 11 months who are at risk of Travelers who choose not to get the hepatitis A
travel-related exposure to hepatitis A should receive vaccine, who are younger than age 6 months, or who
1 dose of hepatitis A vaccine prior to travel, along are allergic to the vaccine should be given IG only.
with a dose of MMR vaccine to protect against The dosage of IG depends on the length of travel.
measles. Hepatitis A vaccine given before the
first birthday does not count toward the routine Can hepatitis A vaccine be given after
2-dose series. exposure to hepatitis A virus?
For unvaccinated people ages 1 through 40 years, the Yes. People who recently have been exposed to
first dose of hepatitis A vaccine should be given as hepatitis A and who previously have not had hepatitis
soon as travel is considered. The second dose should A vaccine should be given a single dose of hepatitis A
be given at least 6 months after the first dose. vaccine as soon as possible, within 2 weeks of
For the best protection, healthcare providers caring exposure. For people older than age 40 years, IG
for travelers over age 40 and travelers who are may also be administered at the clinician’s discretion,
immunocompromised or who have chronic liver but hepatitis A vaccine can be used alone if IG is
disease, and who are traveling within 2 weeks, may unavailable. IG alone should be given to children
administer IG in addition to vaccine, depending upon younger than 12 months of age and people for whom
the patient’s likelihood of a protective antibody vaccine is contraindicated. Both vaccine and IG
response to vaccination, the availability of IG, and the should be given to immunocompromised people and
risk of hepatitis A exposure. The second dose of the to people who have chronic liver disease.
2-dose hepatitis A vaccine series should be given no
sooner than 6 months after the first dose. This second
dose is needed to ensure long-lasting protection.

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