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Hepatitis A

Recent Increase in Cases of Hepatitis A Among Men Who Have Sex with Men

There has recently been an increase in cases of hepatitis A in New York City among gay, bisexual and other men (MSM) who have sex with men. Hepatitis A can be prevented with a safe and effective vaccine. MSM and people in their sexual health networks should consider getting vaccinated.

If you think you may be at risk, talk to your health care provider about getting vaccinated against hepatitis A. You can also visit the Health Department’s Sexual Health Clinics or the Immunization Clinic or find other vaccination sites on the NYC Health Map. The vaccine requires two doses.

Hepatitis A is caused by a virus that infects and can damage the liver. It is usually passed from one person to another through contaminated food or water, or through sexual contact. Hepatitis A can sometimes lead to hospitalization. In rare cases, it can lead to severe liver problems or death.

You can avoid infection by getting vaccinated and regularly washing your hands with soap.

If you think you may have hepatitis A, your doctor can check with a blood test.

Prevention and Care

The hepatitis A virus enters the body through the mouth and is passed in the stool (feces). It can be carried on an infected person’s hands and spread through direct and indirect contact, such as by eating food that was handled by an infected person. Hepatitis A may also be transmitted if someone is exposed to stool during sexual activity.

Infected people are most likely to spread the virus in the two weeks before symptoms appear and in the first week with symptoms.


You can avoid infection and transmission by:

  • Getting vaccinated.
  • Washing your hands with soap regularly, especially before touching food, after using the bathroom or changing diapers, and when taking care of someone with hepatitis A infection.
  • Waiting two weeks after diarrhea to engage in sexual practices that result in hand or mouth contact with stool (anal sex, fingering, rimming). Wash your buttocks, penis, and any sex toys with soap and water before and after these activities. A dental dam during rimming also provides protection (condoms prevent other sexually transmitted infections, including HIV, but may not prevent hepatitis A).
  • Using bottled water or boiling tap water for one minute if you are in a country where hepatitis A is common, including countries in the Caribbean, Central and South America, Africa, Eastern Europe and parts of Asia. You should also avoid eating shellfish that may have come from a contaminated water source in these countries.


For lasting protection against hepatitis A, you should get two doses of the vaccine at least six months apart.

The U.S. Centers for Disease Control and Prevention (CDC) recommends routine hepatitis A vaccination of all children between ages 1 and 2 years. In NYC, all children and adolescents not previously vaccinated should receive the two-dose hepatitis A vaccine series by their 19th birthday for lifetime protection. In addition, you should get vaccinated if:

  • You are traveling to a country with a high rate of hepatitis A. This includes countries in the Caribbean, Central and South America, Africa, Eastern Europe and parts of Asia. You are best protected if you take the first dose at least a month before travel, but the vaccine will still provide protection if you get the first dose two weeks before travel.
  • You work with the hepatitis A virus in a laboratory.
  • You are a man who has sex with men.
  • You have existing chronic liver disease.
  • You use injection or non-injection drugs.
  • You are living on the street, in a shelter, or otherwise do not have a permanent address.
  • You are living with HIV.

You should also consider getting vaccinated if there is an outbreak of the infection in your community.

Studies have not found an increased risk of hepatitis A for people working in certain specific industries, including food service, health care and child care. However, the type of work done in these industries increases the risk of workers transmitting hepatitis A to the people they serve. People who work in these industries should consider vaccination to reduce this risk, especially if they are in a community experiencing an ongoing outbreak.

If you think you may be at risk for hepatitis A, talk to your health care provider about getting vaccinated.


Symptoms of hepatitis A can appear between two and seven weeks after exposure. Most people start experiencing symptoms about one month after being exposed, including:

  • Jaundice (yellowing of eyes and skin)
  • Fatigue
  • Abdominal pain
  • Nausea
  • Diarrhea

Not everyone who is infected will have all of these symptoms.

Symptoms can become severe and lead to hospitalization or death, but most people get better within a few weeks. Less than 1% of cases result in death. People who have chronic liver disease or a weakened immune system are at a higher risk for serious illness.

Infants and young children tend to have very mild symptoms and are less likely to develop jaundice than older children and adults.


There is no treatment for hepatitis A once symptoms appear, but most people fully recover on their own by resting and not drinking alcohol. People with hepatitis A should also avoid taking drugs that can hurt their liver, such as acetaminophen or Tylenol.

If you have had hepatitis A and recovered from the disease, you are now immune and can never get infected again or spread the virus.

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