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Hepatitis A infection is more severe in older children and adults1,2

Jaundice is more frequent in older children and adults with hepatitis A3

Jaundice frequency graph

The same results were first published in Franco et al. 20123
The graph has been independently created by GSK from the original data

Symptoms of acute hepatitis A range from mild to severe1–4

Thermometer Icon


Jaundice Icon


Malaise Icon


Loss of appetite

Loss of appetite3

Abdominal pain and Nausea

Abdominal pain and nausea4

Dark urine and diarrhoea

Dark-coloured urine and diarrhoea2

Though rare, fulminant hepatitis may result in death4

How is hepatitis A transmitted?

Hepatitis A virus is transmitted primarily via the faecal–oral route as a result of:2,4–6

  • Poor sanitation
  • Contaminated food or water
  • Sexual contact

The hepatitis A virus is mainly spread when a susceptible person ingests food or water that has been contaminated with the faeces of an infected person2

Food contamination occurs mostly through:1,7–9

  • Raw or partially cooked fruit or vegetables
  • Ice cubes made from contaminated water
  • Shellfish which can ingest and concentrate HAV and become a reservoir for its spread
  • Globalisation is expected to increase the number of foodborne outbreaks in high-income countries

Higher rates of access to a safe drinking water source are associated with a lower HAV incidence rate. Hepatitis A has an unusual risk profile because a lower incidence rate can raise the number of symptomatic cases occurring in a population by postponing the age at which the typical individual contracts the virus9

Burden of hepatitis A for individuals and on society

Every year, around 1.5 million hepatitis A infections are reported around the world.1 However, it is assumed that many cases go unreported and therefore the true number of infections may be over 100 milllion.1 HAV infections represent a considerable burden to the community and wider society resulting in indirect costs through absenteeism from work, reduced productivity and loss of future income following deaths from hepatitis A4,10,11

At the societal level, hepatitis A outbreaks can have significant economic impacts through disrupted trade and tourism.11 HAV is responsible for a significant burden on healthcare resources, including hospitalisations and treatment costs4,10,11

What is the current epidemiology of hepatitis A and how is it changing?

The prevalence of HAV infection varies across geographical regions with low endemicity in the European region,5 and intermediate or high endemicity in most of Central and South America, parts of Africa and Asia.8 However, most low- and middle-income countries are shifting, or are expected to shift toward, lower risk of HAV infection and therefore toward lower endemicity in the coming years9

The global prevalence of hepatitis A in 20159,12

Global prevalence map

The same data were published in Jacobsen 20189 and reproduced in Jefferies et al. 201812
The figure has been independently created by GSK from the original data

Is Hepatitis A only a problem for the developing world?

No. Hepatitis A is also a problem in the developed world. Recent outbreaks of hepatitis A have occurred in multiple states in the USA13 and in multiple countries in Europe14–17

Vaccinating children with Havrix can offer up to 50 years long term protection and help prevent sever hepatitis A disease later in life18, 19

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USA flag

Recent outbreaks in the USA since 201613

  • >40,000 cases
  • >25,000 hospitalisations
  • This is equivalent to a 61% hospitalisation rate

Overall, reports of hepatitis A cases increased by 294% during 2016–2018 compared with 2013–201518

  • Between 2016 and 2018, 15,000 reports of HAV infections from U.S. states and territories were made to the CDC18
  • Since the outbreaks were first identified in 2016, 36 states have publicly reported >40,000 cases of hepatitis A13
  • The consumption of imported HAV-contaminated food has also contributed to some of these reports18,19
  • The increase in reports of hepatitis A infections during 2016–2018, when compared to 2013–2015, were mostly related to outbreaks associated with contaminated food items, outbreaks in MSM and amongst people experiencing homelessness or who report drug use.18 This increase in incidence of hepatitis A emphasises the need for increasing vaccination in at-risk groups to potentially halt ongoing outbreaks and prevent future outbreaks from occurring18
European Flag

The hepatitis A virus is still circulating in Europe and has been linked to outbreaks:15

  • Between January 2013 and August 2014, a European multi-country outbreak of hepatitis A, likely caused by contaminated frozen berries, was reported. During this outbreak, most cases (1,438) were reported from Italy14,15
  • In 2017, there was a recorded outbreak of over 4,000 cases that mainly affected men who have sex with men, with the highest numbers recorded in Spain and Italy15
  • From January to June 2018, two ongoing hepatitis A outbreaks affected travellers returning from Morocco and there were cases in Europe without travel history, resulting in 163 cases in eight European countries16
  • Due to low seroprevalence in most European countries, substantial proportions of the population are vulnerable to HAV infections and associated complications15

CDC, Centers for Disease Control and Prevention; HAV, hepatitis A virus


  1. World Health Organization (WHO). WHO immunological basis for immunization series. Module 18: Hepatitis A. Available at: (Accessed April 2023). 
  2. World Health Organization (WHO). Hepatitis A key facts. Available at: (Accessed April 2023).
  3. Franco E et al. World J Hepatol 2012; 4:68–73.
  4. Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases (The Pink Book). 14th Edition. 2021. Public Health Foundation, Washington, D.C.; p.125–142.
  5. World Health Organization. Wkly Epidemiol Rec 2022; 97:493–512.
  6. Centers for Disease Control and Prevention (CDC). Hepatitis A questions and answers for health professionals. Available at: (Accessed April 2023).
  7. Fiore AE. Clin Infect Dis 2004; 38:705–715.
  8. Centers for Disease Control and Prevention (CDC). The Yellow Book. Chapter 4: travel-related infectious diseases – hepatitis A. Available at: (Accessed April 2023).
  9. Jacobsen K. Cold Spring Harb Perspect Med 2018; 8:a031716.
  10. World Health Organization (WHO). The global prevalence of hepatitis A virus infection and susceptibility: a systematic review. Available at: (Accessed April 2023). 
  11. Jacobsen K et al. Vaccine 2010; 28:6653–6657.
  12. Jefferies M et al. World J Clin Cases 2018; 6:589–599.
  13. Centers for Disease Control and Prevention (CDC). Widespread person-to-person outbreaks of hepatitis A across the United States. Available at: (Accessed April 2023)
  14. European Centre for Disease Prevention and Control (ECDC). Outbreak of hepatitis A in EU/EEA countries. Available at: (Accessed April 2023).
  15. Andani A et al. J Viral Hepat 2023; doi:10.1111/jvh.13821.
  16. Gassowski M et al. Euro Surveill 2018; 23:1800329.
  17. O’Connor L et al. Epidemiol Infect 2018; 146:705–711.
  18. Agrawal A et al. Infect Dis Ther 2020;9:785 - 796.
  19. Havrix SmPC August 2023.

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PM-RCH-HAV-WCNT-230002 | Date of preparation: Noember 2023