Hepatitis A (HAV)

Unknown HAV immune status

Diagnostic HAV markers and disease stages

ALT (elevated)
anti-HAV IgM +
anti-HAV IgG** -
anti-HAV total** +
HAV RNA +
Symptoms -

* Detection of serum IgM antibodies in the absence of clinical symptoms may reflect prior hepatitis A infection with prolonged persistence of IgM, a false positive result, or asymptomatic infection (which is more common in children <6 years of age than older children or adults). People who test positive for anti-HAV IgM more than 1 year after infection have been reported.

** These markers will also be detected after receiving the HAV vaccine, so they may be used to determine whether a person has developed immunity after vaccination. (…) = potentially present

ALT elevated
anti-HAV IgM +
anti-HAV IgG** (+)
anti-HAV total** +
HAV RNA (+)
Symptoms +

* Detection of serum IgM antibodies in the absence of clinical symptoms may reflect prior hepatitis A infection with prolonged persistence of IgM, a false positive result, or asymptomatic infection (which is more common in children <6 years of age than older children or adults). People who test positive for anti-HAV IgM more than 1 year after infection have been reported.

** These markers will also be detected after receiving the HAV vaccine, so they may be used to determine whether a person has developed immunity after vaccination. (…) = potentially present

ALT normal
anti-HAV IgM (+)*
anti-HAV IgG** +
anti-HAV total** +
HAV RNA -
Symptoms -

* Detection of serum IgM antibodies in the absence of clinical symptoms may reflect prior hepatitis A infection with prolonged persistence of IgM, a false positive result, or asymptomatic infection (which is more common in children <6 years of age than older children or adults). People who test positive for anti-HAV IgM more than 1 year after infection have been reported.

** These markers will also be detected after receiving the HAV vaccine, so they may be used to determine whether a person has developed immunity after vaccination. (…) = potentially present

Adapted from:

  1. Pischke S and Wedemeyer H. Hepatitis A. In: Hepatology - A clinical textbook (10th ed.). Medizin Fokus Verlag;2020. [Internet; updated 2020; cited 2023 Nov 14]. Available from: https://www.hepatologytextbook.com/.
  2. Hollinger FB, et al. Hepatitis A virus. In: Fields Virology. Knipe, D.M., Howley, P.M. (eds), 5th ed., Lippincott Williams and Wilkins, Philadelphia, USA; 2017.
  3. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Viral Hepatitis Serology Training, Hepatitis A. [Internet; updated 2015 Nov 25; cited 2024 Mar 5]. Available from: https://www.cdc.gov/hepatitis/resources/professionals/training/serology/training.htm.
  4. Salete de Paula V. Laboratory diagnosis of hepatitis A. Future Virol. 2012;7:461-472.
  5. World Health Organization (WHO). The immunological basis for immunization series: module 18: hepatitis A. [Internet; updated 2011 Feb; cited 2024 Mar 5]. Available from: https://apps.who.int/iris/handle/10665/44570.
  6. Roque-Afonso AM, et al. Hepatitis A virus: serology and molecular diagnostics. Future Virology. 2010;5:233-242.
  7. Hadem J and Manns MP. Immune Response to Hepatitis A and E Viruses. Role in Disease Pathogenesis and Viral Elimination. In: Gershwin, ME, Manns M., Vierling JM, editors. Liver Immunology Principles and Practice. Totowa, NJ: Humana Press Inc; 2007.
  8. Stapleton JT. Host Immune Response to Hepatitis A Virus. J Inf Dis. 1995;171(suppl 1):S9-S14.
Product Description Tests Product page
Elecsys® Anti-HAV IgM a) Qualitative detection of IgM antibodies to HAV in human serum and plasma 100
Elecsys® Anti-HAV IgM b) 300
Elecsys® Anti-HAV II a) Qualitative detection of total (IgM and IgG) antibodies to HAV in human serum and plasma 100
Elecsys® Anti-HAV II b) 300
cobas® DPX c) Direct qualitative detection of HAV genotypes I, II, and III RNA in human plasma 96

a) for use on the cobas® e 411 analyzer and the cobas® e 601 / 602 modules;
b) for use on the cobas® e 402 and cobas® e 801 analytical units
c) in-process test of plasma intended for further manufacture collected from donors of whole blood, blood components, or plasma; not intended for use as an aid in diagnosis for HAV; for use on the cobas® 6800/8800 Systems

anti-HAV IgM anti-HAV total Results indicate
positive not performed or positive Acute or recent HAV infection
negative* positive No active infection but previous HAV exposure; has developed immunity to HAV or was recently vaccinated for HAV; no further testing required
not performed positive Has been exposed to HAV, but does not rule out acute infection
not performed or negative negative No current or previous HAV infection; vaccination may be recommended if at risk

* Approximately 3 % of HAV-infected people will be IgM negative if blood is drawn on or before the day of onset of jaundice. Suspicious cases with negative IgM results from such early samples should be retested in 4 – 7 days to rule out the diagnosis.7

Adapted from:

  1. Nelson NP, et al., Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020;69(5):1-38.
  2. Hollinger FB, et al. Hepatitis A virus. In: Fields Virology. Knipe, D.M., Howley, P.M. (eds), 5th ed., Lippincott Williams and Wilkins, Philadelphia, USA; 2017.
  3. Salete de Paula V. Laboratory diagnosis of hepatitis A. Future Virol. 2012;7:461-472.
  4. World Health Organization (WHO). The immunological basis for immunization series: module 18: hepatitis A. [Internet; updated 2011 Feb; cited 2024 Mar 5]. Available from: https://apps.who.int/iris/handle/10665/44570.
  5. Roque-Afonso AM, et al. Hepatitis A virus: serology and molecular diagnostics. Future Virology. 2010;5:233-242.
  6. Hadem J and Manns MP. Immune Response to Hepatitis A and E Viruses. Role in Disease Pathogenesis and Viral Elimination. In: Gershwin, ME, Manns M., Vierling JM, editors. Liver Immunology Principles and Practice. Totowa, NJ: Humana Press Inc; 2007.
  7. Stapleton JT. Host Immune Response to Hepatitis A Virus. J Inf Dis. 1995;171(suppl 1):S9-S14.
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Step 1

Perform anti-HAV total antibodies test

anti-HAV total antibodies test
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Step 2

Perform anti-HAV IgM test

anti-HAV IgM test
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Summary

No current or previous HAV
Vaccination may be recommended for person at increased risk for HAV infection.

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Summary

No active infection but previous HAV exposure or vaccination
A positive test for total anti-HAV indicates immunity to HAV infection but does not differentiate current from previous HAV infection.

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Summary

Acute or recent HAV infection
Consider supportive care and surveillance of signs and symptoms. No specific treatment exists for acute hepatitis A infection.

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Next Restart simulation
Step
Result
Interpretation
1
anti-HAV total antibodies test = ...
waiting for input
1
anti-HAV total antibodies test = negative
No current or previous HAV infection
1
anti-HAV total antibodies test = positive
Perform anti-HAV IgM test
2
Antibodies test = ...
waiting for input
2
anti-HAV IgM test = positive
Acute or recent HAV infection
2
anti-HAV IgM test = negative
No active infection but previous HAV exposure or vaccination
End of test sequence