A Viral Hepatitis Transmitted Through Fecal-Oral Contact

Acute hepatitis A is caused by a virus that affects the liver. It is common in developing countries, where it most often affects children. In countries with good hygiene conditions, however, the incidence of hepatitis A is lower, and it more often affects adults. In adults, it is also more likely to be symptomatic than in children and can be severe.

Santé publique France monitors trends in the epidemiology of acute hepatitis A in France through the mandatory reporting system. This surveillance system enables the early detection of clusters of cases or outbreaks, allowing for the implementation of measures to prevent new cases from occurring.

A mode of transmission primarily via the fecal-oral route

Hepatitis A is transmitted primarily from person to person (human-to-human transmission) via the fecal-oral route. Although less common, foodborne transmission can also cause major outbreaks. Food can be contaminated directly by human feces (water, shellfish, vegetables) or indirectly by a food handler infected with the virus.

The hepatitis A virus is responsible for sporadic cases and outbreaks that are most often limited to specific communities (daycare centers, preschools, facilities for people with disabilities). In some cases, these outbreaks can be more widespread and affect a larger population at the local, regional, national, or even international level.

Preventive Measures

These measures are based on personal and community hygiene, particularly simple handwashing with soap and water. This includes washing hands after using the restroom, after changing a baby’s diaper, before preparing meals, and before eating or feeding children.

In the event of a cluster of cases in a community, simple hygiene measures are generally sufficient to contain an outbreak. However, vaccination should be considered, particularly in situations where hygiene measures cannot be followed. All of these context-specific measures are available here.

Clinical Presentation and Diagnosis of Hepatitis A

The hepatitis A virus can cause acute hepatitis. Most often, hepatitis A is asymptomatic or causes only mild symptoms. When symptoms do appear after an incubation period of 15 to 50 days (30 days on average), they most commonly include fever and severe fatigue (asthenia), which may be accompanied by nausea, abdominal pain, and a yellowing of the skin (jaundice). 
Severe or fulminant forms that can progress to end-stage liver failure are also possible, but deaths are rare. The hepatitis A virus does not cause chronic hepatitis.

The diagnosis of acute hepatitis A is based on a blood test that detects antibodies, which are indirect indicators of recent or past exposure to the virus, bacterium, or parasite in question (or of a previous vaccination)." data-tooltip-title="A blood test that detects antibodies, which are indirect indicators of recent or past exposure to the virus, bacterium, or parasite under investigation (or of a previous vaccination)." data-tooltip-content="" data-tooltip-placeholder-is-selection="true" data-tooltip-placeholder-is-selection-text="serology" data-tooltip-data="%5B%7B%22tooltipTitle%22%3A%22A%20blood%20test%20used%20to%20detect%20antibodies%2C%20which%20serve%20as%20at%20least%20indirect%20evidence%20of%E2%80%99a%20recent%20or%20past%20exposure%20to%20the%20virus%2C%20bacteria%2C%20or%20the%20parasite%20under%20study%20(or%20from%20a%20previous%20vaccination).%22%2C%22tooltipContent%22%3A%22%22%2C%22placeholderIsSelection%22%3A%22true%22%2C%22placeholderIsSelectionText%22%3A%22serology%22%7D%5D">serology (detection of anti-HAV IgM antibodies).

Treatment and Management

There is no curative treatment for hepatitis A. In most cases, the disease resolves spontaneously with a favorable outcome. Hospitalization may be necessary in some cases to monitor the patient and provide symptomatic care. Finally, the rare severe or fulminant forms of hepatitis A may require a liver transplant.