Updated March 10, 2016

Hepatitis A is an acute, self-limited liver infection caused by the Hepatitis A Virus (HAV). The virus has a worldwide distribution and is endemic in Central and South America, Africa, India, the Middle East, and Asia.

Seroprevalence rates for HAV are low in Canada. In Ontario, overall incidence of HAV has declined since 2002. In 2013, there were 31 cases reported to Toronto Public Health, with an incidence of 1.3 cases per 100 000 persons. The majority of infections (62%) occurred in males.

  • Symptoms may begin with a prodrome that lasts 1-7 days, including:
    • Fever
    • Malaise
    • Anorexia
    • Nausea
    • Abdominal Pain
  • Adults may then develop jaundice, dark urine, pale stools, pruritis and hepatomegaly. Fulminant hepatitis and liver failure are uncommon, but can occur.
  • Children are usually asymptomatic or have very mild infection. Adults tend to present with more severe disease.

REMINDER: Report all suspect or confirmed cases of hepatitis A infection to Toronto Public Health’s Surveillance Unit at 416-392-7411 during work hours (8:30 am to 4:30 pm, Monday to Friday) or 3-1-1 after hours.

  • Humans are the main reservoir for HAV. Transmission occurs predominantly via the fecal-oral route.
  •  HAV can be acquired by:
    • Direct contact with infected individuals
    • Ingestion of contaminated food and/or water
    • Sexual activity that includes direct oral-anal contact
    • Drug sharing (including intravenous drug use)
    • Blood-borne transmission is less common
  • The incubation period is 15-50 days (on average it is 28-30 days)
  • Persons with HAV are infectious from 2 weeks before the onset of clinical illness to one week after the onset of jaundice.

  • All patients with suspected Hepatitis A should have confirmatory serologic testing (both anti-HAV IgM and IgG):
    • IgM antibodies are detectable 5-10 days after infection is acquired
    • IgM antibodies indicate acute infection; they can be falsely positive if patients have been recently vaccinated (within 2 weeks)
    • The presence of IgG antibodies indicates immunity/previous infection

REMINDER: Report all suspect or confirmed cases of hepatitis A infection to Toronto Public Health’s Surveillance Unit at 416-392-7411 during work hours (8:30 am to 4:30 pm, Monday to Friday) or 3-1-1 after hours.

  • Patient education should emphasize:
    • Proper hand hygiene practices
    • Limiting food-handling activities and sharing of common food items during the infectious period
    • Availability of post-exposure prophylaxis for exposed contacts
  • Any individual with suspected or confirmed HAV who is employed in one of the following areas should be advised to refrain from these activities until the diagnosis is ruled out. An occupational history is critical in anyone with suspected HAV.
    • Food Handlers
    • Child Care Staff or Attendees
    • Health Care Workers
  •  If HAV is confirmed, the infected individual should not return to these activities until 14 days after the onset of symptoms, or 7 days after the onset of jaundice, whichever is earlier.
  • IPAC Considerations for Inpatients:
    • Adults with hepatitis A infection should be managed using Routine Practices.
    • Children and incontinent or non-compliant adults should be managed using contact precautions and in a single room.
    • Duration of precautions:
      • age < 3 years: for the duration of hospital stay,
      • age > 3 years: one week from symptom onset.
    • For more information: PIDAC’s Routine Practices and Additional Precautions in All Health Care Settings 

  • An inactivated hepatitis A vaccine is available and is recommended by the National Advisory Committee on Immunization for several groups. Two doses of vaccine provides lifelong immunity.
  • In Ontario, the hepatitis A vaccine is only publically funded for certain non-immune, high-risk individuals including:
    • Illicit drug users (including injectable and non-injectable drugs)
    • Men who have sex with men (MSM)
    • Individuals with chronic liver disease (including hepatitis B and hepatitis C infections)
  • Vaccine for persons in these groups can be ordered through Toronto Public Health.
  • After natural infection and the development of IgG antibodies, immunity is lifelong.

  • Toronto Public Health will provide health care providers with post-exposure prophylaxis for contacts as indicated. The Provincial Infectious Diseases Advisory Committee (PIDAC) recommends post-exposure prophylaxis (PEP) for household and close contacts of a confirmed HAV case.
  • PEP consists of one dose of hepatitis A vaccine (combined vaccines are not recommended), immunoglobulin or both.
  • One dose of hepatitis vaccine is indicated for healthy children and adults >1 year of age.
  • Immunoglobulin should be provided, in addition to hepatitis A vaccine, for:
    • Adults >50 years
    • Immunocompromised patients
    • Patients with chronic liver disease.
  • Infants < 12 months should receive immunoglobulin only.
  • PEP should be provided as soon as possible and within 14 days of exposure.  
  • For more information: PIDAC Guidance Document on Hepatitis A PEP

REMINDER: Report all suspect or confirmed cases of hepatitis A infection to Toronto Public Health’s Surveillance Unit at 416-392-7411 during work hours (8:30 am to 4:30 pm, Monday to Friday) or 3-1-1 after hours.