How is Hepatitis A primarily transmitted?

Hepatitis A is primarily transmitted through the fecal-oral route, which includes ingestion of contaminated food or water, and contact with stools of infected individuals. This transmission method occurs most commonly when proper sanitation is not maintained, such as during food preparation or when drinking unclean water. Outbreaks often happen in areas with poor sanitation or during situations where food handlers are infected.

While direct contact with infected individuals can pose a risk, particularly through close personal interactions, it is the consumption of contaminated food or water that remains the most significant means of transmission in the general population. Furthermore, the other options mention transmission methods that are either less common for Hepatitis A or not applicable at all, such as blood transfusions or contamination from surfaces, which are more relevant to other types of hepatitis or infections.