Hepatitis A

Hepatitis A is an infection that affects the liver. It is caused by the hepatitis A virus. This is often written as HAV. The chance of getting hepatitis A in the UK is very low.
Hepatitis A is not normally serious. Most children and young people will get better in a few months without treatment.

Hepatitis A is very rare in children and young people in the UK. In 2019, 208 cases were confirmed by blood test. However, many cases are not officially reported due to a lack of symptoms.

Hepatitis A is a lot more common in other parts of the world. It is particularly common in areas that do not have easy access to clean water. It is also common in countries that have poor sanitation and overcrowding. This includes parts of Africa, Asia, the Middle East, Eastern Europe and Central and South America.

Sometimes, there can be small outbreaks of hepatitis A in the UK. This happens when the virus passes between a group of people, usually people who share a home. Small outbreaks are also more common in schools and nurseries. This is because young children pass on the virus very easily.

The hepatitis A virus is carried in the digestive system and leaves the body in the poo. If people with the virus do not wash their hands properly after using the toilet, the virus can stay on their hands. This can spread the virus to anything they touch, including food, water and other people.

Children and young people can get hepatitis A from:

• eating food or drinking water with the virus in it
• touching something that has the virus on it and then touching food or putting their hands in their mouth
• close physical contact (e.g. in household or childcare settings)
• during sexual activity in sexually active young people.

Children and young people may also be at risk of catching hepatitis A if they travel to a country where the virus is more common.

Many children and young people with hepatitis A show no signs or symptoms. This is particularly the case for children younger than 5 years.

If symptoms do develop, they are often mild. First symptoms may include:

• loss of appetite
• feeling sick (nausea)
• being sick (vomiting)
• tiredness (fatigue) and generally feeling unwell
• pain in the upper right part of the tummy
• high temperature (fever)
• headache
• loose stools (diarrhoea)
• constipation
• sore throat and cough
• a raised itchy rash (hives)

Other symptoms may develop later and include:

• pale poo (stool)
• dark wee (urine)
• yellowing of the skin and / or the whites of the eyes (jaundice)
• itching (pruritus)

Once a child or young person has swallowed the hepatitis A virus, it usually takes around 28 days for any symptoms to start (although it can be as short as 15 or as long as 50 days).

The hepatitis A virus is most likely to be passed on during the 2 weeks before symptoms start until a week after.

Yes. Hepatitis A can be diagnosed using a blood test. This will be sent to a laboratory for testing. The test looks for antibodies made by the body to fight the virus.

A different type of test called a PCR may be used in children and young people who are immunosuppressed.

Even if your child has no signs or symptoms, they can still spread the virus to others.

Stop the virus spreading by:

• making sure your child washes their hands thoroughly with soap and water after using the toilet and before eating
• washing dirty laundry separately on a hot cycle
• not sharing towels
• washing crockery and cutlery in very hot soapy water
• cleaning the toilet, handles and taps regularly after use
• good personal hygiene
• limiting contact to carers/guardians only.

Sexually active young people should avoid sexual activity during the infectious period.

No. It is important that children and young people with hepatitis A take time off nursery, school or college. This will help prevent the spread of the virus to others. They must stay away from these settings for at least seven days after the start of symptoms. If you are unsure about the timeframes, or if there have been no symptoms, contact your GP for advice.

Siblings may be allowed to continue attending nursery, school or college but will be asked to follow good hand hygiene practices. They may also be offered a vaccination. Contact the school and local Health Protection Team for specific advice.

There is no specific treatment for hepatitis A. It is generally a mild illness, and most children and young people can be cared for at home. Offer food as needed and make sure they drink plenty of water. Seek advice from your GP for treatment and inform your hospital team as required.

Most children and young people will feel better in a few weeks but for some it can take up to 6 months to fully recover. Hepatitis A does not stay in the body after the infection is gone. This means it does not cause long-term damage to the liver. After recovering, your child should be immune to the virus for the rest of their life.

Hepatitis A vaccines are not routinely offered to all children and young people in the UK. This is because the risk of getting infected with the virus is so low. However, a vaccination may be offered to your child if:

• they are at higher risk of catching the virus
• they are at higher risk of getting seriously ill from the virus
• they are travelling to another country where the virus is common.

Yes. Children and young people who have a long-term liver condition may be more at risk of becoming very unwell if they come into contact with the hepatitis A virus. In rare cases, it can lead to liver damage that requires a liver transplant. This is why some children and young people are offered the hepatitis A vaccine.

Children and young people who are immunosuppressed or have a liver condition may also be offered another treatment in addition to the vaccine if they come into contact with someone who has the hepatitis A virus. This treatment is called human normal immunoglobulin (HNIG).

If you are concerned that your child may be more at risk, or if you are planning to travel to a country where hepatitis A is common, speak to your GP or specialist hospital team.

Contact your child’s GP if you think they may have the hepatitis A virus. If the virus is confirmed by a blood test, you must contact their nursery, school or college. You should also tell anyone they have recently been in close contact with. This will help reduce further spread of the hepatitis A virus.

If you are concerned about your child, contact their GP or specialist hospital team for help and advice. The CLDF Families Team is also here for you. They can be contacted on 0121 212 6023 or via email at: families@childliverdisease.org.