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Hepatitis A

Hepatitis A is an infection of the liver caused by the Hepatitis A virus (HAV) and is spread by contaminated food, water or close contact with an ill individual. It usually manifests as a mild illness that resolves in 1-2 weeks, but some people can have disabling symptoms for up to a year.

This is the single most common vaccine preventable travel illness.

Where does it occur?

The disease is prevalent in the entire developing world. In fact the only places that are NOT risky would be USA, Canada, Western Europe, Japan, New Zealand and Australia. Map

How is it transmitted?

Infected individuals shed the virus in their feces. Travelers commonly contract the infection by ingesting contaminated food and water.

Is it contagious from person to person?

It is contagious from person to person if you ingest fecal material of an infected individual through soiled hands. Injection drug users who share contaminated needles are also a source of person to person transmission.

What is the risk for travelers?

The risk of contracting Hepatitis A is significant, 4 – 10 cases per 10,000 travelers to the developing world. Eating raw seafood is a common risk factor along with food prepared by infected individuals or consuming contaminated water or food.

What are the signs and symptoms?

Symptoms commonly develop on average 4 weeks after exposure. These include fever, fatigue, loss of appetite, nausea, abdominal pain and jaundice. Most individuals have complete resolution in a few weeks, but 10 – 15% of people may have persistent or waxing and waning illness for up to a year.

There is no risk of chronic life long illness, but in those over the age of 50 the disease may be fatal in 2% of cases.

Are there any lab tests to diagnose the illness?

Hepatitis A IgM and IgG blood antibody tests are used to make a diagnosis.

Is there any treatment?

There is no specific anti-viral medication; supportive care is the common practice.

What preventive measures can be taken?

Hepatitis A vaccine taken anytime prior to travel is protective for the majority of individuals.

Ideally one should take the vaccine a minimum of 2-4 weeks prior to departure. A second dose 6-24 months later assures lifelong protection.

If you are traveling in an emergency and do not have 4 weeks prior to your departure, the following are options:

  1. If you are less than 40 years of age and healthy, 1 dose of Hepatitis A vaccine (Havrix or Vaqta) any time prior to departure gives some protection. Finish the series upon return for lifelong protection.
  2. If you are greater than 40 years of age,are immunocompromised or have chronic liver disease we recommend1 dose ofHepatitis A vaccine (Havrix or Vaqta) + Immune globulin 0.02 ml/kg intramuscular injection (at a separate injection site) for protection, any time prior to travel. Finish the series upon return for lifelong protection.
  3. If you are allergic to the vaccine or its components (egg), Immune globulin 0.06 ml/kg intramuscular injection any time before trip likely provides protection for 3 months.
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