Hepatitis A is a liver infection caused by a virus that can spread easily from person to person. It can range from a mild illness lasting a few weeks to a more serious illness lasting several months. Hepatitis A is spread when someone ingests the virus during close, person-to-person contact or when someone eats or drinks something that is contaminated with hepatitis A virus.
Not everyone with hepatitis A infection has symptoms. Adults are more likely to have symptoms than children. If symptoms develop, they usually appear two to seven weeks after being infected and can include:
- Loss of appetite
- Abdominal pain
- Joint pain
- Dark urine
- Light-colored poop
- Yellow skin and eyes
Symptoms can last a few weeks or up to six months. People can still spread hepatitis A without having any symptoms.
The hepatitis A virus is in the poop and blood of people who have a hepatitis A infection. Hepatitis A spreads easily from person to person. People can spread it to others before they even feel sick.
Hepatitis A spreads through close contact with someone who has a hepatitis A infection, such as through having sex, caring for someone who is ill or using drugs.
Sometimes, hepatitis A infections can be traced back to contaminated food. Foods can become contaminated at any point: growing, harvesting, processing, handling and even after cooking. In these cases, health officials will try to determine the source of the contamination and the best ways to keep the public safe from the infection.
The best way to prevent hepatitis A is with the safe and effective hepatitis A vaccine. In the U.S., the hepatitis A vaccine has been a routine childhood vaccine since 2005. You should get hepatitis A vaccine if you:
- Are traveling to countries where hepatitis A is common.
- Are a man who has sexual encounters with men.
- Use or inject drugs.
- Have recently been in prison.
- Lack access to a place to wash your hands.
- Have unstable housing or are experiencing homelessness.
- Have a chronic liver disease, such as hepatitis B or hepatitis C.
- Have clotting factor disorders.
- Work with hepatitis A-infected animals or in a hepatitis A research laboratory.
- Have direct contact with others who have hepatitis A.
- Expect to have close personal contact with someone from a country where hepatitis A is common.
Call your health care provider to get the hepatitis A vaccine. If you don’t have health insurance, contact your Local Health Office to get information about their free immunization clinics.
Practicing good hand hygiene – including thoroughly washing hands after using the bathroom, changing diapers and before preparing or eating food – plays an important role in preventing the spread of hepatitis A. If soap and water aren’t available, clean your hands with hand sanitizer containing at least 60% alcohol. Don’t touch your eyes, nose or mouth. If you need to touch your face, make sure your hands are clean. Try to avoid close contact and sharing utensils or cups with people who are sick.
If you were recently exposed to hepatitis A and have not been vaccinated against it, a health care provider may give you the hepatitis A vaccine or immune globulin (IG) to prevent an infection, depending on your age and overall health. IG contains antibodies that protect the body. To be effective, the vaccine or IG must be given within the first two weeks after being exposed to hepatitis A.
Hepatitis A vaccine or IG may be recommended within two weeks of exposure for people who:
- Live with someone who has hepatitis A.
- Recently had sex with someone who has hepatitis A.
- Recently shared injection or non-injection drugs with someone who has hepatitis A.
- Had ongoing, close personal contact with a person with hepatitis A, such as a regular babysitter or caregiver.
- Have been exposed to food or water known to be contaminated with hepatitis A virus.
To treat the symptoms of hepatitis A, doctors usually recommend rest, a healthy diet and avoiding anything that can irritate the liver, such as acetaminophen and alcohol. A few people will need medical care in a hospital because of severe symptoms or abnormal liver function tests. It can take a few months before people with hepatitis A begin to feel better.
The table and map below shows the number of hepatitis A cases in Vermont by county since January 1, 2019. This information is updated weekly.
Outbreaks in the United States
Multiple states across the country have reported outbreaks of hepatitis A, primarily among people who use drugs and people experiencing homelessness. Since the hepatitis A outbreaks were first identified in 2016, 25 states have publicly reported the following as of July 26, 2019: 22,566 cases, 13,352 (59%) hospitalizations, and 221 deaths. CDC provides updates on state-reported outbreaks here.
The Health Department is taking preventive steps in response to neighboring states Massachusetts and New Hampshire experiencing hepatitis A outbreaks by offering immunization clinics at shelters and syringe services programs.
Requested actions of health care professionals:
- Hospital emergency departments and urgent care centers should offer hepatitis A vaccine to susceptible individuals.
- Clinical and community-based agencies providing services to people experiencing homelessness and those with substance use disorder, especially those injecting drugs, should work with Health Department District Offices to increase hepatitis A vaccination among at-risk individuals. Public health nurses from District Offices can provide on-site clinics for susceptible individuals at homeless shelters, syringe services programs and other locations.
- Check patients’ vaccination status in the Vermont Immunization Registry. Vaccinations should not be postponed if vaccination history cannot be obtained or records are unavailable. Enter vaccine doses administered into the Vermont Immunization Registry.
- Primary care providers should continue their efforts to vaccinate all children and teens with two doses of hepatitis A vaccine. Data from the Vermont Immunization Registry indicates that statewide, only 56% of children aged 13-17 years are fully vaccinated against hepatitis A and less than 15% of adults aged 19-64 years old have received a dose of hepatitis A vaccine.
- Refer uninsured individuals to District Offices for free vaccination.
- Report suspected cases of hepatitis A infection and hepatitis A IgM positive laboratory findings to the Epidemiology Program 24/7 at 802-863-7240.
Hepatitis A Vaccine
Hepatitis A vaccine is highly safe and effective. A complete hepatitis A vaccine series provides long-term protection against hepatitis A infection. One dose of single-antigen hepatitis A vaccine provides up to 95% seroprotection in immunocompetent individuals. Pre-vaccination serologic testing is not required to administer hepatitis A vaccine.
Hepatitis A vaccination is recommended routinely for children at age 12-23 months. It's also recommended for people who are at increased risk for hepatitis A infection and for anyone wishing to obtain immunity. People at increased risk for hepatitis A infection include:
- International travelers to areas with high or intermediate hepatitis A endemicity.
- Men who have sex with men.
- People experiencing homelessness.
- People who use injection and noninjection drugs.
- People who are currently or were recently incarcerated.
- People with chronic liver disease.
- People with clotting factor disorders.
- People who work with hepatitis A-infected primates or with hepatitis A in a research laboratory setting.
Tools, fact sheets and guidelines
- Hepatitis A Vaccination: Information for Health Care Providers (CDC)
- Hepatitis A Vaccination Coverage Data (Vermont Immunization Registry)
Outbreak updates and advisories
- Health Advisory (July 30, 2019)
- Increase in hepatitis A virus infections (MMWR, CDC)
- Massachusetts Hepatitis A Outbreak
- New Hampshire Hepatitis A Outbreak
- Widespread outbreaks of hepatitis A among people who use drugs and people experiencing homelessness across the United States (CDC, HAN)
- Map of reported outbreaks across the United States (CDC)