Hepatitis A virus spreads by the fecal-oral route, principally through fecal contamination of hands, food, or water. Many outbreaks of the disease have originated from restaurants because food handlers who carried the virus failed to wash their hands. Eating raw shellfish is a frequent source of infection since these animals concentrate the hepatitis A virus from fecally polluted seawater. A high percentage of hepatitis A occurs in low socioeconomic groups of people because of crowding and inadequate sanitation. Other groups at high risk of hepatitis A include attendees of day care centers and nursing homes, and homosexual men. Infants and children with hepatitis A can eliminate the virus in their feces for several months after symptoms begin, but the amount of virus in feces usually drops markedly with the appearance of jaundice.
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