epocrates logo
epocrates logo
epocrates logo
  • 0

Diseases

Hepatitis A

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

AAFont SizeShareMore Information
Key Highlights
  • Hepatitis A is one of the most frequently reported infectious diseases in the US.

  • Hepatitis A is not a chronic disease.

  • Transmission usually precedes symptoms by 2 weeks, but can be up to 7 weeks, when stool viral concentrations are highest. Patients are considered noninfectious 1 week after onset of jaundice.

  • Symptomatic patients may present with abrupt-onset fever, abdominal pain, malaise, jaundice, dark urine or light-colored stools, or diarrhea.

  • Immunoglobulin M antihepatitis A virus test should be ordered when a patient is symptomatic or hepatitis A virus (HAV) virus is suspected.

An electron micrograph of the hepatitis A virus
An electron micrograph of the hepatitis A virus
CDC/Betty Partin; used with permission

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

          More information...
        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          • Geographic distribution of the prevalence of hepatitis A (based on summary of available data)

            Geographic distribution of the prevalence of hepatitis A (based on summary of available data)

          • An electron micrograph of the hepatitis A virus

            An electron micrograph of the hepatitis A virus

          • Hepatitis A infection manifested here as jaundice of the conjunctivae and facial skin

            Hepatitis A infection manifested here as jaundice of the conjunctivae and facial skin

          • Eye demonstrating Kayser-Fleischer ring

            Eye demonstrating Kayser-Fleischer ring

          Citations

            Key Articles

            • ​​Centers for Disease Control and Prevention. Hepatitis A. [internet publication].[Full Text]

            • Kemmer NM, Miskovsky EP. Hepatitis A. Infect Dis Clin North Am. 2000 Sep;14(3):605-15.[Abstract]

            • Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38.[Abstract][Full Text]

            Other Online Resources

            • CDC: ACIP vaccine recommendations and guidelines
            • CDC: hepatitis A

            Referenced Articles

            • 1. ​​Centers for Disease Control and Prevention. Hepatitis A. [internet publication].[Full Text]

            • 2. Langan RC, Goodbred AJ. Hepatitis A. Am Fam Physician. 2021 Oct 1;104(4):368-74.[Abstract][Full Text]

            • 3. Shenoy R, Nair S, Kamath N. Thrombocytopenia in hepatitis A: an atypical presentation. J Trop Pediatr. 2004 Aug;50(4):241-2.[Abstract]

            • 4. Schiff ER. Atypical clinical manifestations of hepatitis A. Vaccine. 1992;10(suppl 1):S18-S20.[Abstract]

            • 5. Inman RD, Hodge M, Johnston ME, et al. Arthritis, vasculitis, and cryoglobulinemia associated with relapsing hepatitis A virus infection. Ann Intern Med. 1986 Nov;105(5):700-3.[Abstract]

            • 6. Bhatt G, Sandhu VS, Mitchell CK. A rare presentation of hepatitis a infection with extrahepatic manifestations. Case Rep Gastrointest Med. 2014;2014:286914.[Abstract][Full Text]

            • 7. Shenoy R, Nair S, Kamath N. Thrombocytopenia in hepatitis A--an atypical presentation. J Trop Pediatr. 2004 Aug;50(4):241-2.[Abstract]

            • 8. World Health Organization. Hepatitis A. Feb 2025 [internet publication].[Full Text]

            • 9. Abutaleb A, Kottilil S. Hepatitis A: epidemiology, natural history, unusual clinical manifestations, and prevention. Gastroenterol Clin North Am. 2020 Jun;49(2):191-9.[Abstract][Full Text]

            • 10. Hodges M, Sanders E, Aitken C. Seroprevalence of hepatitis markers; HAV, HBV, HCV and HEV amongst primary school children in Freetown, Sierra Leone. West Afr J Med. 1998 Jan-Mar;17(1):36-7.[Abstract]

            • 11. Sawayama Y, Hayashi J, Ariyama I, et al. A ten year serological survey of hepatitis A, B, and C viruses infections in Nepal. J Epidemiol. 1999 Nov;9(5):350-4.[Abstract]

            • 12. Hau CH, Hien TT, Tien NT, et al. Prevalence of enteric hepatitis A and E viruses in the Mekong River delta region of Vietnam. Am J Trop Med Hyg. 1999 Feb;60(2):277-80.[Abstract]

            • 13. Arankalle VA, Tsarev SA, Chadha MS, et al. Age-specific prevalence of antibodies to hepatitis A and E viruses in Pune, India, 1982 and 1992. J Infect Dis. 1995 Feb;171(2):447-50.[Abstract]

            • 14. Jacobsen KH, Wiersma ST. Hepatitis A virus seroprevalence by age and world region, 1990 and 2005. Vaccine. 2010 Sep 24;28(41):6653-7.[Abstract]

            • 15. Beran J, Douda P, Rychly R. Seroprevalence of viral hepatitis in the Czech Republic. Eur J Epidemiol. 1999 Oct;15(9):805-8.[Abstract]

            • 16. Beutels M, Van Damme P, Aelvoet W, et al. Prevalence of hepatitis A, B and C in the Flemish population. Eur J Epidemiol. 1997 Apr;13(3):275-80.[Abstract]

            • 17. Centers for Disease Control and Prevention. Viral hepatitis surveillance report - United States, 2021. Aug 2023 [internet publication].[Full Text]

            • 18. Centers for Disease Control and Prevention. Person-to-person outbreaks of hepatitis A across the United States. Nov 2023 [internet publication].[Full Text]

            • 19. ​European Centre for Disease Prevention and Control. Hepatitis A - annual epidemiological report for 2021. Dec 2022 [internet publication].[Full Text]

            • 20. Feinstone SM, Kapikian AZ, Purceli RH. Hepatitis A: detection by immune electron microscopy of a viruslike antigen associated with acute illness. Science. 1973 Dec 7;182(4116):1026-8.[Abstract]

            • 21. Coulepis AG, Locarnini SA, Westaway EG, et al. Biophysical and biochemical characterization of hepatitis A virus. Intervirology. 1982;18(3):107-27.[Abstract]

            • 22. Kemmer NM, Miskovsky EP. Hepatitis A. Infect Dis Clin North Am. 2000 Sep;14(3):605-15.[Abstract]

            • 23. Cuthbert JA. Hepatitis A: old and new. Clin Microbiol Rev. 2001 Jan;14(1):38-58.[Abstract][Full Text]

            • 24. Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 14th ed. Atlanta, GA: Centers for Disease Control and Prevention; 2021.[Full Text]

            • 25. Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38.[Abstract][Full Text]

            • 26. ​Centers for Disease Control and Prevention. Viral hepatitis: multistate outbreak of hepatitis A virus infections linked to frozen organic strawberries. Sep 2023 [internet publication].[Full Text]

            • 27. ​Centers for Disease Control and Prevention. Morbidity and mortality weekly report: widespread community transmission of hepatitis A virus following an outbreak at a local restaurant-Virginia, September 2021-September 2022. Apr 2023 [internet publication].[Full Text]

            • 28. Fleischer B, Fleischer S, Maier K, et al. Clonal analysis of infiltrating T lymphocytes in liver tissue in viral hepatitis A. Immunology. 1990 Jan;69(1):14-9.[Abstract]

            • 29. Baba M, Hasegawa H, Nakayabu M, et al. Cytolytic activity of natural killer cells and lymphokine activated killer cells against hepatitis A virus infected fibroblasts. J Clin Lab Immunol. 1993;40(2):47-60.[Abstract]

            • 30. Rezende G, Roque-Afonso AM, Samuel D, et al. Viral and clinical factors associated with the fulminant course of hepatitis A infection. Hepatology. 2003 Sep;38(3):613-8.[Abstract]

            • 31. Mbithi JN, Springthorpe VS, Boulet JR, et al. Survival of hepatitis A virus on human hands and its transfer on contact with animate and inanimate surfaces. J Clin Microbiol. 1992 Apr;30(4):757-63.[Abstract]

            • 32. ​Centers for Disease Control and Prevention. Immunization schedules: child and adolescent immunization schedule by age: recommendations for ages 18 years or younger, United States, 2025. 2024 [internet publication].[Full Text]

            • 33. Centers for Disease Control and Prevention. Immunization schedules: ​adult immunization schedule by age: recommendations for ages 19 years or older, United States, 2025. Nov 2024 [internet publication].[Full Text]

            • 34. American College of Obstetricians and Gynecologists. Practice Guideline No. 6: viral hepatitis in pregnancy. Sep 2023 [internet publication].[Abstract][Full Text]

            • 35. World Health Organization. WHO position paper on hepatitis A vaccines - October 2022. Oct 2022 [internet publication].[Full Text]

            • 36. UK Health Security Agency. Hepatitis A: guidance, data and analysis. Jun 2021 [internet publication].[Full Text]

            • 37. Glikson M, Galun E, Oren R, et al. Relapsing hepatitis A: review of 14 cases and literature survey. Medicine (Baltimore). 1992 Jan;71(1):14-23.[Abstract][Full Text]

            • 38. Taylor RM, Davern T, Munoz S, et al. Fulminant hepatitis A virus infection in the United States: incidence, prognosis, and outcomes. Hepatology. 2006 Dec;44(6):1589-97.[Abstract]

            • 39. Ajmera V, Xia G, Vaughan G, et al; the Acute Liver Failure Study Group. What factors determine the severity of hepatitis A-related acute liver failure? J Viral Hepat. 2011 Jul;18(7):e167-74.[Abstract]

            • 40. Fujiwara K, Kojima H, Yasui S, et al. Hepatitis A viral load in relation to severity of the infection. J Med Virol. 2011 Feb;83(2):201-7.[Abstract]

            • 41. Tong MJ, el-Farra NS, Grew MI. Clinical manifestations of hepatitis A: recent experience in a community teaching hospital. J Infect Dis. 1995 Mar;171(suppl 1):S15-8.[Abstract]

            • 42. Shin SJ, Kim JH. The characteristics of acute kidney injury complicated in acute hepatitis A. Scand J Infect Dis. 2009;41(11-12):869-72.[Abstract]

            • 43. Centers for Disease Control and Prevention. Positive test results for acute hepatitis A virus infection among persons with no recent history of acute hepatitis: United States, 2002-2004. MMWR Morb Mortal Wkly Rep. 2005 May 13;54(18):453-6.[Abstract][Full Text]

            • 44. Gordon SC, Patel AS, Veneri RJ, et al. Acute type A hepatitis presenting with hypotension, bradycardia, and sinus arrest. J Med Virol. 1989 Aug;28(4):219-22.[Abstract]

            • 45. Vento S, Garofano T, Di Perri G, et al. Identification of hepatitis A virus as a trigger for autoimmune chronic hepatitis type 1 in susceptible individuals. Lancet. 1991 May 18;337(8751):1183-7.[Abstract]

            • 46. Rahaman SM, Chira P, Koff RS. Idiopathic autoimmune chronic hepatitis triggered by hepatitis A. Am J Gastroenterol. 1994 Jan;89(1):106-8.[Abstract]

            • 47. ​Centers for Disease Control and Prevention. Morbidity and mortality weekly report: update: recommendations of the Advisory Committee on Immunization Practices for use of hepatitis A vaccine for postexposure prophylaxis and for preexposure prophylaxis for international travel. Mar 2019 [internet publication].[Full Text]

            • 48. UK Health Security Agency. Public health control and management of hepatitis A. Feb 2024 [internet publication].[Full Text]

            • 49. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.[Abstract][Full Text]

            • 50. ​Substance Abuse and Mental Health Services Administration. Advisory: screening and treatment of viral hepatitis in people with substance use disorders (based on TIP 53). Jan 2021 [internet publication].[Full Text]

            • 51. Koff RS. Clinical manifestations and diagnosis of hepatitis A virus infection. Vaccine. 1992;10 (suppl 1):S15-7.[Abstract]

            • 52. Jung DH, Hwang S, Lim YS, et al. Outcome comparison of liver transplantation for hepatitis A-related versus hepatitis B-related acute liver failure in adult recipients. Clin Transplant. 2018 Jan;32(1).[Abstract]

            • 53. ​National Health Service. Hepatitis A. Oct 2025 [internet publication].[Full Text]

          Have feedback?
          Tell us about your experience
          Scroll to Top
          epocrates logo

          Sign in to access our clinical decision support tools

          Sign inCreate Account
          Download Epocrates from the App StoreDownload Epocrates from the Play Store
          About UsFeaturesBusiness SolutionsHelp & Feedback
          © 2026 epocrates, Inc.   Terms of UsePrivacy PolicyEditorial PolicyDo Not Sell or Share My Information