Causes

  • Hepatitis A virus (HAV)
  • In the vast majority of cases illness is  self-limiting
  • Very rarely progresses to acute fulminant hepatitis (less than 1% of cases)
  • Clusters of hepatitis A infections have been reported in men who have sex with men (MSM) from sex on premises venues (SOPVs)

Risk factors

Hepatitis A is spread is via the faecal-oral route.  Risk factors include:

  • Close contact with a person with hepatitis A
  • Sexual transmission from the faeco-oral route.  This is more common amongst men who have sex with men (MSM)
  • Travel to endemic areas
  • Contact with contaminated food or water
  • IV drug use through shared paraphernalia

Clinical presentation

The incubation period is on average 28 days (range 14-50).

Symptomatic illness occurs in over 70% of adults and includes nausea, anorexia, fever, lethargy and abdominal pain. 

After approximately 1-week jaundice begins to develop associated with dark urine and pale stools, and peaks at 2 weeks. 

Clinical signs include:

  • jaundice
  • scleral icterus
  • hepatomegaly (80%)
  • splenomegaly 
  • right upper quadrant tenderness on palpation
     

Diagnosis

  • Patients with the above prodromal symptoms and jaundice and/ or elevated serum transaminases
  • Serum IgM anti-HAV antibodies are detectable from symptom onset and remain detectable until approximately 6 months’ post-infection
  • Serum IgG HAV anti-bodies appear later in the course of disease, remain detectable for decades and confer lifelong immunity
  • Imaging studies are generally not indicated
     

Management

  • Hepatitis A is a notifiable infection
  • Treatment is supportive
  • Alcohol and hepatotoxic medications should be avoided
  • Nearly all patients are completely recovered by 6 months

Prevention

Hepatitis A vaccination is the primary tool to protect against infection. The seroconversion rate following primary vaccination approaches 100% in healthy adults and children.
Hepatitis A vaccination is recommended in all MSM.

References

  1. Lai M, Hepatitis A virus infection in adults: Epidemiology, clinical manifestations and diagnosis. UpToDate, September 2020. Accessed 28/10/20.
  2. Chopra S, Hepatitis A virus infection: Treatment and prevention. UpToDate. September 2020. Accessed 28/10/20.

Disclaimer

We recognise that gender identity is fluid. In our treatment guidelines, the words and language we use to describe genitals and gender are based on the sex assigned at birth.

The content of these treatment guidelines is for information purposes only. The treatment guidelines are generic in character and should be applied to individuals only as deemed appropriate by the treating practitioner on a case by case basis. Alfred Health, through MSHC, does not accept liability to any person for the information or advice (or the use of such information or advice) which is provided through these treatment guidelines. 

The information contained within these treatment guidelines is provided on the basis that all persons accessing the treatment guidelines undertake responsibility for assessing the relevance and accuracy of the content and its suitability for a particular patient. Responsible use of these guidelines requires that the prescriber is familiar with contraindications and precautions relevant to the various pharmaceutical agents recommended herein.