Hepatitis A for health professionals

Hepatitis A is a vaccine-preventable viral infection of the liver. It is a nationally notifiable disease. We monitor and report on national case numbers and epidemiological trends. We publish case definitions and national guidelines to support health professionals and health authorities.

For health professionals For everyone

Disease

  • The hepatitis A virus is a member of the Picornaviridae family.

  • Hepatitis A is usually mild and self-limiting. Symptoms generally last 1 to 3 weeks.

    The likelihood of symptoms developing increases with age.[1] Symptoms are uncommon in children under 6 years of age. However, at least 70% of infected adults develop symptoms. [2]

    Initial symptoms typically include:

    A few days later, people may develop:

    • dark-coloured urine
    • light-coloured stools
    • jaundice (yellow skin and eyes)
    • pruritis (itchy skin).

    Complications include:

    • relapsing hepatitis
    • extrahepatic disease, such as arthritis, vasculitis and myocarditis
    • autoimmune hepatitis.

    Rarely, people may develop fulminant hepatitis requiring liver transplantation.

    Most people recover completely within 2 to 6 months. Up to 1 in 5 infected people require hospitalisation.

    Read more about symptoms, diagnosis and treatment of hepatitis A.

Public health importance

  • Hepatitis A is a vaccine-preventable viral infection. It has the potential to cause illness and outbreaks, especially among people who have not previously been exposed to the virus. Although large outbreaks are rare, they can cause:

    • significant demands on hospital and public health resources
    • economic impacts, such as temporary closures of affected food establishments or facilities.

    Hepatitis A is still common in many countries with poor water and sanitation. Australians travelling to these regions are at increased risk of getting infected, especially if they are not vaccinated. Occasionally, outbreaks in Australia have been linked to imported food products from areas where the hepatitis A virus is endemic.[3] [4]

    For this reason, effective surveillance and timely public health actions are essential to control and reduce the impact of hepatitis A.

    Because of this, we work to:

  • Hepatitis A virus infections in Australia have significantly declined since the 1950s, largely due to:

    • better hygiene and sanitation
    • improved safe water supply
    • availability of an effective vaccine
    • effective public health actions to limit outbreaks and prevent further cases.

    Hepatitis A notification rates in Australia have shown a consistent downward trend, falling from over 10 cases per 100,000 people in the 1990s to fewer than 1 case per 100,000 by the 2010s. In 2024, there were 240 hepatitis A cases reported in Australia, with a notification rate of 0.9 per 100,000 people.

    In 2005, the National Immunisation Program introduced a hepatitis vaccination program for Aboriginal and Torres Strait Islander children in high-risk areas. Since then, notification rates among Aboriginal and Torres Strait Islander people – previously at least 5 times higher than those in non-Indigenous populations – have significantly declined and are now lower than rates in non-Indigenous people.

    Despite relatively low disease prevalence, sporadic hepatitis A outbreaks still occur in Australia. These are often linked to:

    • overseas travel to endemic regions
    • imported food products (for example, frozen berries)
    • small outbreaks arising from close contact with infected individuals including among:
      • childcare and early learning settings
      • people who inject drugs[5]
      • people who experience homelessness, due to person-to-person transmission.[5]

    For the latest information on hepatitis A cases in Australia, see our data visualisation tool.

Spread of infection

  • Hepatitis A is highly contagious and is mainly spread through the faecal-oral route.

    The virus can survive in the environment – including on surfaces, in water and on frozen foods – for several months. [6] [7] [8]

    Transmission can happen by:

    • eating contaminated raw, frozen or undercooked food
    • drinking contaminated water
    • touching your mouth after handling soiled nappies, linen or towels of an infectious person
    • sharing contaminated personal items, such as toothbrushes
    • close or intimate contact (including oral or anal sex) with an infectious person
    • caring for an infectious person.

  • Symptoms usually start 15 to 50 days after exposure.[9]

  • People are considered infectious from 2 weeks before symptoms start until either:

    • 1 week after jaundice appears (if it occurs)
    • 2 weeks after symptoms start (if jaundice does not occur).

    In some cases, people can remain infectious for up to several months.

Priority populations

  • People who are not immune to hepatitis A – either through past infection or vaccination – are at increased risk of severe disease if they:

    • are older
    • are immunocompromised
    • have chronic liver disease (including hepatitis B or hepatitis C)
    • have had a liver transplant.

    Read more about measures people can take to protect themselves.

  • People who are at risk of acquiring hepatitis A include those who are more likely to be exposed through their work, travel, lifestyle or where they live.

    Occupational exposure

    • People who live, work or care for children in rural and remote Aboriginal and Torres Strait Islander communities in the Northern Territory, Queensland, South Australia, and Western Australia
    • Early childhood educators and carers
    • Carers of people with developmental disabilities
    • Plumbers and sewage workers

    Travel-related exposure

    • People who travel to areas where hepatitis A is endemic

    Lifestyle-related exposure

    • People who have anal sex (including men who have sex with men, and sex workers)
    • People who inject drugs
    • People in correctional facilities

    See what measures people can take to protect themselves.

  • Hepatitis A can spread quickly in homes and other settings, including:

    • early childhood centres
    • schools
    • settings where food is handled
    • residential care facilities
    • disability settings
    • correctional and detention centres
    • sex-on-premises venues.

    An outbreak in these settings may require a public health response.

    Read more about the prevention, control and public health management of outbreaks.

Prevention

  • A safe and effective vaccine is available against hepatitis A.

    Two vaccine doses at least 6 months apart will provide protection against infection for many years.

    Hepatitis A vaccination is funded under the National Immunisation Program for Aboriginal and Torres Strait Islander children living in the Northern Territory, Queensland, South Australia and Western Australia at:

    • 18 months of age
    • 4 years of age.

    Vaccination is also recommended for certain high-risk groups, including people:

    • with medical risk factors
    • whose occupation or lifestyle increases their risk
    • who travel to areas where hepatitis A is endemic.

    See:

  • Other prevention measures include educating people about:

    • hand hygiene, especially after going to the toilet or touching soiled nappies or other items contaminated with body fluids
    • avoiding touching the face, mouth, eyes, or nose while providing care (such as childcare or disability care) or handling human waste and sewage
    • hygienic food handling – from production to consumption
    • appropriate food standards and safety
    • ensuring appropriate protections for occupational and lifestyle-related exposures.

Diagnosis and clinical management

  • Hepatitis A is diagnosed by detecting antibodies against hepatitis A virus in the blood of a person with symptoms.

    Nucleic acid amplification testing (such as PCR) can be used on blood or faecal samples.

  • Read more about laboratory testing and the laboratory case definitions.

  • There is no specific treatment for hepatitis A.

    Clinical management consists of supportive care, including:

    • rest
    • adequate fluid intake.

Notification and reporting

Public health response

  • The CDNA National guidelines for public health units inform the public health response to hepatitis A.

  • Public health units investigate all cases of hepatitis A. Case management focuses on:

    • determining the likely source of infection
    • identifying cases whose activities may put others at risk of infection, such as food handlers
    • ensuring control measures, including safe hand hygiene practices, to prevent further spread.

    Australia has low population immunity to the hepatitis A virus, so a single infected person could result in an outbreak. This is especially true for:

    • food handlers
    • childcare workers
    • healthcare workers
    • people who have anal sex.

    People with hepatitis A should be provided information about how to minimise the risk of infecting others, including advice to avoid:

    • preparing food or drink for other people
    • providing personal care to others
    • attending childcare, school or (if they may put others at risk) work
    • sharing utensils, towels or personal items with other people
    • having close contact (including sex) with others.

    Read more about how state and territory health department manage cases.

  • Public health units undertake contact tracing to:

    • identify all potential contacts
    • assess the susceptibility of contacts to infection
    • provide advice and public health education.

    Susceptible contacts may be considered for post-exposure prophylaxis (PEP) within 14 days of exposure to an infectious person. They may be offered:

    • hepatitis A vaccine
    • normal human immunoglobulin (NHIg).

    See the CDNA national guidelines for public health units for detailed guidance on how public health units manage contacts of hepatitis A cases.

  • How public health agencies respond to hepatitis A cases and outbreaks depends on:

    • state or territory legislation
    • local reporting requirements
    • the nature of the outbreak
    • available resources.

    Effective outbreak control depends on the setting and source of transmission. Below are examples of targeted control measures public health authorities may use for different scenarios.

    Cases in food handlers may involve:

    • excluding affected food handlers from work until medically cleared
    • offering PEP to close contacts within 14 days of exposure
    • deep cleaning and disinfecting food preparation areas and utensils
    • issuing public alerts, if necessary, to inform consumers and prevent further spread.

    Outbreaks in childcare and care-based facilities may involve:

    • keeping infected individuals away from others (if possible) until they are no longer infectious
    • offering PEP to close contacts within 14 days of exposure
    • reinforcing hygiene practices, including supervised handwashing after toileting and before meals
    • cleaning and disinfecting of high-touch surfaces and objects (such as toilets, toys, change tables, cutlery)
    • communicating with staff and families about symptoms, transmission risks, and the importance of early reporting.

    Contamination from widely distributed food products may involve:

    • recalling contaminated food products
    • issuing national or regional media alerts
    • coordinating with Food Standards Australia and New Zealand (FSANZ) and food distributors to trace and investigate supply chains
    • offering PEP to individuals who consumed the product within the past 2 weeks
    • displaying signage in retail outlets to alert consumers to monitor for symptoms.

    The CDNA National guidelines for public health units provide detailed information on how public health units should respond to hepatitis A outbreaks.

    In addition, OzFoodNet follows agreed guidelines to undertake multi-jurisdictional foodborne outbreak investigations.

  • Special situations and high-risk settings might require extra infection and control actions. These include:

    • childcare settings
    • schools
    • hospitals
    • work settings
    • if the case is a food handler
    • locally acquired cases in gay, bisexual and other men who have sex with men.

    See information about how public health units should respond to these situations.

Resources

References

  • 1 EC Shin EC and SH Jeong, ‘Natural history, clinical manifestations, and pathogenesis of hepatitis A’,Cold Spring Harbor Perspectives in Medicine, 2018, 8(9):a031708,doi:10.1101/cshperspect.a031708.
  • 2 WM Lednar, SM Lemon, et al., ‘Frequency of illness associated with epidemic hepatitis A virus infections in adults’,American Journal of Epidemiology, 1985, 122(2):226–233,doi:10.1093/oxfordjournals.aje.a114093.
  • 3 EJ Donnan, JE Fielding, et al., ‘A multistate outbreak of hepatitis A associated with semidried tomatoes in Australia, 2009’,Clinical Infectious Diseases, 2012, 54(6):775–781,doi:10.1093/cid/cir949.
  • 4 C O'Neill, N Franklin, et al., ‘Hepatitis A outbreak in Australia linked to imported Medjool dates, June–September 2021’,Communicable Diseases Intelligence, 2022, 46 (October),doi:10.33321/cdi.2022.46.68.
  • 5 BL Harney, B Whitton, et al., ‘Quantitative evaluation of an integrated nurse model of care providing hepatitis C treatment to people attending homeless services in Melbourne, Australia’,International Journal of Drug Policy, 2019, 72:195–198,doi:10.1016/j.drugpo.2019.02.012.
  • 6 N Cook, I Bertrand, et al., ‘Persistence of hepatitis A virus in fresh produce and production environments, and the effect of disinfection procedures: A review’,Food and Environmental Virology, 2018, 10(3):253–262,doi:10.1007/s12560-018-9349-1.
  • 7 D Leblanc, MJ Gagné, et al., ‘Persistence of murine norovirus, bovine rotavirus, and hepatitis A virus on stainless steel surfaces, in spring water, and on blueberries’,Food Microbiology, 2019, 84:103257,doi:10.1016/j.fm.2019.103257.
  • 8 Y Zhang, X Wang, et al., ‘Survival of hepatitis A virus on two-month stored freeze-dried berries’,Journal of Food Protection, 2021, 84(12):2084–2091,doi: 10.4315/jfp-21-110.
  • 9 PR Spradling, ‘Viral hepatitis’, in DL Heymann (ed), Control of communicable diseases manual, 20th edn, American Public Health Association, Washington, 2015.

We are adding new content to this website and expanding these pages, including a suite of disease-related information. In the meantime, information about diseases in Australia is available on the Department of Health, Disability and Ageing’s website.

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