Travel Warning: Hot Spots for Hepatitis A

Hepatitis A is an infection of the liver caused by the virus hepatitis A or HAV. It is an acute infection, meaning that once a person has it and recovers, they are immune and will not get hepatitis A again. Nor do persons who have had hepatitis A carry the disease to others.

For this reason, it might not be on the minds of most travelers to get a hepatitis A vaccination before traveling to "hot spots" or endemic areas known to have a higher incidence of hepatitis A infections. The only vaccination currently required for overseas travel from the United States is a yellow fever vaccination when the destination is certain African countries and tropical regions of South America.

According to a 2006 article in Kid's Health magazine, prior to 1999 when certain states mandated hepatitis A vaccinations for toddlers, the highest rate of infection was among young children. Western states were considered "hot spots" in the United States for Hepatitis A infections. Since HAV transmission is orally received and transmitted by fecal matter, that rate of incidence makes perfect sense. Infection in young children occurs when proper hygiene between diaper changes is not followed, and when proper toddler hand-washing isn't observed.

In 1999, however, 10 Western states and one Southern state mandated a hepatitis A vaccine for all toddlers. The rate of incidence has declined until no particular region of the United States stands out as a "hot spot" any longer. Toddlers are no longer the most significant risk group for hepatitis A infections, either. In fact, the rate of infection in the United States suggests that closer attention needs to be paid when traveling to other countries.

Transmission of Hepatitis A occurs through person to person contact; through contaminated water, ice or seafood; and from uncooked fruits and vegetables that were contaminated during harvest or other handling. The incubation period for hepatitis A is on average about 28 days, with a reported range of 15 to 50 days. The symptoms of Hepatitis A have an abrupt onset, and the severity of those symptoms varies depending on age and general physical condition, including other liver conditions that might affect the infected person.

In children under 6 years old, the infection is mostly asymptomatic, meaning this subset of the population has little to no illness associated with hepatitis A. Usual symptoms of Hepatitis A include fever, nausea, lack of appetite, abdominal discomfort, and general weakness, followed by characteristic jaundice or yellowed skin, and darkened urine. In most people, these symptoms last a week or two. In some cases with a weakened condition, the symptoms of hepatitis A can linger for several weeks or months.

The Center for Disease Control and Prevention (or the CDC) has some cautionary words for people planning to travel in 2008 in the CDC Health Information for Travel 2008. Obviously, the risk of HAV infection when traveling varies with length of stay, living conditions, and the area in which you will be traveling. People from North America whose destination is Japan, Australia, New Zealand, or developed countries in Europe have no higher incidence of infection than if they had stayed home. Other areas, though, including Mexico in North America, will have a higher incidence of hepatitis A infection. The Middle East, Africa, Asia, parts of the South Pacific, and Central and South America are all considered hot spots or endemic areas for HAV.

Obviously, those travelers who are trekking in back-country or traveling in rural areas, and therefore eating and drinking in less sanitary conditions are at higher risk of infections, including hepatitis A. However, a growing number of travel-related hepatitis A infections are occurring in so-called standard accommodations in developing countries.

It takes about four weeks after vaccination for hepatitis A before most people have protection against this infection, so it's important to begin talking with your health care provider about this, and other vaccinations needed as soon as plans for travel commence.

Anti-HAV vaccines have been shown to carry protection for anywhere from 5 to 12 years after vaccination, so if you are unsure if you need a new one, you can ask that your blood be tested for antibodies or immunity if the cost of that is less than a vaccination, or if there are other factors that you may prefer not to be vaccinated again.

Since hepatitis A is one of the more preventable infections occurring to world travelers, take a few moments while planning your itinerary to consider being vaccinated against HAV.