🧭 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

• 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

Suspect it in the right context: an acute hepatitic illness in:

• A returning traveller

• A contact of a known case

• A person from an at-risk group

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

• 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
• Flu-like prodrome (fever, fatigue, anorexia, nausea) then jaundice
• Dark urine and pale stools
• Right upper quadrant (RUQ) discomfort with tender hepatomegaly
• Generalised itch (pruritus) of cholestasis
• Markedly raised transaminases on incidental bloods

Higher-risk groups and exposures
• Recent travel to areas of poor sanitation (parts of Africa, Asia, the Middle East, Central/South America)
• Close or household contact with a confirmed case
• Men who have sex with men (MSM) and people who inject drugs (PWID)
• Contaminated food or water (e.g. shellfish, raw produce, ice)
• Food handlers, and chronic liver disease (higher risk of severe illness)

Source: UK Health Security Agency · NHS

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