Hepatitis A is a liver infection caused by hepatitis A virus (HAV) — transmitted by the fecal-oral route through contaminated food, water or close personal contact. Unlike hepatitis B and C, hepatitis A NEVER becomes chronic — every infection eventually resolves with complete recovery and lifelong immunity. However, the acute illness can be severe (especially in adults and those with pre-existing liver disease) and rarely causes fulminant hepatic failure requiring liver transplantation. An effective, safe, inexpensive vaccine provides lifelong protection.

How is hepatitis A different from hepatitis B and C?

Key differences: HAV: fecal-oral transmission (food, water, contaminated hands); acute self-limiting infection only (no chronic hepatitis A); full recovery with lifelong immunity; vaccine-preventable; treatment is supportive only. HBV: blood-borne and sexual transmission; can cause chronic infection (15-25% of cases — leading to cirrhosis and HCC); effective vaccine; antivirals for chronic infection. HCV: blood-borne; 55-85% become chronic (no vaccine); DAAs cure approximately 95% in 8-12 weeks.

Who is most at risk of severe hepatitis A?

Severity of HAV infection increases dramatically with age: children under 6 years — mostly asymptomatic (1-2% icteric disease); older children/young adults — symptomatic with jaundice in approximately 40-70%; adults — symptomatic and more severe. Special risk groups: people with pre-existing chronic liver disease (HBV, HCV, MASLD, alcoholic liver disease) have up to 1.8% risk of fulminant hepatitis A; immunocompromised individuals; pregnant women (higher risk of fulminant disease and preterm delivery). These high-risk groups should be prioritised for vaccination.

How is hepatitis A diagnosed?

Serology: Anti-HAV IgM — appears at the onset of symptoms, remains positive for 3-6 months; the diagnostic marker for acute HAV infection. Anti-HAV IgG — appears after anti-HAV IgM; indicates past infection or vaccination; provides lifelong protective immunity. PCR: detects HAV RNA in blood or stool — used in outbreak investigation and for early diagnosis before IgM is detectable.

What is the treatment for hepatitis A?

There is no specific antiviral treatment for hepatitis A — management is entirely supportive: rest; adequate hydration; avoiding hepatotoxic substances (alcohol, paracetamol at high doses, potentially hepatotoxic drugs). Most patients recover at home. Hospitalisation criteria: dehydration; inability to maintain oral intake; monitoring for signs of hepatic failure (encephalopathy, coagulopathy — rising INR despite clinical improvement). Fulminant hepatitis A: liver transplantation evaluation; intensive care support.

Is hepatitis A relevant to Georgia?

Yes — Georgia has intermediate HAV endemicity based on seroprevalence studies. This creates a particular risk pattern: older adults and urban residents may be seronegative and susceptible to severe disease if exposed. Food handlers, healthcare workers, travellers to high-endemicity areas, people with chronic liver disease, MSM and people who inject drugs should be prioritised for hepatitis A vaccination. Water, food safety and sanitation improvements are the long-term structural prevention measures.

How does GMJ News cover hepatitis A?

GMJ News covers WHO HAV burden data, the self-limiting vs chronic hepatitis distinction, hepatitis A vaccine evidence and WHO EML listing, fulminant hepatitis A risk groups, MSM outbreak epidemiology, and Georgian intermediate endemicity. Hepatitis A is directly relevant to PHIG's viral hepatitis elimination programme and the Georgian Medical Journal.

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Hepatitis A

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

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Hepatitis A — caused by hepatitis A virus (HAV) — causes an estimated 1.4 million symptomatic cases per year globally, with millions more mild or subclinical infections; unlike hepatitis B and C, HAV never causes chronic liver disease — acute infection resolves completely with lifelong immunity — but can cause rare fulminant hepatic failure (<1%, higher in those with pre-existing liver disease) (WHO). Hepatitis A is transmitted fecal-orally — through contaminated food, water and close personal contact — making it a disease of inadequate sanitation and food safety. Two doses of inactivated hepatitis A vaccine provide lifelong protection and are on the WHO Essential Medicines List. The Caucasus/Georgia region has intermediate-to-high HAV endemicity.

Key messages

1.4 million cases/year — entirely preventable

Hepatitis A causes approximately 1.4 million symptomatic cases and 11,000-40,000 deaths per year globally, primarily through fecal-oral transmission in areas with inadequate sanitation. Two doses of hepatitis A vaccine provide lifelong protection (WHO).

Never chronic — unlike HBV and HCV

HAV infection is always self-limiting — it never causes chronic liver disease. After acute infection (which may last weeks), patients recover completely with lifelong immunity. This distinguishes hepatitis A fundamentally from hepatitis B and C.

Higher severity in adults — lowest in children

In children under 6 years (the most commonly infected group in endemic areas), HAV infection is typically asymptomatic or mild. In older children and adults, symptomatic disease is common — with jaundice, severe fatigue and risk of fulminant hepatic failure increasing with age.

Fulminant hepatic failure risk

Approximately 1 in 1,000 HAV infections causes acute liver failure — rising to 1-2% in adults over 40 and up to 1.8% in those with pre-existing liver disease (HBV/HCV, MASLD). Fulminant hepatitis A may require liver transplantation.

Hepatitis A vaccine on WHO EML

The inactivated hepatitis A vaccine — requiring two doses 6-12 months apart — provides >94% protection lasting at least 25+ years (likely lifetime). WHO recommends hepatitis A vaccination in all settings with intermediate-to-high endemicity.

Caucasus/Georgia — intermediate endemicity

Georgia has intermediate HAV endemicity — vaccination is particularly important for food handlers, healthcare workers, travellers and all adults who are seronegative. Anti-HAV IgG seroprevalence surveys guide immunisation strategy.

Key statistics

~1.4M

symptomatic HAV cases/year (WHO estimate)

WHO

11-40K

HAV-related deaths per year

WHO

>94%

protection from 2-dose hepatitis A vaccine

WHO

25+yr

duration of hepatitis A vaccine protection (likely lifetime)

WHO

1.8%

fulminant hepatic failure risk in those with pre-existing liver disease

WHO

chronic HAV infections documented (always self-limiting)

WHO

Hepatitis A global endemicity by region — WHO classification

Source: WHO. Low-endemicity regions (older susceptible adults) can experience large outbreaks.

Glossary of key terms

Hepatitis A virus (HAV)
WHOA non-enveloped positive-sense RNA virus — family Picornaviridae, genus Hepatovirus. Single serotype (unlike influenza — no antigenic drift); stable in the environment. Excreted in faeces for 1-2 weeks before and 1 week after symptom onset.

Fecal-oral transmission
WHOHAV is transmitted by the fecal-oral route: ingesting food or water contaminated with infected faeces; eating raw shellfish (bivalve molluscs filter HAV from contaminated water); close personal contact with an infected person. Sexual transmission (particularly anal-oral contact in MSM): an increasingly recognised route in high-income countries.

Inactivated hepatitis A vaccine
WHO EMLFormaldehyde-inactivated whole virus vaccine — available as single antigen (Havrix, Avaxim, Vaqta) or combined with HBV (Twinrix). Two-dose schedule (0 and 6-12 months) provides >94% protection; likely lifelong. Well-tolerated; can be given to immunocompromised (inactivated vaccine).

Icteric hepatitis
WHO/ClinicalJaundice (yellowing of skin and eyes from bilirubin accumulation) — the classic hepatitis A presentation in adults. Preceded by 1-2 weeks of prodromal illness (malaise, anorexia, nausea, right upper quadrant discomfort, low-grade fever). Cholestatic hepatitis A: prolonged jaundice (months), often with intense pruritus — rare but self-limiting variant.

HRIG (Human immunoglobulin) post-exposure
WHOHepatitis A immunoglobulin can be given within 2 weeks of HAV exposure to prevent or attenuate disease in unvaccinated contacts — particularly important for immunocompromised individuals, those with liver disease, infants <12 months and pregnant women. Hepatitis A vaccine is an alternative for healthy adults ≤40 years exposed within 2 weeks.

MSM HAV outbreaks (high-income countries)
WHO/ECDCSince 2016, large HAV outbreaks have affected MSM (men who have sex with men) in the US and Europe — with hundreds of cases in previously low-endemicity settings. Anal-oral sexual contact is the primary transmission route. WHO/ECDC recommend hepatitis A vaccination for all sexually active MSM.