Hepatitis A is a liver infection caused by the hepatitis A virus. The virus is contagious and can be found in the stool of an infected person. This is a concern for travelers because it can be spread is by consuming contaminated food or drinks. For example, if a cook with hepatitis A does not wash his or her hands properly after going to the bathroom, the virus can be spread to the meal being prepared or to an object, like a cup or fork. Contamination can happen anywhere along the way—from the fields where vegetables are irrigated with polluted water to a restaurant that has poor sanitation.
Hepatitis A Symptoms
If you do become infected with the virus, it can cause a range of flu-like symptoms, such as fever, fatigue, or stomach pain. Hepatitis A can also cause jaundice, a yellowing of the skin and eyes. School-aged children and adults usually have symptoms, while very young children may not have any. In most cases, the virus goes away within 2-5 weeks, and the person makes a full recovery. But for some, the symptoms keep coming back and can last up to 9 months. In rare cases, liver failure and death can result.
People at High Risk
Traveling to certain regions does put you at a higher risk. The highest rates of hepatitis A are in Africa and India. High rates of the disease also exist in Mexico, Central and South America, Asia, the Middle East, and the Caribbean. Keep in mind that developed countries are not immune to outbreaks of hepatitis A.
How you travel, where you stay, and how long you stay also affect your level of risk. Do you have an adventurous trip planned, like following a guide through an African National Park to see the wildebeest migration? Or will you be pampered in a thatched-roof villa with white sand beaches right outside the door? While you may feel more secure about the safety of your meals at a 5-star hotel, there have been cases of hepatitis A at top tourist destinations.
Take for example this real-life scenario: A waitress at a hotel and resort in New Zealand, a country that has a low incidence of hepatitis A, was diagnosed with the virus. The public health authority estimated that she could have exposed thousands of guests to the virus during the incubation period, a 3-5 week period before any symptoms appear. This is when the virus is the most contagious. The concern was that many of the guests had since returned home, unaware of their exposure. If they did have the virus and were not treated in time, it could have a ripple effect, spreading to family members, coworkers, and people in the community.
The good news is that there is a vaccine for hepatitis A. This highly effective vaccine contains an inactivated form of the virus, which means it will not infect you. You should get the vaccine as soon as you know your plans. Although 1 dose protects most healthy people aged 1-40 years, a second dose is needed 6 months later to give you long term protection. With enough time, the vaccine will stimulate your own immune system to protect you against hepatitis A.
In healthy adults, the US Centers for Disease Control and Prevention (CDC) recommends vaccination for the following:
- Travel to countries with medium to high rates of hepatitis A infection regardless of purpose or length of stay, as soon as travel is considered.
- All unvaccinated household members in cases of international adoption, ideally 2 weeks or more before the arrival of the adoptee.
Certain people who are traveling with less than 2 weeks notice may need to take extra precautions. These include travelers age 40 years and older, those with poor immune systems, or those with chronic conditions. These people should receive the hepatitis A vaccination and hepatitis A immune globulin (IG). IG shots contain antibodies that offer short term protection.
If you cannot get the hepatitis A vaccine for any reason before you depart, consider getting a hepatitis A immune globulin shot. This can provide some protection for a few months.
The CDC does not recommend vaccination for US travelers going to Canada, Western Europe, Australia, New Zealand, or Japan.
In addition to travelers, the vaccine is recommended for all children aged 12 months and older, people with high risk occupations, people who engage in high risk lifestyle behaviors, and those with certain medical conditions, such as liver disease and blood-clotting disorders. Also, any person who wants protection from hepatitis A can be vaccinated.
There are limitations with the vaccine, though. It cannot be given to children under 12 months or to people who have had an allergic reaction to the vaccine or its components. Vaccination is not necessary for those who have had hepatitis A. Once you have had hepatitis A, you have immunity for life.
How Else Can You Protect Yourself?
Beyond the vaccines and IG, there are other measures that you can take to protect yourself from hepatitis A and other foodborne disease:
- Carefully wash your hands with soap and water before eating and drinking and after using the bathroom.
- To kill the virus, food and drinks need to reach a temperature of 185°F (85°C) for at least 1 minute. Remember, though, food can still become contaminated between the time you cook it and the time you eat it.
- When eating at a restaurant, be sure the food has been cooked thoroughly and is served hot. Avoid buying food from a street vendor or places that are unsanitary.
- Depending on what area you are traveling to, the entire water supply can be polluted. To be safe, use only bottled water for everything (even brushing your teeth) and avoid having ice in your drinks.
- Certain types of food are more likely to be contaminated. Avoid raw or undercooked shellfish, unpasteurized (raw) milk or milk products, and uncooked fruits and vegetables, especially those that are unpeeled.
What To Do Before Traveling
See Your Doctor
As soon as you begin planning a trip, talk to your doctor about your risk for hepatitis A. Provide details about the area, accommodations, types of activities, and your health. Rather than going to your regular doctor, you may want to make an appointment with a specialist in travel medicine. On the International Society of Travel Medicine website, you can search for a doctor in your state.
Do Your Research
Visit the US Embassy website to get contact information for the consulates and to register your trip with the US Department of State. Registration is voluntary; the information is used in case of an emergency. On the website, you can also read about current outbreaks, medical facilities, and health insurance. Keep in mind that many insurance companies do not pay for treatment abroad or for emergency care, like being flown by helicopter to a hospital. Also, the country you are visiting may not accept your insurance. So, you may want buy travel medical insurance to cover these expenses.
Another useful resource is the CDC’s Traveler’s Health website. The site provides information on how to prepare for your trip, including what medications and vaccinations are needed.
Among travelers, hepatitis A is one of the most common infections that can be prevented with a vaccine. So, whether you are planning on visiting museums in Beijing or white water rafting in the Mekong River, take action now to protect yourself and the people around you.
International Society of Travel Medicine
US Centers for Disease Control and Prevention
Canadian Liver Foundation
Public Health Agency of Canada
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Update: prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2007;56:1080-1084.
Last reviewed February 2017 by Michael Woods, MD, FAAP Last Updated: 2/17/2015