Hepatitis A and Younger Adult Travellers

Author(s):  Dr Sherilyn Houle

Surveillance data from 13 countries in the European Union between 2009-2015 found that 27.8% of confirmed hepatitis A diagnoses were travel-related.¹ Of these, 42% were among people aged 15-44 years of age, with cases more likely among males than females.¹ GeoSentinel data from 68 sites in 28 countries spanning 2008-2020 is consistent with this, reporting on 245 cases of hepatitis A among returning travelers. Of these, 59% were among males, and the median age of cases was 28 years.² Among those with information available, more than three-quarters (78.2%) did not report having a pre-travel consultation, and 98% were unvaccinated.²

Vaccination against hepatitis A is recommended for most travelers.³ Often spread through contaminated food and water, many clinicians recommend food and water precautions to reduce the risk of this and other food-borne illnesses, including avoiding salads, raw or unpeeled fruits and vegetables, tap water or products made using unboiled tap water such as ice or fountain drinks, and raw or undercooked meat or seafood. However, adherence to these preventive measures is low. For example, a study of over 400 travelers visiting a travel clinic in Italy reported that upon their return, 55% had consumed raw vegetables, 36% consumed fruit they did not personally peel, 32% consumed street vendor food, and 30% consumed drinks containing ice.⁴

Hepatitis A vaccination, with protective antibodies achieved among 95-100% of recipients,⁵ is a traveler's best bet; however, uptake of vaccination is suboptimal, with lack of information/awareness the leading reason. A study of over 27,000 travelers visiting a hepatitis A or B endemic country in 2014 found that 63% of those who were not vaccinated cited lack of information on vaccination or its schedule as the reason, compared to only 12% who cited cost, 11% lack of time, and 12% safety concerns.⁶ Recognizing that cost considerations may be top of mind for younger and often budget-conscious travelers, the difficulty of avoiding exposure and the protection offered by even a single dose of hepatitis A vaccine before travel⁵ may help encourage this population to accept a vaccination recommendation.

References

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[2].  Acute hepatitis A in international travellers: a GeoSentinel analysis, 2008-2020.  Balogun O, Brown A, Angelo KM, Hochberg NS, Barnett ED, Nicolini LA, Asgeirsson H, Grobusch MP, Leder K, Salvador F, Chen L, Odolini S, Díaz-Menéndez M, Gobbi F, Connor BA, Libman M, Hamer DH ‐ J Travel Med 2022;29(2):taac013 [link]
[3].  Hepatitis A.  Hofmeister MG, Weng MK ‐ CDC Yellow Book 2026 [link]
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[5].  Hepatitis A vaccines: Canadian Immunization Guide.  Public Health Agency of Canada [link]
[6].  Pre-travel advice, attitudes and hepatitis A and B vaccination rates among travellers from seven countries.  Heywood AE, Nothdurft H, Tessier D, Moodley M, Rombo L, Marano C, De Moerlooze L ‐ J Travel Med 2016;24(1):taw069. [link]