Risk is greatest for those who live in or visit rural areas, trek in backcountry areas, or frequently eat or drink in settings with poor sanitation. Cases of travel-related hepatitis A can occur in travelers to developed and developing countries and who have standard tourist accommodations, eating behaviors, and itineraries. Hepatitis A is among the most common vaccine-preventable infections acquired during travel. Infants and children can shed virus for up to 6 months after infection. Viral excretion and the risk for transmission diminish rapidly after liver dysfunction or symptoms appear, which is concurrent with the appearance of circulating antibodies to HAV. People are most infectious 1–2 weeks before the onset of clinical signs and symptoms of jaundice or elevation of liver enzymes, when virus concentration is greatest in the stool and blood. Recent large-scale outbreaks have been caused by common-source food exposures (e.g., frozen berries, fresh fruit and vegetables, seafood) and through person-to-person spread among people experiencing homelessness and people who use injection and non-injection drugs. HAV can be transmitted from raw or inadequately cooked foods contaminated during growing, processing, or distribution, and through contamination by an infected food handler. Heat inactivation must occur at temperatures >185☏ (>85☌) for 1 minute. Freezing does not inactivate the virus, and HAV can be transmitted through ice and frozen foods. HAV can survive in the environment for prolonged periods at low pH. HAV is transmitted through direct person-to-person contact (fecal–oral transmission) or through ingestion of contaminated food or water. Hepatitis A virus (HAV) is a nonenveloped RNA virus classified as a picornavirus. For more information, please visit CDC's Test Directory webpage. A clinical laboratory certified in moderate complexity testing state health department or for testing at CDC.
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