Hepatitis A is spread by people with an active infection, even though they may not have symptoms. The virus commonly spreads from the stool of one person to the mouth of another. This can occur when an infected person uses the bathroom, does not wash his or her hands, and then handles food that others will eat. Or the virus can be waterborne, meaning it is picked up from contaminated water or by eating contaminated raw shellfish. The virus can also be spread through the saliva, blood, and other bodily fluids of a person with the infection, such as through anal sex. Hepatitis A is contagious for two to three weeks before symptoms appear, then for two to three weeks afterward. Treatment includes bed rest, a balanced diet, and avoidance of alcohol and certain medications that could affect the liver for at least 6 months. Hospitalization is only necessary for more serious cases, or for severe dehydration. Persons known to have been exposed to hepatitis A are recommended an injection of a substance called immune globulin, which can reduce the symptoms of hepatitis A. There is also a vaccine available that may provide years of protection against hepatitis A. The vaccine is usually given to people who will be traveling in areas where there is a high risk of contracting hepatitis A, or work in high risk areas, such as healthcare.