7 Hepatitis A

Key information

Mode of transmission The hepatitis A virus (HAV) is spread through the faecal–oral route, either from person-to-person contact or through contaminated food or drink. It is also occasionally spread by injected drug use.
Incubation period 28–30 days average (range 15–50 days).
Period of communicability The 1–2 weeks before and the first few days after the onset of jaundice.
Burden of disease Infants and children are usually asymptomatic. Severity in adults increases with age. The disease is more serious in those with chronic liver disease and the immune compromised. There is no carrier state.
Vaccines (registered and available) Monovalent inactivated HAV vaccine (Havrix; Avaxim).

Combined inactivated HAV-recombinant hepatitis B surface antigen protein vaccine (Twinrix).

Combined HAV-purified Salmonella typhi Vi polysaccharide vaccine (Hepatyrix; Vivaxim).
Funded vaccine indications HAV vaccine (Havrix) is recommended and funded for:
  • transplant patients
  • children with chronic liver disease
  • ​close contacts of hepatitis A cases.
Vaccine efficacy/effectiveness High efficacy: HAV infection has been almost eliminated in immunised populations.
Public health measures   In an outbreak (if within 2 weeks of exposure):
  • age <12 months, immunoglobulin (IG) is recommended
  • age 12 months through 40 years, vaccination is recommended
  • ​age ≥41 years, IG is recommended.