Hepatitis A

About hepatitis A

Hepatitis A is a liver infection caused by a virus that’s spread in the poo of an infected person.

It’s uncommon in the UK, but certain groups are at increased risk. This includes travellers to parts of the world with poor levels of sanitation, men who have sex with men, and people who inject drugs.

Hepatitis A can be unpleasant, but it’s not usually serious and most people make a full recovery within a couple of months.

Some people, particularly young children, may not have any symptoms. But hepatitis A can occasionally last for many months and, in rare cases, it can be life-threatening if it causes the liver to stop working properly (liver failure).

A hepatitis A vaccine is available for people at a high risk of infection.

This page covers:

Symptoms of hepatitis A

When to get medical advice

How you can get hepatitis A

Vaccination against hepatitis A

Treatments for hepatitis A

Outlook for hepatitis A

Symptoms of hepatitis A

The symptoms of hepatitis A develop, on average, around 4 weeks after becoming infected, although not everyone will experience them.

Symptoms can include:

• feeling tired and generally unwell
• joint and muscle pain
• a high temperature (fever)
• loss of appetite
• feeling or being sick
• pain in the upper-right part of your tummy
• yellowing of the skin and eyes (jaundice)
• dark urine and pale stools
• itchy skin

The symptoms will usually pass within a couple of months.

Read more about symptoms of hepatitis A.

When to get medical advice

See your GP for advice if:

• you have symptoms of hepatitis A – a blood test can usually confirm whether you have the infection
• you might have been exposed to the hepatitis A virus recently but you don’t have any symptoms – treatment given early on may be able to stop the infection developing
• you think you might need the hepatitis A vaccine – your GP can advise you about whether you should have the vaccine (see below)

Although hepatitis A isn’t usually serious, it’s important to get a proper diagnosis to rule out more serious conditions with similar symptoms, such as hepatitis C or cirrhosis (scarring of the liver).

It may also be necessary to test your friends, family and any sexual partners, in case you’ve spread the infection to them.

How you can get hepatitis A

Hepatitis A is most widespread in parts of the world where standards of sanitation and food hygiene are generally poor, such as parts of Africa, the Indian subcontinent, the Far East, the Middle East, and Central and South America.

You can get the infection from:

• eating food prepared by someone with the infection who hasn’t washed their hands properly or washed them in water contaminated with sewage
• drinking contaminated water (including ice cubes)
• eating raw or undercooked shellfish from contaminated water
• close contact with someone who has hepatitis A
• less commonly, having sex with someone who has the infection (this is particularly a risk for men who have sex with men) or injecting drugs using contaminated equipment

Someone with hepatitis A is most infectious from around two weeks before their symptoms appear until about a week after the symptoms first develop.

Read more about the causes of hepatitis A.

Vaccination against hepatitis A

Vaccination against hepatitis A isn’t routinely offered in the UK because the risk of infection is low for most people.

It’s only recommended for people at an increased risk, including:

• close contacts of someone with hepatitis A
• people planning to travel to or live in parts of the world where hepatitis A is widespread, particularly if levels of sanitation and food hygiene are expected to be poor
• people with any type of long-term (chronic) liver disease
• men who have sex with other men
• people who inject illegal drugs
• people who may be exposed to hepatitis A through their job – this includes sewage workers, staff of institutions where levels of personal hygiene may be poor (such as a homeless shelter) and people working with monkeys, apes and gorillas

The hepatitis A vaccine is usually available for free on the NHS for anyone who needs it.

Read more about the hepatitis A vaccine.

Treatments for hepatitis A

There’s currently no cure for hepatitis A, but it will normally pass on its own within a couple of months. You can usually look after yourself at home.

While you’re ill, it’s a good idea to:

• get plenty of rest 
• take painkillers such as paracetamol or ibuprofen for any aches and pains – ask your GP for advice about this, as you may need to take lower doses than normal or avoid certain medications until you’ve recovered
• maintain a cool, well-ventilated environment, wear loose clothing, and avoid hot baths or showers to reduce any itching
• eat smaller, lighter meals to help reduce nausea and vomiting
• avoid alcohol to reduce the strain on your liver
• stay off work or school and avoid having sex until at least a week after your jaundice or other symptoms started
• practise good hygiene measures, such as washing your hands with soap and water regularly 

Speak to your GP if your symptoms are particularly troublesome or haven’t started to improve within a couple of months. They can prescribe medications to help with itchiness, nausea or vomiting, if necessary.

Read more about treating hepatitis A.

Outlook for hepatitis A

For most people, hepatitis A will pass within 2 months and there will be no long-term effects. Once it passes, you normally develop life-long immunity against the virus.

For around 1 in every 7 people with the infection, the symptoms may come and go for up to 6 months before eventually passing.

Life-threatening complications such as liver failure are rare, affecting less than 1 in every 250 people with hepatitis A. People most at risk include those with pre-existing liver problems and elderly people.

If liver failure does occur, a liver transplant is usually needed to treat it. 

Symptoms of hepatitis A

The symptoms of hepatitis A develop, on average, around 4 weeks after becoming infected, although not everyone with the infection will experience them.

See your GP if you think you could have been infected with the virus. A blood test will be needed to rule out more serious conditions that have similar symptoms.

Initial symptoms

The initial symptoms of hepatitis A can include:

• feeling tired and generally unwell
• joint and muscle pain
• a mild fever – usually no higher than 39C (102.2F)
• loss of appetite
• feeling or being sick
• pain in the upper-right part of your tummy
• a headache, sore throat and cough
• constipation or diarrhoea
• a raised, itchy rash (hives)

These symptoms usually last from a few days up to a couple of weeks.

Later symptoms

After the initial symptoms, the following symptoms may develop:

• yellowing of the skin and eyes (jaundice)
• dark urine
• pale stools
• itchy skin
• the upper-right part of your tummy becoming swollen and tender

Most people make a full recovery within a couple of months, although the symptoms can come and go for up to six months.

Signs of a serious problem

Hepatitis A isn’t usually a serious illness, but in rare cases it can cause the liver to stop working properly (liver failure).

In addition to the symptoms above, signs of liver failure can include:

• sudden, severe vomiting
• a tendency to bruise and bleed easily (for example, frequent nosebleeds or bleeding gums)
• irritability
• problems with memory and concentration
• drowsiness and confusion

Get medical advice as soon as possible if you experience these symptoms. Liver failure can be life-threatening if not treated quickly.

Causes of hepatitis A

Hepatitis A is caused by the hepatitis A virus, which is spread in the poo of someone with the infection.

Most infections occur in parts of the world where standards of sanitation and food hygiene are generally poor, although there is a small risk of becoming infected in the UK.

How hepatitis A is spread

You can get hepatitis A from:

• eating food prepared by someone with the infection who hasn’t washed their hands properly, or washed them in water contaminated with sewage
• drinking contaminated water (including ice cubes)
• eating raw or undercooked shellfish from contaminated water
• close contact with someone who has hepatitis A
• having sex with someone who has the infection – particularly if you touch their rectum (back passage) with your fingers, mouth or tongue
• injecting drugs using equipment contaminated with the hepatitis A virus

Someone with hepatitis A is most infectious from around 2 weeks before they start to develop symptoms until about a week afterwards.

At-risk destinations

Hepatitis A is found worldwide, but areas where it’s most widespread include:

• sub-Saharan and northern Africa
• the Indian subcontinent (particularly India, Bangladesh, Pakistan and Nepal)
• some parts of the Far East (excluding Japan)
• the Middle East
• South and Central America

People at risk of hepatitis A in the UK

Although the chances of getting hepatitis A in the UK are much smaller than in other parts of the world, certain groups are at an increased risk.

These include:

• close contacts of someone with hepatitis A
• men who have sex with other men
• people who inject illegal drugs
• people who may be exposed to hepatitis A through their job – this includes sewage workers, staff of institutions where levels of personal hygiene may be poor (such as a homeless shelter) and people working with monkeys, apes and gorillas (these animals may be infected with hepatitis A)

People in these groups are usually advised to have the hepatitis A vaccine to minimise their risk of infection.

Treating hepatitis A

There’s currently no cure for hepatitis A, but it will normally pass on its own within a couple of months. You can usually look after yourself at home.

However, it’s still a good idea to see your GP for a blood test if you think you could have hepatitis A, as more serious conditions can have similar symptoms.

Your GP can also advise you about treatments and they may carry out regular blood tests to check how well your liver is working.

Go back to your GP if your symptoms get worse or haven’t started to improve within a couple of months.

Relieving your symptoms

The following advice may help:

• Get plenty of rest, especially during the initial stages of the infection, as you will probably feel very tired.
• Take painkillers such as paracetamol or ibuprofen if you have any aches and pains – how much you can take depends on how well your liver is working; ask your GP for advice.
• Reduce itching by maintaining a cool, well-ventilated environment, wearing loose clothing and avoiding hot baths or showers – your GP may recommend using an antihistamine in severe cases.
• Eat smaller, lighter meals to help reduce nausea and vomiting – your GP can prescribe a medication called an antiemetic if the problem persists.
• Avoid alcohol – drinking alcohol can put additional strain on your liver, so avoid it until your GP says it’s safe.

Preventing the spread of infection

While you’re ill, it’s also important to try to reduce the risk of spreading the infection to others.

You should:

• Stay off work or school until at least a week after your jaundice or other symptoms started.
• Avoid preparing food for others if possible.
• Wash your hands with soap and water regularly – particularly after going to the toilet and before preparing food.
• Avoid sharing towels and wash soiled laundry separately on a hot cycle.
• Clean the toilet, flush handles and taps more frequently than usual.
• Avoid having sex while you’re infectious – hepatitis A is most infectious from around 2 weeks before the symptoms start until about a week after they first develop. Ask your GP for advice about this.

Any close contacts, such as people who live in the same house as you, may be advised to have the hepatitis A vaccine to reduce their risk of becoming infected.

Hepatitis A vaccination

Vaccination against hepatitis A isn’t routinely offered in the UK because the risk of infection is low for most people. It’s only recommended for people at high risk.

Who should have the hepatitis A vaccine

People usually advised to have the hepatitis A vaccine include:

• close contacts of someone with hepatitis A
• people planning to travel to or live in parts of the world where hepatitis A is widespread, particularly if levels of sanitation and food hygiene are expected to be poor
• people with any type of long-term (chronic) liver disease
• men who have sex with other men
• people who inject illegal drugs
• people who may be exposed to hepatitis A through their job – this includes sewage workers, staff of institutions where levels of personal hygiene may be poor (such as a homeless shelter) and people working with monkeys, apes and gorillas

Contact your GP surgery if you think you should have the hepatitis A vaccine or you’re not sure whether you need it.

Types of hepatitis A vaccine

There are 3 main types of hepatitis A vaccination:

• a vaccine for hepatitis A only
• a combined vaccine for hepatitis A and hepatitis B
• a combined vaccine for hepatitis A and typhoid fever

Talk to your GP about which vaccine is most suitable for you. All 3 types are usually available for free on the NHS.

If you’ve travelling abroad, try to plan your vaccinations in advance. They should ideally be started at least two or three weeks before you leave, although some can be given up to the day of your departure if necessary.

Extra doses of the vaccine are often recommended after 6-12 months if you need long-term protection.

You can find more information about the various hepatitis A vaccines on the NHS Fit for Travel website.

Side effects of the hepatitis A vaccine

Some people develop temporary soreness, redness and hardening of the skin at the injection site after having the hepatitis A vaccine.

A small, painless lump may also form, but this usually disappears quickly and isn’t a cause for concern.

Less common side effects include:

• a slightly raised temperature
• feeling unwell
• tiredness
• headache
• feeling sick
• loss of appetite