Hepatitis A And International Travel
Who should receive protection against hepatitis A virus before travel?
All susceptible people traveling to or working in countries that have high or intermediate HAV endemicity are at increased risk for HAV infection. These travelers should be vaccinated or receive immune globulin before departure . For more information on international travel and hepatitis A, see CDCs travel page or ACIP updated recommendations on Prevention of Hepatitis A after Exposure to Hepatitis A Virus and in International Travelers.
How soon before international travel should the first dose of hepatitis A vaccine be given?
All unvaccinated people 12 months of age planning travel to an area with high or intermediate HAV endemicity should receive a single dose of vaccine as soon as travel is considered they should then complete the vaccine series with the appropriate dose and schedule. People traveling within 2 weeks should receive the initial dose of hepatitis A vaccine before departure and also simultaneously may be administered IG at a separate anatomic injection site for additional short-term protection . The hepatitis A vaccine series should be completed according to the routine schedule. Information on immune globulin dosing and additional information on hepatitis A vaccine and travel is available.
What should be done to protect international travelers < 6 months of age and other travelers unable to receive hepatitis A vaccine?
Types Of Hepatitis A Vaccine
There are 3 main types of hepatitis A vaccination:
- a vaccine for hepatitis A only
- a combined vaccine for hepatitis A and hepatitis B
- a combined vaccine for hepatitis A and typhoid fever
Talk to your GP about which vaccine is most suitable for you. All 3 types are usually available for free on the NHS.
Plan your vaccinations in advance if you’re travelling abroad. They should ideally be started at least 2 or 3 weeks before you leave, although some can be given up to the day of your departure if necessary.
Extra doses of the vaccine are often recommended after 6 to 12 months if you need long-term protection.
You can find more information about the various hepatitis A vaccines on the NHS Fit for Travel website.
How Can I Contract Hepatitis B
You can contract hepatitis B by coming into contact with the bodily fluids of an infected person.
Resort activities that may put you at risk for hepatitis B include:
Getting a manicure, pedicure, tattoo, piercing, or acupuncture with improperly sterilized tools
Having sexual contact with an infected partner
Giving first aid to, or receiving it from, an infected person
Receiving a medical or dental procedure with contaminated equipment
Sharing personal grooming items with an infected person
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How Is Hepatitis A Transmitted
Hepatitis A is normally spread by a person unknowingly consuming the virus from various objects, food or drinks that have been previously contaminated by small amounts of stool from an infected person. It can also spread by personal contact with an infected person through activities such as sex or caring for an ill person.
How Is Hepatitis A Spread
The hepatitis A virus is found in the bowel movements of infected persons. People with hepatitis A infection who use the bathroom without proper hand washing can pass the virus on to others through food preparation or other hand-to-mouth contact. The disease can also be spread by sexual contact, or sharing of equipment used in illegal drug use, such as needles or pipes.
Hepatitis A can also be spread by drinking contaminated water, or by eating raw or under-cooked shellfish, such as crabs, clams, oysters or mussels that have been contaminated with sewage.
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Where Can People Get The Hepatitis A Vaccine
Talk to your medical provider about the hepatitis A vaccine. In South Carolina, adults 18 years and older can get vaccinated at some local pharmacies without a prescription, depending on your insurance coverage. To search for a nearby pharmacy that offers vaccines, visit www.vaccinefinder.org.
DHECs local health departments also provide hepatitis A vaccines. DHEC has an Adult Vaccine Program that provides low-cost vaccines for uninsured or underinsured individuals who are 19 years and older.DHECs local health departments are currently providing no-cost hepatitis A vaccines to individuals in at-risk groups .
Hepatitis A In Other Countries
Hepatitis A occurs worldwide. Developing countries with poor hygiene measures are at higher risk of hepatitis A infection and transmission.
In areas of high endemicity, such as parts of Africa, Asia, Central America and South America, up to 90% of children have been infected with hepatitis A.2
Hepatitis A is commonly reported in foodborne outbreaks.
Inactivated hepatitis A vaccines are prepared from hepatitis A virus harvested from human diploid cell cultures.
Different strains of HAV are in different vaccines, but there is only 1 known serotype. Immunity induced by a particular strain probably protects against all strains. 7
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Hepatitis A Vaccine: Canadian Immunization Guide
For health professionals
Last partial chapter update
: The immunoglobulin dosage for Hepatitis A pre-exposure and post-exposure prophylaxis was increased based on the Product Monograph update for GamaSTAN®, which is available on Health Canada’s Drug Product Database.
Last complete chapter revision: March 2018
Hepatitis A And B Vaccination
Effective and well-tolerated hepatitis A and B vaccines are available either as monovalent formulations or in various combinations. Although the benefits of a full primary vaccination course are clearprotection against potentially life-threatening diseasesthe requirement for a booster varies in different countries. Recommendations for the administration of hepatitis boosters in the United States, the United Kingdom, and Germany illustrate this. In the United States, a hepatitis B booster is not recommended for children and adults with a normal immune status , whereas in the United Kingdom, administration of a single booster dose 5 years after completion of the primary course is deemed necessary . In Germany, for example, Empfehlungen der Ständigen Impfkommission recommendations published in July 2004 state that immune response should be checked for persons who are immunodeficient and suggest the same for persons aged > 40 years. For persons with antihepatitis B surface antigen titers of < 100 mIU/mL, 1 extra dose is recommended, followed by an additional antibody test. In vaccinees with anti-HBs titers of > 100 mIU/mL, a booster is recommended after 10 years when the potential for risk continues . The World Health Organization has recognized that almost all children are protected against hepatitis B after vaccination, without a requirement for boosters, and that the protection is most likely lifelong .
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Treatment And Manifestation Of Hepatitis A And B
Hepatitis A has an incubation time of two to six weeks. Hepatitis B only manifests after two to six months. Often patients with hepatitis A and B infection have moderate to no signs of the infection.
In persons who show symptoms, they will get flu-like symptoms, which will occur about three to ten days before symptoms of the liver develop.
Thereafter, the urine will darken, and jaundice may grow. With jaundice, the skin and the whites of a person’s eyes have a yellow hue. The inflamed liver cannot conduct its normal biochemical processes, so a material called bilirubin increases in the body.
Typically, you tend to feel healthy when you have jaundice, even though you keep looking worse.
In hepatitis A the jaundice stage only lasts for about one week. After that, you’ll continue to heal and usually feel like your usual self within a month. You are immune for life after recovering from hepatitis A.
In hepatitis B, the jaundice stage is about two weeks.
How Do Doctors Diagnose Hepatitis A
Doctors diagnose hepatitis A based on symptoms and a blood test. A health care professional will take a blood sample from you and send the sample to a lab. A blood test will detect antibodies to the hepatitis A virus called immunoglobulin M antibodies and show whether you have acute hepatitis A. If the blood test finds antibodies to the hepatitis A virus that are not IgM antibodies, then you are immune to hepatitis A, due to either past hepatitis A infection or hepatitis A vaccination.
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Where Does Hepatitis A Occur
Hepatitis A is a very common illness throughout the world. Even developed countries like Canada, the United States or Australia can have outbreaks. But, some regions carry a higher risk of infection.
The vaccine is recommended for travel to almost every region of the world. Some of the most popular destinations where hepatitis A vaccination would be recommended include:
To find out if hepatitis A vaccination is recommended for your trip, see our destination advice portal.
Aboriginal And Torres Strait Islander People
Aboriginal and Torres Strait Islander children living in these states and territories are recommended to receive 2 doses of monovalent hepatitis A vaccine:
- the Northern Territory
This is due to the increased risk for hepatitis A in this population.1 See Epidemiology.
These children should receive:
- 1st dose at 18 months of age
- 2nd dose at 4 years of age
Aboriginal and Torres Strait Islander children < 10 years of age who have not received hepatitis A vaccine at the recommended schedule points may need extra doses of vaccine and/or an alternative schedule.
See Catch-up vaccination for more details, including minimum intervals between doses.
Hepatitis A vaccination is recommended for people with chronic liver disease of any aetiology, if they are not immune to hepatitis A.2,3 This includes:
- people with chronic liver disease
- people who have received a liver solid organ transplant
- people with chronic hepatitis B
- people with chronic hepatitis C
2 doses are required, with a recommended minimum interval between doses of 6 months.
People with chronic liver disease should receive the vaccine as early in the course of the disease as possible. Immune responses to vaccination in these people can vary for example:
- people with chronic liver disease of mild to moderate severity usually mount a good immune response
- people with end-stage liver disease do not respond as well
- liver transplant recipients may not respond at all 4,5
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How Long Should I Wait After Getting The Hepatitis A Vaccine Before I Travel
The hepatitis A vaccine is most effective if given at least four weeks before traveling, but the vaccine is still somewhat effective if given at least two weeks before traveling.
If you are 40 years of age and older, are immunocompromised, or have chronic liver disease and are going to travel within two weeks of receiving the vaccine, you may also be recommended to get a dose of “immunoglobulin.” Immunoglobulin contains antibodies directed against hepatitis A virus. You don’t develop long-lived protection by receiving immunoglobulin, but the antibodies will help protect you during the trip. Protection afforded by immunoglobulin lasts several months. The second dose of hepatitis A vaccine should be received 6 months after the first dose for long term protection.
Are Infections Caused By Hepatitis A Virus Similar To Those Caused By Hepatitis B Virus
Although hepatitis A virus sounds like it would be similar to hepatitis B virus, the viral infections are really quite different. Hepatitis B virus can cause long-term problems, such as cirrhosis and liver cancer. On the other hand, hepatitis A virus doesn’t cause long-term problems. Also, hepatitis B virus kills about 750 people every year, whereas hepatitis A virus kills about 75 people every year. Finally, hepatitis B virus is transmitted by coming in contact with someone who is infected, but hepatitis A virus is typically transmitted in contaminated food or water.
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Managing Fever After Immunisation
Common side effects following immunisation are usually mild and temporary . Specific treatment is not usually required.There are a number of treatment options that can reduce the side effects of the vaccine including:
- Drinking extra fluids to drink and not overdressing if there is a fever.
- Although routine use of paracetamol after vaccination is not recommended, if fever is present, paracetamol can be taken check the label for the correct dose or speak with your pharmacist .
How Does One Administer Twinrix
Twinrix is given by injecting the liquid into the muscles. How many Twinrix shots do I need? It is provided as a sequence of three dosages. With the second dose given at least one month after the first. The final and third dose given at least six months after the first dosage.
A 4-dose rapid schedule is also accessible for individuals 19 years of age and over. It is safe to receive the hepatitis A and B vaccination in conjunction with other vaccines.
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What Can Travelers Do To Prevent Hepatitis A
Getting vaccinated is the best way to protect against hepatitis A. The hepatitis A vaccine is very effective and has been a routine childhood vaccine since 1996. The vaccine is recommended for international travelers 6 months of age or older going to countries where hepatitis A infection is common. Check if hepatitis A vaccine is recommended for your destination.
Hepatitis A vaccine is given in two or three doses. If your plans dont allow you to get all doses before your trip, get at least 1 dose, as soon as possible before you travel.
Infants 6 to 11 months old should be vaccinated when protection against hepatitis A is recommended for the destination. This dose does not count toward the routine 2-dose series.
Travelers allergic to a vaccine component or 6 months of age or younger should receive a single dose of immune globulin, which provides effective protection for up to 2 months depending on dosage given. Talk to your doctor to see if this is the best option for you.
If you traveled and feel sick, particularly if you have a fever, talk to a healthcare provider, and tell them about your travel. Avoid contact with other people while you are sick.
If you need medical care abroad, see Getting Health Care During Travel.
People At High Risk For Hepatitis A
Some people are more likely than others to get hepatitis A. The following groups of people may be at an increased risk of hepatitis A and should get the vaccine:
- People who are homeless
- People who use drugs, either injection or non-injection
- Men who have sex with men
- People in jail or prison
- People who recently got out of jail or prison
- People who are exposed to a hepatitis A outbreak
- People who travel to countries with high rates of hepatitis A
- This includes countries in Central and South America, Asia , Africa, Eastern Europe, and Mexico. If you plan to go to one of these areas you should get your first dose of hepatitis A vaccine at least four weeks before you travel.
If you are traveling:
- Start the hepatitis A vaccine series at least four weeks before you travel.
- Babies aged six months and older should get the hepatitis A vaccine before any travel outside of the U.S.
- For more information, see Health for Travelers and Immunizations for Travelers.
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What Are The Possible Reactions After The Vaccine
Vaccines are very safe. It is much safer to get the vaccine than to get hepatitis A.
Common reactions to the vaccine may include soreness, redness and swelling where the vaccine was given. Headache, fatigue, fever, and stomach upset may also occur after getting the vaccine. These reactions are mild and generally last 1 to 2 days.
For more information on Reye Syndrome, see HealthLinkBC File #84 Reye Syndrome.
It is important to stay in the clinic for 15 minutes after getting any vaccine because there is an extremely rare possibility, less than 1 in a million, of a life-threatening allergic reaction called anaphylaxis. This may include hives, difficulty breathing, or swelling of the throat, tongue or lips. Should this reaction occur, your health care provider is prepared to treat it. Emergency treatment includes administration of epinephrine and transfer by ambulance to the nearest emergency department. If symptoms develop after you leave the clinic, call 9-1-1 or the local emergency number.
It is important to always report serious or unexpected reactions to your health care provider.
Who Should Get Hepatitis Vaccinations
Since the vaccines were first developed, the hepatitis A and B vaccines have become part of the regular childhood immunization schedule. They are not considered a routine adult immunization.
“When we’re talking about adults, I would say yes, get the vaccine if they fit into one of these risk factors” says Poland. “If they don’t fit into the risk factors, their risk is so low that there’s no compelling reason to do it.”
People at risk for hepatitis A include:
- Anyone traveling to or working in areas where hepatitis A is more widespread.
- People whose work puts them in potential contact with hepatitis A, such as those who work with the hepatitis A virus in research labs
- People who are treated with clotting-factor concentrates
- People who have chronic liver disease
- People who use recreational drugs, injected or not
- Men who have sex with men
People at risk for hepatitis B include:
- Anyone traveling to or working in areas where hepatitis B is more widespread.
- Health care workers and other people whose job exposes them to human blood
- People with HIV infection, end-stage kidney disease, or chronic liver disease
- People who live with someone with hepatitis B
- People who inject street drugs
- Sexually active people who have had more than one partner
- Anyone who has had an STD
- Men who have sex with men
- Sex partners of people with hepatitis B
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