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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Mary Nettleman, MD, MS, MACP

Mary Nettleman, MD, MS, MACP

Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.

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If a person has hepatitis A, strict personal hygiene and hand washing help prevent transmission of HAV to others. There are ways to help reduce or prevent HAV infection.

• Wash hands thoroughly every time after use of the bathroom, before touching or preparing food, and before touching others. Wash hands with soap and warm water, and then dry the hands thoroughly (with paper or air so the drying towel in not reused by anyone).
• Contaminated surfaces should be cleaned with household bleach to kill the virus.
• Heat food or water to 185 F or 85 C to kill the hepatitis A virus.

If people are not infected with HAV, they can reduce the chance of becoming infected by the following methods:

• Wash hands carefully with soap and warm water several times a day, including every time the bathroom is used, every time a diaper is changed, and before preparing food.
• Do not eat raw or undercooked seafood or shellfish such as oysters from areas of questionable sanitation (just about everywhere, including developed countries).
• Individuals traveling to developing countries should not drink untreated water or beverages with ice in them. Fruits and vegetables should not be eaten unless cooked or peeled.

In addition to the above methods, there are vaccines that work to prevent infection with HAV, but are not substitutes for good hygiene and careful food and drink consumption..

• 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. There is a combined vaccine available for both hepatitis A and B termed Twinrix for patients over age 18.
• The vaccines are given in a series of two shots. The second is given 6-18 months after the first. The shots can be given at the same time as other vaccines.
• Protection from HAV starts about 2-4 weeks after the first shot. The second dose is necessary to ensure long-term (years or lifetime) 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 and infection.

Not everyone needs to have the hepatitis A vaccines. However, the CDC recommends HAV vaccine for the following groups:

• All children older than one year are recommended to get the vaccine, especially children who live in communities where the number of HAV infections is unusually high or where there are periodic outbreaks of hepatitis A. The vaccines are not recommended for children younger than one year old.
• 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 usually recommended for health care workers, food service workers, daycare personnel, and sewage and waste-water workers.
• People traveling to developing countries (preferably given at least 4 weeks before travel); travel is a major source of hepatitis A in people who live in developed countries.
• Men who have sex with men
• People who use illegal drugs. This group of individuals have had 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

If a person has never had hepatitis A and is exposed to the virus, call a primary health care practitioner immediately. There is a treatment that may prevent individuals from becoming infected. It is called immune serum globulin (Gammastan, Gammar-P) and is composed of antibodies that help destroy the virus.

• Immune serum globulin is a preparation of antibodies that can fight the virus in the body.
• It is given as a one-time shot (injection).
• It must be given within 2 weeks after exposure for maximum protection.
• Immune serum globulin can be safely given to children younger than 2 years.
• Immune serum globulin can be given during pregnancy and breastfeeding.
• Immune serum globulin can provide short-term protection against infection if given before exposure. This protection lasts no longer than 3 months. If the person is likely to be exposed immediately to HAV (for example emergency travel to an endemic area in Africa) both the immune serum globulin and HAV vaccine can be given at the same time.

If a person has had hepatitis A confirmed by a blood test, they almost never get it again. People should continue to practice preventive measures, however, to prevent transmission of other infections.

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