Traveler
Immunization

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but not hazardous to your health"

Hepatitis-A

Hepatitis A Vaccine

What is the hepatitis A vaccine, and who should get one?

There are vaccines that work to prevent infection with hepatitis A virus.

  • The vaccines, Havrix and VAQTA, contain no live virus and are very safe. No serious adverse effects have been reported. Some people have some soreness at the injection site for a few days.
  • The vaccines are given in a series of 2 shots. The second is given 6-18 months after the first. The shots can be given at the same time as other vaccines.
  • Your protection starts about 2-4 weeks after the first shot. The second dose is necessary to ensure long-term protection.
  • The vaccines are thought to protect from infection for at least 20 years.
  • The vaccines must be given before exposure to the virus. They do not work after exposure.

Not everyone needs to have the hepatitis A vaccines. However, the vaccines are recommended for the following groups:

  • People who are likely to be exposed to HAV at work – The only group of workers shown to be at higher risk than the general population is people who work in research laboratories where HAV is stored and handled. Routine vaccination is not recommended for health care workers, food service workers, daycare personnel, and sewage and waste-water workers.
  • Individuals visiting developing countries (it must be given at least 4 weeks before the trip).
  • Men who have sex with men.
  • People who use illegal drugs – This group has higher-than-average rates of HAV infection.
  • People who are likely to become seriously ill if they are infected with HAV – This includes people with impaired immune systems or chronic liver disease.
  • People with blood-clotting disorders who receive clotting factors.

Causes, incidence, and risk factors

The hepatitis A virus is found mostly in the stools and blood of an infected person about 15 – 45 days before symptoms occur and during the first week of illness.

You can catch hepatitis A if:

  • You eat or drink food or water that has been contaminated by stools (feces) containing the hepatitis A virus (fruits, vegetables, shellfish, ice, and water are common sources of the hepatitis A virus).
  • You come in contact with the stool or blood of a person who currently has the disease.
  • A person with hepatitis A does not wash his or her hands properly after going to the bathroom and touches other objects or food.
  • You participate in sexual practices that involve oral-anal contact

About 3,600 cases of hepatitis A are reported each year. Because not everyone has symptoms with hepatitis A infection, many more people are infected than are diagnosed or reported.

Risk factors include:

  • International travel, especially to Asia or South or Central America
  • IV drug use
  • Living in a nursing home or rehabilitation center
  • Working in a health care, food, or sewage industry

Other common hepatitis virus infections include hepatitis B and hepatitis C. Hepatitis A is the least serious and mildest of these diseases. The other hepatitis infections may become chronic illnesses, but hepatitis A does not become chronic.

Symptoms

Symptoms will usually show up 2 – 6 weeks after being exposed to the hepatitis A virus. They are usually mild, but may last for up to several months, especially in adults.

Symptoms include:

Signs and tests

The doctor will perform a physical examination and may discover that you have an enlarged and tender liver.

Blood tests may show:

  • Raised IgM and IgG antibodies to hepatitis A (IgM is usually positive before IgG)
  • Elevated liver enzymes (liver function tests), especially transaminase enzyme levels

Treatment

There is no specific treatment for hepatitis A. Rest is recommended when the symptoms are most severe. People with acute hepatitis should avoid alcohol and any substances that are toxic to the liver, including acetaminophen(Tylenol).

Fatty foods may cause vomiting, because substances from the liver are needed to digest fats. Fatty foods are best avoided during the acute phase.

Expectations (prognosis)

The virus does not remain in the body after the infection has gone away.

Over 85% of people with hepatitis A recover within 3 months. Nearly all patients get better within 6 months.

There is a low risk of death, usually among the elderly and persons with chronic liver disease.

Complications

There are usually no complications. One in a thousand cases becomes fulminant hepatitis, which can be life threatening.

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of hepatitis.

Prevention

The following tips can help reduce your risk of spreading or catching the virus:

  • Always wash your hands thoroughly after using the restroom and when you come in contact with an infected person’s blood, stools, or other bodily fluid.
  • Avoid unclean food and water.

The virus may spread more rapidly through day care centers and other places where people are in close contact. Thorough hand washing before and after each diaper change, before serving food, and after using the restroom may help prevent such outbreaks.

If you have recently been exposed to hepatitis A and have not had hepatitis A before or have not received the hepatitis A vaccine series, ask your doctor or nurse about receiving either immune globulin or the hepatitis A vaccine. Common reasons why you may need to receive one or both of these include:

  • You live with someone who has hepatitis A
  • You recently had sexual contact with someone who has hepatitis A
  • You recently shared illegal drugs, either injected or noninjected, with someone who has hepatitis A
  • You have had close personal contact over a period of time with someone who has hepatitis A
  • You have eaten in a restaurant where food or food handlers were found to be infected or contaminated with hepatitis A

Vaccines that protect against hepatitis A infection are available. The vaccine begins to protect 4 weeks after receiving the first dose. The 6- to 12-month booster is required for long-term protection. See: Hepatitis A vaccine

Travelers should take the following precautions:

  • Avoid dairy products.
  • Avoid raw or undercooked meat and fish.
  • Beware of sliced fruit that may have been washed in contaminated water. Travelers should peel all fresh fruits and vegetables themselves.
  • Do not buy food from street vendors.
  • Get vaccinated against hepatitis A (and possibly hepatitis B) if traveling to countries where outbreaks of the disease occur.
  • Use only carbonated bottled water for brushing teeth and drinking. (Remember that ice cubes can carry infection.)
  • If no water is available, boiling water is the best method for eliminating hepatitis A. Bringing the water to a full boil for at least 1 minute generally makes it safe to drink.
  • Heated food should be hot to the touch and eaten