Distribution and Transmission Hepatitis A is present in all countries with poor sanitation and public hygiene. Hepatitis A is spread through contaminated food and water, particularly shellfish, or person to person contact when poor hygiene is an issue. Travellers from countries where hygiene is good are at risk because few would have developed immunity from pre-exposure. Signs and Symptoms: Hepatitis A has an incubation period of 3 – 6 weeks. The number of people infected with Hepatitis A who exhibit symptoms is less than 10%. The symptoms experienced by these people can include mild fever, an upset stomach, sometimes a rash, nausea/vomiting and diarrhea. These symptoms are followed by jaundice and itching. Once jaundice is established patients usually feel better by themselves.