Protect yourself from hepatitis A when traveling

Immunization against the hepatitis A virus (HAV) is recommended for anyone traveling to any country or area except :¹

• Australia.
• Canada.
• Japan.
• New Zealand.
• The United States.
• Western Europe and the Scandinavian countries (Norway, Sweden, and Finland).

Talk to your doctor before visiting any other areas.

If you plan to travel to a part of the world where sanitation is poor or where hepatitis A is a known problem, see your doctor about receiving the hepatitis A vaccine, immune globulin (IG), or the combination hepatitis A and B vaccine. (Risk of hepatitis B increases if you go to a high-risk country frequently or stay for a long time.)

• If you complete the hepatitis A vaccination series, it is believed that you will be protected against hepatitis A virus (HAV) for at least 20 years.² In adults (people older than 18 years of age), it is best if the first shot is given at least 4 weeks before a person may be exposed to the hepatitis A virus. But the vaccine does provide some protection shortly after the first shot.³ A second shot should be given 6 to 18 months later to prolong protection. (Immunization with hepatitis A vaccine is recommended for all children beginning at 1 year of age. Two separate doses are given at least 6 months apart. The second shot should be given 6 to 18 months after the first shot.)⁴
• If you receive IG and are planning an extended stay in an area where hepatitis A is a problem, you should get a higher dose of IG. You will need to get additional injections of the same high dose of IG every 3 to 5 months.
• Immune globulin (IG) is made from components of human blood. There is no risk of getting a bloodborne disease from IG made in the United States. The safety of IG manufactured in other countries cannot be guaranteed.
• If you will be visiting countries where hepatitis A is a problem and you will be staying for less than 3 months, you will receive enough protection at a lower cost by choosing the IG injection. But if you plan to travel abroad on a regular basis, getting the vaccine will save you money in the long run.
• People who are allergic to the components of the hepatitis A vaccine and children younger than 1 year of age should receive IG.

When traveling in an area where hepatitis A is a known problem or where water quality is questionable:

• Boil water before drinking it. Bring the water to a rolling boil for 1 minute. If you are at an elevation of 6562ft or higher, boil the water for 3 minutes. Do not drink tap water or well water or beverages containing ice cubes.
• Do not brush your teeth with tap water or well water.
• Make sure all foods are cooked well, especially shellfish.
• Eat only raw fruits and vegetables that you have washed in uncontaminated water and peeled yourself.
• Don't swim in water that has not been treated with chlorine.
• Don't drink bath or shower water.

Citations

1. Centers for Disease Control and Prevention (2008). Prevention of specific infectious diseases: Hepatitis, viral, type A. Yellow Book: Health Information for International Travel 2008. Available online: wwwn.cdc.gov/travel/yellowbook/ch4/hep-a.aspx.

2. Craig AS, Schaffner W (2004). Prevention of hepatitis A with the hepatitis A vaccine. New England Journal of Medicine, 350(5): 476–481.

3. Centers for Disease Control and Prevention (2007). 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, 56(RR-41): 1080–1084. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5641a3.htm.

4. Centers for Disease Control and Prevention (2008). Recommended immunization schedules for persons aged 0–18 years-United States, 2008. MMWR, 57(01): Q1–Q4. Also available online: http://www.cdc.gov/mmwr/pdf/wk/mm5701-immunization.pdf. [Erratum in MMWR, 57(12): 319. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5712a6.htm.]