Hepatitis A
Preventing Infection While Traveling
By Gary P. Barnas, MD
Although the risk of Hepatitis A is minimal in the U.S., Canada, Western Europe, Japan, Australia, and New Zealand, it is much greater in the developing world. The risk of infection increases with length of stay, visits to rural areas, and eating in places with poor sanitation such as food stands and vendors. However, even the most cautious tourist may be unavoidably exposed. Most episodes of infection are spread by infected food handlers that may not yet have any sign of illness. By failing to wash their hands adequately after a bowel movement, such disease carriers can spread the virus to food in the preparation and serving process. Spread can also occur by drinking sewage contaminated water, or by eating contaminated raw shellfish.
For protection, travelers should receive either of the hepatitis A vaccines (Havrix or Vaqta) or an injection of immune globulin (previously called gamma globulin) which contains antibodies against the hepatitis A virus. The vaccines have been available in the U.S. since March, 1995. The vaccine is given as a single dose, preferably at least two weeks prior to departure, and can be followed by a booster dose in 6-12 months with protection estimated to last at least 10-20 years. Side effects have been reported to be minimal.
Since immune globulin is not a true vaccine, antibody levels will decline with time. For the greatest protection, this injection should be given close to the time of departure, ideally within 3-5 days. Depending on the dose given, this protection can last from three to five months. Immune globulin shots are given in the buttock and usually are associated with minimal local side effects, such as soreness at the injection site. There is no evidence that immune globulin can transmit any disease, such as AIDS, and it can be safely given to pregnant women. Recently immune globulin has been difficult to obtain due to manufacturing shortages and newly implemented testing for the hepatitis C virus.
Persons who are known to have had hepatitis A in the past already have antibodies to the disease and do not need further protection. A blood test is available to confirm this immunity if uncertainty exists. Frequent or long term travelers should definately consider receiving the hepatitis A vaccine rather than immune globulin.
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