Key messages

  • Victoria is currently experiencing a significant outbreak of hepatitis A and case numbers are rising. There are many reasons why people in Victoria have become infected with hepatitis A, with some people having multiple risk factors.

  • Most cases of hepatitis A in Victoria are occurring in four risk groups: men who have sex with men (MSM); people who inject drugs; people who are homeless and sleeping rough; and adult prisoners. These cases are referred to as 'outbreak cases'.

  • Cases are also occurring in returning international travellers (or their household contacts) from countries with circulating hepatitis A, and after the consumption of imported frozen pomegranates. In some cases it is not possible to determine the likely source of infection.

  • The most important and effective action to protect against hepatitis A is to get vaccinated. Vaccination involves two injections spaced six months apart. Protection begins within weeks of having the first vaccine injection, with lifelong protection probably occurring after the second injection.

  • A free hepatitis A vaccine is available in Victoria until 31 December 2018 for all MSM, people who have injected drugs in the past 12 months, homeless people who are sleeping rough. and adult prisoners .

  • Victorians should consider hepatitis A vaccination prior to travelling overseas, especially those in occupations with a higher risk for further spread; for example, food handlers, healthcare workers and those who live or work in institutional settings.

  • In patients presenting with a compatible illness, hepatitis A infection should be considered and blood should be taken for serology (IgM). These people should avoid sexual activity and preparing food for others while results are pending.

  • Hepatitis A is a Group A notifiable condition, with all suspected or confirmed cases requiring immediate notification to the Department of Health and Human Services by calling 1300 651 160.  This allows for precautionary infection control measures. When infection is confirmed, the department can also ensure there is timely post-exposure prophylaxis given to contacts.

What is the issue?

Since March 2017 there has been an ongoing outbreak of hepatitis A in Victoria resulting in the largest number of notified cases in a 12 month period for almost a decade.

Most cases are occurring in four population groups: men who have sex with men (MSM); people who inject drugs; homeless people who are sleeping rough; and adult prisoners. Many cases in this outbreak appear to have more than of these risk factors.

Cases continue to occur in overseas travellers who have not been vaccinated against hepatitis A, including in MSM travellers. Some of these travellers have returned from countries where the disease is common, and others have visited countries in Europe and North America where there are hepatitis A outbreaks occurring currently.

There are also hepatitis A infections linked to the consumption of certain frozen pomegranates that were imported from overseas. More information on that outbreak is available on the Food Standards Australia New Zealand website.

Between 10 March 2017 and 25 May 2018 there have been 152 outbreak cases of hepatitis A and 47 non-outbreak cases, most of whom have acquired their infection overseas.

Figure 1: Hepatitis A cases by fortnight of onset and outbreak status, Victoria, 1 January 2017 to 25 May 2018

Hepatitis A cases by fortnight of onset and outbreak status, Victoria, 1 January 2017 to 25 May 2018

What are the symptoms of hepatitis A?

Adults who get hepatitis A usually develop symptoms, which include fever, nausea, vomiting and abdominal discomfort, followed by dark urine and yellow skin/eyes (also known as jaundice). Sometimes only some of these symptoms are present. Symptoms may last for several weeks, but full recovery usually occurs.

Symptoms of hepatitis A infection take between 15 to 50 days to develop after exposure, and on average around four weeks after exposure.

Hepatitis A does not cause long term liver disease, but can be more severe in people with other conditions such as hepatitis B, or hepatitis C or HIV. Hepatitis A can be fatal in up to 2 per cent of cases in people aged over 50 years.

Up to 30 per cent of adults and 70 per cent of children under the age of five show no symptoms at all, however they are still capable of spreading hepatitis A.

How is hepatitis A transmitted?

Hepatitis A usually spreads through ingestion of virus from food, drink or objects contaminated by small, undetected amounts of stool (poo) from an infected person. It can also spread through close contact with an infected person, for example through sex or through caring for a person who is infectious with hepatitis A.

Symptoms of hepatitis A infection take between 15 to 50 days to develop after exposure, and on average around four weeks after exposure.

People with hepatitis A are usually infectious to others from two weeks prior to developing symptoms, and up until one week after yellowing of the eyes or skin (jaundice).

What is the treatment for hepatitis A?

There is no specific treatment for hepatitis A. In most cases, the immune system will clear the infection and the liver will completely heal. Treatment aims to ease symptoms and reduce the risk of complications. Treament options may include:

  • rest - hepatitis A can make a person tired and have less energy for day-to-day life, so rest when necessary
  • eating small meals more often - nausea can affect the ability to eat and can contribute to tiredness, so eat high-calorie foods if nausea is a problem
  • protecting the liver - the liver processes medication and alcohol, so infected people should avoid alcohol and review any medication with a doctor.

How can hepatitis A be prevented?

The most important and effective action to protect against hepatitis A - particularly for those at higher risk - is to get vaccinated.

The inactivated hepatitis A vaccine is highly effective and induces nearly 100 per cent protection within four weeks after vaccination. Receiving a second dose, given at least six months later, provides lifelong immunity.

Free hepatitis A vaccine is available in Victoria until 31 December 2018 for all MSM, people who have injected drugs in the past 12 months, homeless people who are sleeping rough, and adult prisoners. The vaccine should be offered to all patients from these groups.

Practising good personal hygiene can reduce the spread of hepatitis A, especially in food handlers. This means everyone should:

  • wash their hands thoroughly in soap and running water after visiting the toilet, before eating and before handling food
  • wash their hands and their lower areas after sex
  • make sure they're using condoms and changing condoms between any sexual activity.

People who inject drugs can reduce the spread of hepatitis A by:

  • not sharing or re-using needles, spoons, swabs, water or any other equipment
  • taking special care when injecting in groups, or when being injected by others
  • labeling or marking their syringes
  • washing their hands in warm soapy water before and after injecting, and swabbing the injection site with alcohol swabs
  • not recappng someone else's needles when using in groups or injecting others.

Who is at risk and who should be vaccinated?

All Victorians who have never had HAV infection or have not received two-doses of the hepatitis A vaccine are potentially at risk.

The following groups are at increased risk for hepatitis A infection and are recommended to receive hepatitis A vaccination:

  • men who have sex with men (MSM)
  • people who inject drugs
  • homeless people who are sleeping rough
  • adult prisoners
  • travellers to countries where hepatitis A is endemic
  • people at higher risk due to their occupation; for example, staff working in early childhood education and care, carers of persons with developmental disabilities, plumbers and sewage workers
  • people with developmental disabilities and susceptible carers
  • people with chronic hepatitis B infection, chronic hepatitis C infection, chronic liver disease and liver solid organ transplant recipients.

MSM who attend sex-on-premises venues appear to be at particular risk, although attendance at such venues accounts for only a small proportion of all MSM cases. MSM travellers to countries with current outbreaks including many countries in Europe and North America are also at particular risk.

Cases that occur in people in high risk settings including food handlers, healthcare workers and in institutional settings are of particular public health concern due to the risk of transmission to others.

More information for health professionals on general recommendations for hepatitis A vaccination can be found in the Australian Immunisation Handbook.

Who is eligible for free vaccination?

A free hepatitis A vaccine is available until 31 December 2018 in Victoria to:

  • men who have sex with men (MSM)
  • people who inject drugs
  • homeless people who are sleeping rough
  • adult prisoners

If you are a Victorian immunisation provider and wish to order vaccine for eligible patients, please use the online vaccine order form.

Factsheets for health professionals and immunisation providers

Free vaccines, including hepatitis A vaccine, for men who have sex with men

Free vaccines, including hepatitis A vaccine, for people who inject drugs

Free vaccines, including hepatitis A vaccine, for homeless people who are sleeping rough

Free vaccines for men who have sex with men - online campaign 

The Department of Health and Human Services is conducting an online campaign to promote four free vaccines to Victorian MSM until 31 December 2018.

See the campaign on the Better Health Channel.

Advice for health professionals 

  • Offer the free, two-dose hepatitis A vaccine to all MSM, people who inject drugs, homeless people who are sleeping rough, and adult prisoners.
  • Report all administrations of hepatitis A vaccine to the Australian Immunisation Register.
  • If your patient presents with symptoms compatible with hepatitis, in addition to the usual tests include a request for serology (IgM) for hepatitis A.
  • While waiting for results of hepatitis A testing, advise your patient to avoid sexual activity.
  • If your patient is a food handler,  child care worker or healthcare worker, advise them to not prepare food for others while wait for results of hepatitis A testing.
  • If hepatitis A is confirmed, your patient should not: engage in any sexual activity; prepare food or drink for others; share utensils; provide personal care for others; share linen or towels; or donate blood until one week after the onset of jaundice; or if no jaundice was present, two weeks after the onset of symptoms.
  • If you suspect acute viral hepatitis, notify the department immediately by calling 1300 651 160. This will assist with patient assessment, consideration of public health control measures and will enable rapid post-exposure prophylaxis for close contacts.

More information

For more information please contact the department's Communicable Disease Prevention and Control section.

Resources for health professionals

Disease information and advice - hepatitis A - Department of Health and Human Services
Online vaccine order forms
Important health information for men who have sex with men: a guide for health professionals and immunisation providers
Important health information for people who inject drugs: a guide for health professionals and immunisation providers
Important information for homeless rough sleepers
Food standards - Hepatitis A and frozen pomegranate FAQs

Information for consumers

Better Health Channel: Time to Immunise
Hepatitis A - Better Health Channel