7 Hepatitis A

7.2 Clinical features

The incubation period between ingestion of the virus and clinical symptoms is 15 to 50 days, with an average of 28 to 30 days. The virus can be detected in blood and faeces within a few days of ingestion, and it increases to a peak in the two weeks prior to the onset of clinical illness, which is the time that subjects are most likely to spread the infection. Faecal viral shedding continues for one to three weeks in adults, but has been reported to last longer in young children. Virus excretion falls sharply in the week following the onset of hepatitis.

In infants and preschool children, most infections are either asymptomatic or cause only mild, non-specific symptoms without jaundice. Most adults and adolescents develop symptomatic disease, the severity of which generally increases with age. Symptomatic HAV infection is characterised by an acute febrile illness with jaundice, anorexia, nausea, abdominal discomfort, malaise and dark urine. Signs and symptoms usually last less than two months, although 10–15 percent of symptomatic persons have prolonged or relapsing illness lasting up to six months. Liver enzymes almost always return to normal by six months after the illness, and often much sooner. The disease is more serious in people with chronic liver disease or those who are immune compromised (including people with HIV infection). Chronic carrier states do not occur following hepatitis A infection and persisting liver damage is very rare.