Hepatitis A

What is hepatitis A?

Hepatitis A, also known as hep A or HAV (hepatitis A virus) is a virus which can cause liver disease. Hepatitis A is normally an acute (short term) infection, meaning that people normally clear the virus naturally within 6 months. Hepatitis A only causes serious liver damage in extremely rare circumstances.


How common is hepatitis A?


Hepatitis A is common in places where water supplies or sanitation (sewage) systems are poor or where personal/food hygiene standards are poor. As such hepatitis A is most common in developing or poorer countries, including in Southern and Eastern Europe, Africa, parts of the Middle East and Far East.


How do you get it?


Hepatitis A is usually passed on through contaminated food or drinking water. It is present in human bowel movements meaning that personal hygiene and hand washing are important. Drinking water may also be contaminated in countries with poor sanitation systems.


Fruit, vegetables and uncooked food washed in contaminated water can cause infection particularly in hotter countries. Shellfish may also be contaminated by sewage in sea water, but cooked food is safe so long as it is not then handled by someone who is infected.


Hepatitis A can also be transmitted sexually, particularly where the mouth comes into contact with the anal area.


What are the symptoms?


There are rarely symptoms in the first 2 – 6 weeks and so people may not know they are infected but may still pass the virus on to others. People usually experience general symptoms which can be misdiagnosed as flu, such as fever, aches and pains, fatigue and a loss of appetite. They may also experience symptoms such as nausea, sickness, stomach ache, diarrhoea. Jaundice may also develop. This can be easily identified because the whites of the eyes turn yellow, the skin may turn yellow, urine may turn dark and bowel motions may turn pale.


Generally people recover from hepatitis A infection within a few weeks, although it may be longer before they feel fully recovered. Once the body has cleared the infection you cannot be infected with hepatitis A again, as you will have a natural immunity.


How do I avoid hepatitis A?


The easiest way to avoid hepatitis A infection is by being vaccinated if you are planning to visit a country where hepatitis A is common, or if you are in a higher risk group for contracting hepatitis A.


You are at higher risk for contracting hepatitis A if you:


  • Are visiting a country where the virus is common
  • Are an injecting drug user
  • Identify as a man who has sex with men or engage in oral – anal sex
  • Are at risk through work (e.g. healthcare provider, sewage worker)
  • Already have long term liver disease.


If you meet any of the above criteria you should contact your GP about getting vaccinated. You may be offered the dual hepatitis A and hepatitis B vaccination as the transmission routes and risk factors are the same or similar for both viruses.


You can find out more about vaccinations when travelling abroad by visiting the travel vaccinations section of NHS Choices. You need to be vaccinated 4-6 weeks before travelling.




You can also avoid hepatitis A when travelling abroad by not drinking tap water, including having ice cubes in your drinks, cleaning your teeth with tap water or eating ice cream.


What is the treatment?


There is no treatment for hepatitis A as it is usually a short term infection which is cleared naturally by the body. You may need treatment to alleviate some of the symptoms. You can help your body by eating and drinking healthily. It is also best to avoid alcohol if you become infected.


In some rare cases people may develop fulminant hepatitis where the liver becomes severely damaged very quickly. This can be fatal and may require a liver transplant. If you think you have contracted hepatitis A you should visit your GP.

Guidance for professionals


Hepatitis A, The Green Book: Chapter 17


HPA: Guidance for the prevention and control of hepatitis A

Hepatitis E

What is hepatitis E?


Hepatitis E, also known as hep E or HEV (hepatitis E virus) is a virus which can cause liver disease. Hepatitis E is fairly rare in the UK, and chronic infection is particularly rare. There are 4 strains of the virus called genotypes 1-4. Genotypes 1 and 3 are most commonly diagnosed in the UK, depending whether the infection was picked up abroad or at home.


How do you get it?


Hepatitis E is transmitted similarly to hepatitis A, through faecal-oral transmission (ingestion of faecal matter, for example through contaminated drinking water). For this reason it is most common in developing countries with poor sanitation systems.


However, in European countries it is also transmitted through ‘zoonosis’. This means that the virus can be found in animals such as pigs, dear or rabbits. It doesn’t make the animals ill but it can be passed on to humans, for example by eating raw or undercooked meat. There is no evidence of transmission through sharing equipment for drug use or via bodily fluids or sexual contact – although there is a risk here where there is mouth contact with the anal area.


There have also been a number of cases reported due to blood transfusions or organ transplants.


What are the symptoms?


The virus has an incubation period of 2-9 weeks during which there are normally no symptoms. After this period symptoms may show including:


  • Mild flu like symptoms
  • Fatigue
  • Change in urine colour – dark or brown
  • Fever
  • Jaundice
  • Itching
  • Nausea and sickness
  • Joint/muscle aches and pains
  • Loss of appetite


Most people infected with hepatitis E will have a short illness and recover completely within a few months. Because the symptoms of hepatitis E are fairly general and due to the normally short duration of illness may not be diagnosed. If you have fallen ill after recently travelling abroad to a country where hepatitis E is common, you should inform your doctor.


If you are diagnosed with hepatitis E you should avoid preparing meals for people, try to limit contact with others and especially pregnant women or those with a pre-existing liver condition.


In some rare cases hepatitis E may cause severe liver damage in a quick space of time. This is called fulminant hepatitis and can be fatal, usually requiring a liver transplant to save a patient’s life. Pregnant women are at high risk of developing fulminant hepatitis if they become infected with hepatitis E and this can cause premature delivery or be fatal for both mother and child.


Hepatitis E may become chronically infected if they have a suppressed immune system (normally due to taking immunosuppressant drugs for a pre-existing medical condition) which could eventually lead to cirrhosis of the liver.


The virus may also attack the nervous system, causing severe pain in the arms and legs. This may last for several months.


How do I avoid hepatitis E?


There is currently no vaccine for hepatitis E so it is important to take precautions when travelling to countries where the virus is common. Be sure to wash your hands properly after using the toilet and before preparing or eating food. Use alcohol hand gel or baby wipes if soap and water are not available.


If you are travelling to a country where the virus is common you should avoid:


  • Drinking tap water
  • Having ice cubes in your drinks
  • Cleaning your teeth with tap water
  • Eating uncooked meat or shellfish
  • Eating unpeeled fruit or uncooked vegetables, including salads, that have not been prepared by you.


To avoid becoming infected in European countries you should ensure you cook all meat thoroughly before eating, especially pork. You should wash your hands after touching uncooked meat or meat products. If you are pregnant or have a pre-existing liver condition you should be particularly careful with raw meat, shellfish and pork products.


A hepatitis E vaccine is currently being developed but is it is not clear how long this may take to become available.


What treatment is available?


Hepatitis E infection rarely lasts longer than around 4 weeks before your body clears it naturally. If you have a pre-existing liver condition you may become more unwell and anti-viral therapy using ribavirin has been successfully used to treat such patients.


If you have a pre-existing liver condition or are pregnant and are diagnosed with hepatitis E, you should be referred to a specialist urgently.


Guidance for professionals

PHE: Operational guidelines for hepatitis E


Hepatitis Scotland
91 Mitchell Street
G1 3LN

Telephone: 0141 225 0419
Fax: 0141 248 6414