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September 21, 1994

Epidemiology and Prevention of Hepatitis A in Travelers

Author Affiliations

From the Division of Epidemiology and Prevention of Communicable Diseases, Institute of Social and Preventive Medicine of the University of Zurich (Switzerland) (Dr Steffen); Microbiology and Immunology Support Services, Division of Communicable Diseases, World Health Organization, Geneva, Switzerland (Dr Kane); Hepatitis Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Shapiro); International Union Against Tuberculosis and Lung Diseases, Paris, France (Dr Billo); Hawaii Immunization Program, Epidemiology Branch, Hawaii Department of Health, Honolulu (Ms Schoellhorn); and Department of Epidemiology, University of Antwerp (Belgium) (Dr van Damme).

JAMA. 1994;272(11):885-889. doi:10.1001/jama.1994.03520110065031

Objective.  —To assess the risk of hepatitis A in international travelers and to recommend preventive measures.

Data Sources.  Index Medicus, 1974 through 1983; MEDLINE, 1984 through 1993; and unpublished data of the Centers for Disease Control and Prevention.

Study Selection.  —Review of all retrospective and cohort studies on hepatitis A and other vaccine-preventable diseases in travelers, of seroepidemiologic surveys of hepatitis A virus (HAV) antibodies in travelers, of data on the various hepatitis A vaccines, of economic analyses, and of recommendations of recognized organizations.

Data Extraction.  —Independent analysis by multiple observers.

Data Synthesis.  —The incidence rate for unprotected travelers, including those staying in luxury hotels, is estimated to be three per 1000 travelers per month of stay in a developing country. Persons eating and drinking under poor hygienic conditions have a rate of 20/1000 per month. This makes hepatitis A the most frequent infection in travelers that may be prevented by immunization. In many industrialized countries persons born after 1945 have an HAV antibody seroprevalence (immunity) of less than 20%. New inactivated HAV vaccines induce protective antibodies in more than 95% of recipients and offer protection estimated to last for 10 years or more, whereas protection by immune globulin lasts only 3 to 5 months.

Conclusions.  —Hepatitis A vaccine, or immune globulin where HAV vaccine is not available, is recommended for all nonimmune travelers visiting developing countries. Prescreening for antibodies to HAV in travelers living in countries with low prevalence is usually not necessary in persons born after 1945.(JAMA. 1994;272:885-889)