🧭 When to suspect

Hepatitis A is an acute, self-limiting infection of the liver caused by the hepatitis A virus (HAV), spread by the faecal–oral route – through contaminated food or water, person-to-person contact, or sexual contact. After an incubation of typically 2–6 weeks (around 28 days on average), it produces a flu-like prodrome (fever, malaise, fatigue, nausea, anorexia, right upper quadrant discomfort) followed several days later by an icteric phase – jaundice, dark urine and pale stools – often with paradoxical improvement in the prodromal symptoms as the jaundice appears.

The single most useful clinical reflex is to suspect it in the right context: an acute hepatitic illness in a returning traveller, a contact of a known case, or a person from an at-risk group. Crucially, hepatitis A causes no chronic carrier state and no chronic liver disease; most people recover fully within 1–2 months (a minority have a prolonged or relapsing, sometimes cholestatic, course lasting up to 6 months), and recovery confers lifelong immunity. Acute liver failure is rare (well under 1% of cases) but more likely in older adults and those with pre-existing liver disease or chronic hepatitis B or C.

Clinical clues to suspect	Higher-risk groups / exposures
• Flu-like prodrome (fever, fatigue, anorexia, nausea) then jaundice	• Recent travel to areas of poor sanitation (parts of Africa, Asia, the Middle East, Central/South America)
• Dark urine and pale stools	• Close or household contact with a confirmed case
• Right upper quadrant (RUQ) discomfort with tender hepatomegaly	• Men who have sex with men (MSM) and people who inject drugs (PWID)
• Generalised itch (pruritus) of cholestasis	• Contaminated food or water (e.g. shellfish, raw produce, ice)
• Markedly raised transaminases on incidental bloods	• Food handlers, and chronic liver disease (higher risk of severe illness)

Source: UK Health Security Agency · NHS

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