Hepatitis A Prevention for Travelers
]]>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, he can spread the virus to the meal he is preparing or to an object, like a cup or fork. But contamination 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, stomach pain), as well as ]]>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. For example, Asia, Africa, Eastern Europe, Latin America, South America, the Middle East, and the Caribbean have higher rates of the virus. But, even in developed countries there are outbreaks of hepatitis A. In the US, it ranks as one of the top 10 causes of ]]>foodborne illnesses]]> .
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.
In May 2008, 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 weren’t treated in time, it could have a ripple effect—spreading to family members, coworkers, and people in the community.
How Do You Protect Yourself?
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. For travelers, the US Centers for Disease Control and Prevention (CDC) recommends the shot if you are going to medium- to high-risk areas. The general guideline is to get the first dose 2-4 weeks before your trip. But newer CDC recommendations state that as long as you are healthy and get the shot before leaving you will have some protection from the virus. A second dose is needed six months later to give you long-term protection (up to 25 years in adults, 14-20 years in children).
Who Should Receive the Vaccine?
In addition to travelers, the vaccine is recommended for all children aged 12 months and older, people who engage in high-risk behavior (eg, having anal sex, using drugs), and those with certain medical conditions, such as liver disease and blood-clotting disorders.
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, are pregnant, or sick. Vaccination is not necessary for those who have had hepatitis A (which gives you life-long immunity).
For individuals who are at risk, immune globulin (IG) is a safe option. IG, given as a shot, has antibodies that provide short-term protection (up to three months). In some cases, the vaccine and IG are administered at the same time. For example, if you are aged 40 or older, have a chronic condition, and will be traveling in two weeks or less, your doctor may give you both shots to protect you from being infected.
In addition, doctors treat cases of hepatitis A exposure with either the vaccine or IG, depending on the person’s age and health. If given within two weeks, either shot can prevent the virus and stop it from spreading. This is especially helpful in controlling outbreaks in communities. In one outbreak, over 70 people ended up being immunized.
Twinix is yet another way to prevent not only hepatitis A, but also ]]>hepatitis B]]> . This dual vaccine can be used in healthy people aged 18 and older. It’s faster dosing schedule—the first three doses are given within the first three weeks—make it a good option for travelers.
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, cook foods and drinks at 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 eating shellfish (eg, oysters, muscles), unpasteurized (raw) milk or milk products (such as cheese and ice cream), salads, fruits and vegetables (especially those that are unpeeled), and cold meats.
What Should You Do Before Traveling?
See Your Doctor
As soon as you begin planning the trip (ideally 4-6 weeks before leaving), 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.
Do Your Research
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. You can also call the International Traveler’s hotline at 1-800-CDC-INFO for updates on diseases in the country you’ll be visiting.
Among travelers, hepatitis A is one of the most common infections that can be prevented with a vaccine. So, whether you’re 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.
International Society of Travel Medicine
Centers for Disease Control and Prevention
US Department of State
Canadian Liver Foundation
Public Health Agency of Canada
70 vaccinated for hepatitis A. International Food Safety and Quality Network website. Available at: http://www.ifsqn.com/forum/index . Published May 2008. Accessed January 16, 2009.
Alan R. Hepatitis A. EBSCO Publishing Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated November 2007. Accessed January 16, 2009.
ALF policy statement on hepatitis A. American Liver Foundation website. Available at: http://www.liverfoundation.org/about/advocacy/hepapolicy/ . Updated October 2007. Accessed January 16, 2009.
Avoiding hepatitis when you travel. Johns Hopkins Medicine Health Alerts website. Available at: http://www.johnshopkinshealthalerts.com/alerts/healthy_living/JohnsHopkinsDigestiveDisordersHealthAlert_2150-1.html?CMP=OTC-RSS . Published July 2008. Accessed January 16, 2009.
Country specific information—medical insurance. US Department of State website. Available at: http://travel.state.gov/travel/cis_pa_tw/cis/cis_1470.html . Accessed January 16, 2009.
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 . Accessed January 16, 2009.
Health information for travelers to Kenya. Centers for Disease Control and Prevention website. Available at: http://wwwn.cdc.gov/travel/destinationKenya.aspx#notices . Updated January 2009. Accessed January 16, 2009.
Hepatitis A. American Liver Foundation website. Available at: http://www.liverfoundation.org/education/info/hepatitisa/ . Updated November 2007. Accessed January 16, 2009.
Hepatitis A. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated January 2009. Accessed January 16, 2009.
Hepatitis A. Public Health Agency of Canada website. Available at: http://www.phac-aspc.gc.ca/tmp-pmv/info/hepa-eng.php. Updated June 2001 . Accessed January 16, 2009.
Hepatitis A: FAQs for the public. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/hepatitis/A/aFAQ.htm#overview . Updated June 2008. Accessed January 16, 2009.
Hepatitis A questions and answers. Immunization Action Coalition website. Available at: http://www.immunize.org/catg.d/p4204.pdf . Accessed January 16, 2009.
Hepatitis A: what you need to know. Centers for Disease Control and Prevention website. Available at: http://www.passporthealthusa.com/files/PDF/Hepatitis_A_VIS_3.21.06.pdf . Published March 2006. Accessed January 16, 2009.
Kohnle D. Hepatitis A vaccine. EBSCO Publishing Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated February 2008. Accessed January 16, 2009.
Preventing hepatitis. Hepatitis Foundation International website. Available at: http://www.hepfi.org/living/liv_preventing.html . Accessed January 16, 2009.
Travel clinic directory. International Society of Travel Medicine website. Available at: http://www.istm.org/ . Accessed January 16, 2009.
Traveler’s Health Yellow Book, Chapter 4: hepatitis, viral, type A. Centers for Disease Control and Prevention website. Available at: http://wwwn.cdc.gov/travel/yellowBookCh4-HepA.aspx . Updated January 2009. Accessed January 16, 2009.
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.
What I need to know about hepatitis A. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/hepa_ez/index.htm . Updated December 2003. Accessed January 16, 2009.
What is hepatitis A? US Department of Veterans Affairs website. Available at: http://www.hepatitis.va.gov/vahep?page=basics-15-02 . Accessed January 16, 2009.
Last reviewed February 2009 by ]]>David L. Horn, MD, FACP]]>
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.
Copyright © 2007 EBSCO Publishing All rights reserved.