Overview

Hepatitis A is a highly contagious viral disease that causes inflammation of the liver, affecting its ability to function. Increased awareness, timely intervention and adaptive preventive measures are crucial in addressing this health issue, particularly in settings where access to health care and resources are limited.

Hepatitis A ranges from a mild to a severe illness and is caused by the hepatitis A virus which can be contracted by consuming contaminated food or drinking unsafe water.

Symptoms of hepatitis A include jaundice (yellowing of the skin or eyes), loss of appetite, nausea, vomiting, fever, malaise (general fatigue and tiredness), dark urine, light-coloured stool, diarrhoea and joint pain. While most individuals with hepatitis A fully recover and acquire lifelong immunity a few may experience severe complications, including acute liver failure, which can be fatal.

Children under 6 years old might not show obvious symptoms when infected. Adults and the elderly are at a higher risk of experiencing more severe forms of the illness.

The likelihood of contracting hepatitis A is significantly higher in areas with unsafe water, inadequate sanitation and poor hygiene practices, including insufficient hand washing before handling food and after using the bathroom.

A safe and effective vaccine is available to prevent hepatitis A and is highly recommended for children and adults who have not yet been vaccinated.

Transmission

The main way hepatitis A spreads is through the faecal-oral route, which means someone can catch it by eating contaminated food or drinking unsafe water. Hepatitis A outbreaks can start quickly, spread fast and affect entire communities for many months.

Hepatitis A can spread within families if:

Someone with the virus does not wash their hands properly after going to the bathroom and then prepares food.

There is close personal contact with an infected person, such as through oral-anal sex.

You cannot catch the virus from casual contact such as shaking hands.

Outbreaks linked to water, though rare, usually happen when drinking water gets contaminated with sewage or is not treated properly.

Symptoms

Symptoms of hepatitis A range from mild to severe.

Symptoms usually appear 2 to 7 weeks after exposure to the virus.

Symptoms include:

jaundice (yellowing of the skin or eyes)

loss of appetite

nausea

vomiting

fever

malaise (general fatigue and tiredness)

dark urine

light-coloured stool

diarrhoea

joint pain

The severity of symptoms can vary. Older individuals and those with underlying liver conditions face higher risks of severe disease.

Hepatitis A sometimes relapses, meaning a person who has just recovered may experience another acute episode. This is normally followed by recovery.

Who is at risk?

Anyone who has not been vaccinated or who has not been previously infected with the hepatitis A virus.

People residing in areas where the virus is widespread (high endemicity).

Risk factors include:

poor sanitation

lack of safe water

living in a household with an infected person

being a sexual partner of someone with acute hepatitis A infection.

Pregnant women with hepatitis E are at a greater risk than others of developing liver failure and adverse outcomes. Early elective delivery has not been shown to reduce morbidity or mortality among pregnant women with hepatitis E or their newborns.

Treatment and management

Diagnosing hepatitis A relies on specific blood tests to distinguish the type of hepatitis virus (A, B, C, E).

There is no specific treatment for hepatitis A. Management of the disease mainly relies on supportive care including rest, adequate nutrition and hydration. Recovery may take weeks or months.

It is important to avoid unnecessary medications that might harm the liver, e.g. acetaminophen/paracetamol.

Hydration: The illness can lead to dehydration due to vomiting and diarrhoea. Keep hydrated with small sips of clean or treated water. A simple rehydration solution made of clean water, sugar and salt can support recovery.

Seek medical advice immediately if you notice any signs of hepatitis A, especially severe ones like jaundice (yellow skin or eyes) and joint pain. Prompt care is particularly important for the young and elderly.

Managing ongoing symptoms: Most patients recover from hepatitis A without lasting liver damage. In rare instances, hepatitis A can lead to liver failure. Stay in continuous contact with health care providers and community health workers for support, especially if symptoms do not improve.

Warning and early signs of acute liver failure: Patients with the following symptoms may need to be closely watched as they have a higher risk of developing severe disease. They should report quickly to a medical facility for admission.

Severe or persistent vomiting

Persistent sense of not feeling well

Photophobia

Irritability

Disorientation or confusion

Sleepiness

Prevention

Hepatitis A protection measures

Hygiene practices: Maintaining cleanliness is key to preventing hepatitis A.

Encourage hygiene practices: Promote good hygiene practices, such as regular handwashing and mask use if symptoms appear, especially in crowded settings.

If sinks are not available in patient areas, Veronica buckets (portable handwashing stations) can be installed to provide water for hand hygiene close to the point of care. Alternatively, a handwashing basin, soap and a jug of clean water can be placed on a trolley used for ward rounds to encourage handwashing as often as needed between patient contacts.

When soap, clean water and alcohol-based hand rubs are unavailable, the following options can be considered:

Sodium hypochlorite may be added to water to achieve an end formulation of 0.05% sodium hypochlorite for use in dispenser containers for hand hygiene.

Sodium hypochlorite solution becomes inactive when exposed to air and organic materials. If this method is used during supply shortages, it is recommended that the solution be prepared in small batches daily and dispensed from closed containers.

Sodium hypochlorite added to water with a high saline content (seawater) is also an option, as long as an end formulation of 0.05% sodium hypochlorite is achieved. Other water sources, such as rainwater, may be considered.

Hand hygiene products that have antimicrobial properties, such as waterless no-rinse hand soaps.

Food and water safety: Hepatitis A can spread through contaminated food or water. Boil or treat water prior to drinking and cooking and ensure food is well-cooked. Use any available heat source, like a fire from wood or charcoal, to bring water to a rolling boil for at least one minute. Ensure food is thoroughly cooked. These steps are critical in areas where hepatitis A is common and resources limited.

Stay safe while on the move: Constant maving makes following standard health practices challenging. Carry soap with you for hand cleaning, and water purification tools or tablets if available, to prevent hepatitis A.

Prioritizing at-risk groups: Individuals with conditions such as chronic liver disease and compromised immune systems, and those undergoing treatments like chemotherapy, should be particularly vigilant when it comes to hepatitis A exposure. Ensure water and hygiene practices are followed to prevent exposure and infection. Vaccination, when available, is recommended for these groups.

Vaccination

Prioritizing the acquisition of vaccines for preventive measures is crucial.

Where vaccine access is limited, efforts should focus on securing vaccine supplies for high-risk populations, including children, the elderly and those with chronic liver conditions or compromised immune systems.

Inform communities about the ineffectiveness of vaccines post-infection, and emphasize preventive vaccination and health measures before exposure to hepatitis A occurs.

Training community health care workers in efficient vaccine administration is crucial to reaching every population segment, especially in remote or highly mobile communities.

Education campaigns emphasizing vaccine safety, efficacy and the importance of completing the full series of shots for vaccines requiring multiple doses are crucial to achieving widespread immunity and preventing outbreaks.

Community engagement and health care coordination

Enhance community awareness about hepatitis A, focusing on symptoms, transmission and effective prevention techniques. Share knowledge on ensuring food and water safety and maintaining good hygiene practices.

Emphasize education across all age groups, particularly targeting vulnerable populations to improve their understanding and awareness.

To promote early detection and timely treatment, provide accurate and clear information to community members to help recognize and monitor hepatitis A symptoms.

To facilitate swift responses to potential outbreaks encourage active participation in the early detection, reporting and management of cases.

Collaborate with local health authorities, NGOs and international organizations to strengthen hepatitis A surveillance and response strategies.

Work together to enhance health care access, train health care workers and develop the robust emergency response mechanisms essential for effective disease management and prevention.

Sources

Infection prevention and control and water, sanitation and hygiene measures in health-care settings and shelters/congregate settings in Gaza: technical note. Geneva: World Health Organization and United Nations Children’s Fund; 2024 (https://www.unicef.org/sop/media/3681/file/Infection%20prevention%20%20and%20control%20and%20water,%20%20sanitation%20and%20hygiene%20%20measures%20in%20health-care%20%20settings%20and%20shelters%20congregate%20settings%20in%20Gaza.pdf).

WHO Hepatitis A Outbreak Toolbox (https://www.who.int/emergencies/outbreak-toolkit/disease-outbreak-toolboxes/hepatitis-a-outbreak-toolbox ).

Waterborne outbreaks of hepatitis E: recognition investigation and control: technical report (https://www.who.int/publications/i/item/9789241507608).