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How serious?
Risk of death
Yes
Vaccine available?
Time to symptoms
Countries affected
Active outbreaks
Highly preventable with vaccination (effective within 2 weeks of first dose). Common risk in countries with poor sanitation. If unvaccinated, avoid raw food and untreated water. Recovery provides lifelong immunity.
Acute viral liver infection transmitted through contaminated food and water. The most common vaccine-preventable travel disease worldwide.
Symptoms | Frequency | Severity | Onset |
|---|---|---|---|
| Abdominal pain | 60% | Moderate | Early |
| Fatigue | 80% | Moderate | Early |
| Fever | 70% | Mild | Early |
| Loss of appetite | 80% | Mild | Early |
| Malaise | 75% | Mild | Early |
| Nausea | 70% | Moderate | Early |
| Headache | 50% | Mild | Early |
| Myalgia | 50% | Mild | Early |
| Vomiting | 40% | Mild | Early |
| Dark urine | 80% | Moderate | Peak |
| Hepatomegaly | 60% | Moderate | Peak |
| Jaundice | 70% | Severe | Peak |
| Itching | 40% | Mild | Peak |
| Weight loss | 30% | Mild | Peak |
| Arthralgia | 15% | Mild | Peak |
| Splenomegaly | 15% | Mild | Peak |
| Rash | 5% | Mild | Peak |
| Diarrhea | 20% | Mild | Any phase |
Highly contagious liver infection caused by the hepatitis A virus.
Hepatitis A is caused by the Hepatitis A virus (HAV), a non-enveloped RNA virus of the family Picornaviridae. Transmission occurs via the fecal-oral route — through ingestion of contaminated water or food (especially raw shellfish, unpeeled fruits, salads), direct person-to-person contact, or rarely through blood. The virus is highly stable in the environment, surviving weeks on surfaces and resistant to freezing. Unlike hepatitis B and C, hepatitis A does not cause chronic infection; recovery confers lifelong immunity.
Seek emergency medical care immediately if:
Persistent vomiting with inability to keep fluids down
Severe abdominal pain (especially right upper quadrant)
Signs of liver failure: confusion, drowsiness, personality changes (hepatic encephalopathy)
Bruising or bleeding easily (coagulopathy)
Very dark urine with pale stools and worsening jaundice after initial improvement
Fever returning after jaundice has appeared
Most common signs and symptoms
Incubation period: 15–50 days (average 28–30 days). Clinical presentation varies with age:
Children <6 years: Usually asymptomatic (>70% of cases) or mild non-specific illness without jaundice.
Older children and adults — prodromal phase (5–7 days):
Abrupt onset of fatigue, malaise, and anorexia
Nausea, vomiting, and abdominal discomfort (right upper quadrant)
Low-grade fever (38–39°C)
Myalgia and arthralgia
Icteric phase (2–6 weeks):
Jaundice (scleral icterus progressing to skin yellowing)
Dark urine (cola-colored) — often the first sign noticed
Pale/clay-colored stools (acholic)
Hepatomegaly with tenderness
Pruritus (itching) in some patients
Paradoxical improvement — fever and GI symptoms often resolve as jaundice appears
Recovery phase: Gradual resolution over weeks to months. Fatigue may persist for several months.
Knowing the symptoms is the first step to a quick response.
Hepatitis A typically resolves within 2-6 months. Rarely, it can cause acute liver failure.
How this disease is identified
Laboratory confirmation:
Anti-HAV IgM: Positive at symptom onset, detectable for 3–6 months — confirms acute infection
Anti-HAV IgG: Appears during convalescence, persists lifelong — indicates past infection or vaccination
Liver function tests: ALT/AST markedly elevated (often >1,000 IU/L), bilirubin elevated in icteric cases
HAV RNA (RT-PCR): Available in reference labs; useful for outbreak investigation and genotyping
Stool HAV detection: Virus shed in stool 1–2 weeks before symptoms through ~1 week after jaundice onset
Differential diagnosis: hepatitis B, C, E; EBV; CMV; leptospirosis; drug-induced liver injury.
Available treatment methods
No specific antiviral therapy exists. Management is supportive:
Rest and hydration: Avoid strenuous activity during acute phase
Nutrition: Small, frequent meals
avoid alcohol for ≥6 months after illness (hepatotoxicity risk)
Symptom relief: Antiemetics for nausea
cholestyramine for pruritus
avoid hepatotoxic medications (paracetamol limited to <2 g/day)
Monitoring: Serial liver function tests in severe cases
Hospitalization criteria: Persistent vomiting, INR >1.5, encephalopathy signs, inability to maintain hydration
Fulminant hepatitis (<1% of cases): Requires ICU care
liver transplantation may be needed
Most patients recover completely within 2–6 months with no residual liver damage.
Most cases are effectively treated with early diagnosis.
How to protect yourself
Vaccination (primary prevention):
Inactivated HAV vaccine: 2-dose schedule — dose 1 provides ~95% protection within 2–4 weeks; dose 2 at 6–12 months for long-term immunity (estimated 25–40+ years, possibly lifelong)
Combined HAV/HBV vaccine (Twinrix): 3-dose schedule (0, 1, 6 months) or accelerated (0, 7, 21 days + 12-month booster)
Pre-travel: Vaccinate ≥2 weeks before departure; single dose protects most travelers
Post-exposure prophylaxis: HAV vaccine within 2 weeks of exposure (for healthy persons 1–40 years); immunoglobulin for <12 months, >40 years, immunocompromised, or chronic liver disease patients
Food and water hygiene:
Drink only bottled or boiled water; avoid ice
Eat thoroughly cooked food; peel fruits yourself
Avoid raw shellfish (filter-feeding shellfish concentrate HAV)
Strict hand hygiene with soap after toilet use and before eating
Preparation is the best protection.
Risk to travelers:
High risk: All destinations in Africa, Asia (except Japan), Central and South America, Eastern Europe, the Middle East
Hepatitis A is the #1 vaccine-preventable travel infection — vaccinate before ALL travel to endemic regions, regardless of trip duration or accommodation standard
Luxury resorts and business hotels are NOT protective — HAV outbreaks have occurred in 4-5 star hotels
Single dose provides rapid protection (2 weeks); schedule dose 2 upon return for long-term immunity
Combined HAV/HBV vaccine (Twinrix) is efficient for frequent travelers
Practice strict food and water hygiene even when vaccinated (vaccine is ~95%, not 100% effective)
Travelers with chronic liver disease should be prioritized for vaccination — hepatitis A superinfection carries high mortality
Statistics and geographic data
Hepatitis A is the most common vaccine-preventable infection in travelers. WHO estimates ~159 million new infections annually (2019 data), with ~39,000 deaths. Prevalence correlates inversely with sanitation:
High endemicity: Sub-Saharan Africa, South Asia, Central America — nearly universal childhood infection; most adults immune
Intermediate: Eastern Europe, Middle East, Latin America — shifting epidemiology with rising adult susceptibility
Low endemicity: Western Europe, North America, Japan, Australia — susceptible adult populations at risk when traveling
Outbreaks occur via contaminated water supplies, food handlers, MSM populations, PWID, and institutional settings. Seroprevalence in returning travelers with acute hepatitis: HAV is the cause in ~40% of cases (GeoSentinel data). Attack rate among unvaccinated travelers to endemic areas: 3–20 per 1,000 person-months of travel.
Who is most at risk
Traveling to endemic areas, consuming contaminated food or water, poor hygiene practices.
Potential complications
Hepatitis A is generally self-limiting, but complications increase with age and pre-existing liver disease:
Prolonged/relapsing hepatitis: 10–15% of cases
symptoms relapse 1–3 months after initial resolution, may last up to 6 months
Cholestatic hepatitis: Prolonged jaundice (>3 months) with intense pruritus
excellent prognosis
Fulminant hepatic failure: <1% overall (higher in patients >50 years and those with chronic hepatitis B or C)
mortality 50–70% without transplantation
Autoimmune hepatitis trigger: HAV may trigger autoimmune hepatitis in genetically predisposed individuals
Extrahepatic manifestations (rare): Vasculitis, arthritis, cryoglobulinemia, acute kidney injury, aplastic anemia, pancreatitis
Case fatality rate: 0.1% in children <15 years
0.3% in adults 15–39
2.1% in adults ≥40 (WHO data)
Expected outcomes and recovery
Prognosis is excellent with supportive care. Most people recover completely within 2-6 months.
This disease is vaccine-preventable. Effective protection is available through vaccination.
Talk to a travel health specialist about the recommended schedule before your trip.
Find a vaccination clinic →The content on this page is for informational and educational purposes only. It does not constitute medical advice, diagnosis, or treatment recommendations. If you have health concerns, consult a qualified healthcare professional. Medova is not a medical service provider.
Full terms of useGeographic distribution and active outbreaks
| Flag | Country | Risk level |
|---|---|---|
 | South Sudan | High risk |
 | Guinea | High risk |
 | Liberia | High risk |
 | Pakistan | High risk |
 | Sudan | High risk |
 | Somalia | High risk |
 | Mali | High risk |
 | Burkina Faso | High risk |
 | Djibouti | High risk |
 | Iraq | High risk |
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