Protecting travellers from hepatitis A

Vaccine should be used for almost every occasion when prevention is required

Infection with hepatitis A virus, an RNA virus of the picornoviridae family, remains an important public health problem in many regions of the world and is probably the commonest vaccine-preventable disease in travellers to developing countries. Although the incidence of acute hepatitis A virus infection is falling in developed countries, outbreaks continue to be reported1 and it remains the cause of half the cases of acute viral hepatitis notified in England and Wales. Recent changes in official advice on protective prophylaxis need to be incorporated into the advice clinicians give to travellers who may be at risk of infection.

Hepatitis A infection usually follows oral ingestion of virus, spread by faecal shedding from an infected individual. The high seroprevalence of anti-hepatitis A virus antibodies in developing countries (more than 70% of adults), is largely due to a high rate of asymptomatic infection in childhood. As improved sanitation has led to less childhood infection in developed countries (less than 2% of 5–14 year olds are now seropositive in the United Kingdom2), fewer adults are now naturally immune, so a higher proportion of travellers are at risk of infection while abroad. Although the total number of cases of hepatitis A reported …