Symptoms usually take about four weeks (with a range of fifteen to fifty days) to appear after infection with hepatitis A. Fewer than one in ten children below the age of three develops symptoms, whereas most adults become symptomatic. Symptoms usually start abruptly with muscle aches, headache, fatigue, malaise, loss of appetite, nausea, and vomiting. Occasionally a period of fever and muscle aches occurs before the onset of acute infection. Diarrhea usually follows. Jaundice, darkening of the urine, and lightening of the color of the stools usually come later in the course of the illness. Liver swelling leading to abdominal pain is also common. Some experience a sore throat. Most people resolve the infection within several weeks to two months after becoming symptomatic. On rare occasions symptoms may briefly recur a short time after the initial infection and then resolve completely.
The symptoms are very similar when a person becomes infected with and symptomatic from other types of viral hepatitis, such as hepatitis B and C. Fatalities are less common for hepatitis A than B during this acute phase, however, with fewer than 0.2 percent of those infected dying from hepatitis A. Fatalities are more common among people older than fifty years; especially vulnerable are people with underlying liver problems or other medical problems. Because of this, it is especially important for people with liver problems from other causes to receive a hepatitis A vaccine.
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