Transmission: Fecal-oral.

Incubation Period– average 28-30 days (range 15-50 days).

Symptoms- anorexia, vomiting, abdominal pain, fatigue, followed by jaundice. Severity of illness increases with age.

Infectious period- 14 days prior to onset of jaundice to 7 days after onset of jaundice. Infants can excrete virus in the stool for longer periods of time.

Epidemiology: Since the mid-1990s, the number of hepatitis A cases reported in the U.S. has fallen sharply due to routine childhood vaccination for hepatitis A. In Pierce County, there have been from 0-5 cases per year since 2007.

Reported number of Hep A cases in the US. For an explanation of the graph, call (253) 798-6410

Source: CDC  


Positive hepatitis A IgM and markedly elevated ALT and AST (hundreds to thousands) are diagnostic of acute hepatitis A.  False positive hepatitis A IgM is common; in the absence of illness and/or elevated liver enzymes, hepatitis A IgM is not significant.

Vaccine Recommendations

Two doses of hepatitis A vaccine, given six months apart after age 12 months are approximately 99% effective at preventing disease. One dose is approximately 95% effective.

Although most children in the U.S. have received hepatitis A immunization, many adults are susceptible. Hepatitis A vaccine is routinely recommended for international travelers, men who have sex with men, and persons with pre-existing liver disease (including hepatitis C). However, there is no recommendation for routine immunization of adults at this time.

Infants and very young children usually show no signs of hepatitis A. Families who adopt infants or young children from developing countries should be vaccinated.

Post-Exposure Prophylaxis

Unimmunized household, sexual and close contacts of persons diagnosed with hepatitis A should receive post-exposure prophylaxis. The following regimens are recommended:

  • Healthy persons age 12 months-40 years who have received no previous doses of hepatitis A vaccine should be vaccinated as soon possible after exposure.
  • Infants < 12 months, persons over age 40, and persons with chronic illness should receive immune globulin 0.02ml/kg within 2 weeks of exposure. Persons who have had at least one dose of vaccine do not need immune globulin.

Post-exposure prophylaxis may not prevent acute hepatitis A. Counsel exposed persons to practice good hand washing after using the toilet and before preparing food.


Please contact Communicable Disease Control at  253 798-6410 (please press “0” for the operator) for more information.