Those at increased risk

• Travellers to areas of high incidence for hepatitis A.
  People living in, or relocating to, areas of high incidence.
• Certain ethnic and geographic populations that experience cyclic hepatitis A epidemics.
• Persons engaging in high risk sexual activity (such as men having sex with men).
• Residents of a community experiencing an outbreak of hepatitis A.
• Injecting drug users.
• Persons who have clotting-factor disorders (haemophiliacs and other recipients of therapeutic blood products).
• Certain institutional workers (e.g., caretakers for the developmentally challenged).
• Employees of child day-care centres.
• Laboratory workers who handle live hepatitis A virus.
• Handlers of primate animals that may be harbouring hepatitis A virus.

Hepatitis A vaccination is also indicated for people with chronic liver disease (including alcoholic cirrhosis, chronic hepatitis B, chronic hepatitis C, autoimmune hepatitis and primary biliary cirrhosis).

Outbreaks have also been attributed to food handlers who can contract hepatitis A and transmit the hepatitis A virus to others. The Advisory Committee on Immunization Practices (ACIP) of the Centres for Disease Control and Prevention (CDC) states that to decrease the costs associated with outbreaks, vaccination of food handlers may be considered where it is deemed cost-effective

Symptoms of Hepatitis A infection

• Fever
• Nausea
• Vomiting
• Diarrhoea
• Fatigue
• Abdominal pain
• Appetite loss
• Jaundice
• Dark urine

Infection can spread by

• Drinking contaminated drinking water or ice
• Eating uncooked fruits or vegetables grown with or washed in contaminated water, or raw or uncooked shellfish (oysters, clams or mussels)
• In day-care centres where children have not been toilet-trained
• Infected food handlers
• After breakdowns in usual sanitary conditions, such as after floods and other natural disasters.
• Through blood transfusions or by sharing contaminated needles and syringes
• Travellers at Risk
• The U.S. Centres for Disease Control and Prevention (CDC) recommends hepatitis A vaccination for travellers going to hepatitis A endemic areas.

Consequences of infection

• Symptoms of hepatitis A include flu-like illness with chills and high fever, nausea, vomiting, diarrhoea, fatigue, abdominal pain, loss of appetite, jaundice (yellowing of the skin and eyes) and dark urine.
• In the United States, the annual cost associated with hepatitis A is estimated at more than $450 million. Medical care alone can cost $2,800 for each hospitalized case and $700 for non-hospitalized cases. In addition to medical expenses, infection with hepatitis A leads to an average of five missed weeks of work, resulting in approximately $2,600 in lost wages.
• The infection in young children is often mild or asymptomatic, while more than 70 percent of older children and adults develop symptoms of clinical hepatitis.
• Since those with hepatitis A are typically contagious for at least two weeks before symptoms appear, they may spread the virus to others unknowingly.
• While most patients begin to recover from acute illness within two months, in up to 15% of patients, relapses may occur and symptoms may persist for up to 6 months.
• Approximately 100 people in the United States die annually from severe hepatitis A.
• Although discomfort can be relieved to some extent by rest and proper nutrition, there is no medical therapy available to treat hepatitis A infection, but vaccines are available to prevent it.