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Hepatitis A Prevention for Travelers

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What Are the Symptoms? | What Puts You at Risk? | Vaccine Recommendations | Vaccine Limitations | How Else Can You Protect Yourself? | What Should You Do Before Traveling?

Hepatitis A is a liver infection caused by the hepatitis A virus. The virus is contagious and can be found in the stool of an infected person. This is a concern for travelers because one way it can be spread is by consuming contaminated food or drinks. For example, if a cook with hepatitis A does not wash his hands properly after going to the bathroom, the virus can be spread to the meal being prepared or to an object, like a cup or fork. Contamination however, can happen anywhere along the way, from the fields where vegetables are irrigated with polluted water to a restaurant that has poor sanitation.

What Are the Symptoms?

If you do become infected with the virus, it can cause a range of flu-like symptoms like fever, fatigue, or stomach pain. Hepatitis A can also cause jaundice, a yellowing of the skin and eyes. School-aged children and adults usually have symptoms, while very young children may not have any. In most cases, the virus goes away within 2-5 weeks, and the person makes a full recovery. But for some, the symptoms keep coming back and can last up to nine months. In rare cases, liver failure and death can result.

What Puts You at Risk?

Traveling to certain regions does put you at a higher risk. The highest rates of hepatitis A are in Africa and India. High rates of the disease also exist in Mexico, Central and South America, Asia, the Middle East, and the Caribbean. Keep in mind that developed countries are not immune to outbreaks of hepatitis A.

How you travel, where you stay, and how long you stay also affect your level of risk. Do you have an adventurous trip planned, like following a guide through an African National Park to see the wildebeest migration? Or will you be pampered in a thatched-roof villa with white sand beaches right outside the door? While you may feel more secure about the safety of your meals at a five-star hotel, there have been cases of hepatitis A at top tourist destinations.

Take for example this real-life scenario: A waitress at a hotel and resort in New Zealand, a country that has a low incidence of hepatitis A, was diagnosed with the virus. The public health authority estimated that she could have exposed thousands of guests to the virus during the incubation period, a 3-5 week period before any symptoms appear. This is when the virus is the most contagious. The concern was that many of the guests had since returned home, unaware of their exposure. If they did have the virus and were not treated in time, it could have a ripple effect, spreading to family members, coworkers, and people in the community.

Vaccine Recommendations

The good news is that there is a vaccine for hepatitis A. This highly effective vaccine contains an inactivated form of the virus, which means it will not make you sick. You can get the vaccine as soon as you know your plans, but keep in mind a second dose is needed six months later. This will give you long term protection. With appropriate time, the vaccine will stimulate your own immune system to protect you against hepatitis A.

In healthy adults, the US Centers for Disease Control and Prevention (CDC) recommends vaccination for the following:

  • Travel to countries with medium to high rates of hepatitis A infection regardless of purpose or length of stay, as soon as travel is considered.
  • All unvaccinated household members in cases of international adoption, ideally two weeks or more before the arrival of the adoptee.
  • Healthy international travelers under the age of 40 regardless of departure date.

Certain people who are traveling with less than two weeks notice may need to take extra precautions. These include travelers age 40 years and older, those with poor immune systems, or those with chronic conditions. These people should receive the hepatitis A vaccination and hepatitis A immune globulin (IG). IG shots contain antibodies that offer short term protection.

If you cannot get the hepatitis A vaccine for any reason before you depart, consider getting a hepatitis A immune globulin shot. This can provide some protection for a few months.

The CDC does not recommend vaccination for US travelers going to Canada, Western Europe, Australia, New Zealand, or Japan.

In addition to travelers, the vaccine is recommended for all children aged 12 months and older, poeple with high risk occupations, people who engage in high risk lifestyle behaviors, and those with certain medical conditions, such as liver disease and blood-clotting disorders. Also, any person who desired protection from hepatitis A can be vaccinated.

Vaccine Limitations

There are limitations with the vaccine, though. It cannot be given to children under 12 months or to people who have had an allergic reaction to the vaccine or its components. Vaccination is not necessary for those who have had hepatitis A. Once you have had hepatitis A, you have immunity for life.

How Else Can You Protect Yourself?

Beyond the vaccines and IG, there are other measures that you can take to protect yourself from hepatitis A and other foodborne disease:

  • Carefully wash your hands with soap and water before eating and drinking and after using the bathroom.
  • To kill the virus, food and drinks need to reach a temperature of 185°F (85°C) for at least one minute. Remember, though, food can still become contaminated between the time you cook it and the time you eat it.
  • When eating at a restaurant, be sure the food has been cooked thoroughly and is served hot. Avoid buying food from a street vendor or places that are unsanitary.
  • Depending on what area you are traveling to, the entire water supply can be polluted. To be safe, only drink bottled water and avoid having ice in your drinks.
  • Certain types of food are more likely to be contaminated. Avoid raw or undercooked shellfish, unpasteurized (raw) milk or milk products, and uncooked fruits and vegetables, especially those that are unpeeled.

What Should You Do Before Traveling?

As soon as you begin planning the trip talk to your doctor about your risk for hepatitis A. Provide details about the area, accommodations, types of activities, and your health. Rather than going to your regular doctor, you may want to make an appointment with a specialist in travel medicine. On the International Society of Travel Medicine’s website, you can search for a doctor in your state.

Visit the US Embassy’s website to get contact information for the consulates and to register your trip with the US Department of State. Registration is voluntary; the information is used in case of an emergency. On the website, you can also read about current outbreaks, medical facilities, and health insurance. Keep in mind that many insurance companies do not pay for treatment abroad or for emergency care, like being flown by helicopter to a hospital. Also, the country you are visiting may not accept your insurance. So, you may want buy travel medical insurance to cover these expenses.

Another useful resource is the CDC’s Traveler’s Health website. The site provides information on how to prepare for your trip, including what medications and vaccinations are needed.

Among travelers, hepatitis A is one of the most common infections that can be prevented with a vaccine. So, whether you are planning on visiting museums in Beijing or white water rafting in the Mekong River, take action now to protect yourself and the people around you.

RESOURCES:

International Society of Travel Medicine

http://www.istm.org

US Centers for Disease Control and Prevention Travelers Health

http://wwwnc.cdc.gov/travel

CANADIAN RESOURCES:

Canadian Liver Foundation

http://www.liver.ca

Public Health Agency of Canada

http://www.phac-aspc.gc.ca

References:

ALF policy statement on hepatitis A. American Liver Foundation website. Available at: http://www.liverfoundation.org/about/advocacy/hepapolicy/. Updated October 4, 2011. Accessed February 28, 2013.

Country specific information—medical insurance. United States Department of State website. Available at: http://travel.state.gov/travel/cis_pa_tw/cis/cis_1470.html. Accessed February 28, 2013.

Fear of hepatitis A at Copthorne Hotel and Resort in Queenstown. Medindia website. Available at: http://www.medindia.net/news/Fear-of-Hepatitis-A-at-Copthorne-Hotel-and-Resort-Queenstown-36807-1.htm. Published May 2008 Published May 2008. Accessed February 28, 2013.

Hepatitis A. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated December 18, 2012. Accessed February 28, 2013.

Hepatitis A. Centers for Disease Control and Prevention Travelers Health website. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/hepatitis-a.htm. Updated July 1, 2011. Accessed February 28, 2013.

Hepatitis A FAQs for health professionals. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/hepatitis/hav/havfaq.htm. Updated August 4, 2011. Accessed February 28, 2013.

Hepatitis A questions and answers. Immunization Action Coalition website. Available at: http://www.immunize.org/catg.d/p4204.pdf. Accessed February 28, 2013.

Hepatitis A Virus Vaccine Inactivated. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated January 18, 2013. Accessed February 28, 2013.

Update: prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2007;56:1080-1084.

Vaccinations. Centers for Disease Control and Prevention Travelers Health website. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/hepatitis-a.htm. Updated November 13, 2009. Accessed February 28, 2013.

Last reviewed February 2013 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


 
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