Hepatitis A Vaccine for Travel: Do You Need It and When to Get It

Why does travel increase hepatitis A risk?

Hepatitis A is a liver infection caused by the hepatitis A virus (HAV). Unlike hepatitis B and C, it spreads almost entirely through contaminated food and water rather than blood or sexual contact. Travelers are at elevated risk because they eat and drink in environments where water treatment and food handling may differ significantly from home — tap water, ice made from tap water, raw shellfish, and food handled by someone with an active infection are the most common exposure routes 1Ref 1Centers for Disease Control and Prevention (2023).CDC Yellow Book 2024: Health Information for International Travel.Destination-specific hepatitis A risk levels, food and water safety precautions for travelers, and the recommendation for hepatitis A vaccination before travel to higher-risk regions.

Most people recover fully, but the illness can cause weeks or months of fatigue, jaundice (yellowing of the skin and eyes), nausea, and abdominal discomfort. Older adults and people with chronic liver disease are at higher risk for serious complications.

Which destinations are considered higher risk for hepatitis A?

The hepatitis A vaccine is generally recommended for travel to countries with intermediate or high HAV transmission rates 1Ref 1Centers for Disease Control and Prevention (2023).CDC Yellow Book 2024: Health Information for International Travel.Destination-specific hepatitis A risk levels, food and water safety precautions for travelers, and the recommendation for hepatitis A vaccination before travel to higher-risk regions2Ref 2Nelson NP, Link-Gelles R, Hofmeister MG, Romero JR, Moore KL, Ward JW, Schillie SF (2018).Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel.ACIP recommendations on hepatitis A vaccination for international travel, timing of doses, two-dose series for long-term protection, and indications for immune globulin. This broadly includes:

• Most of sub-Saharan Africa and North Africa
• The Middle East and the Indian subcontinent
• Southeast and Central Asia
• Much of Latin America and the Caribbean
• Parts of Eastern Europe

Even tourist-popular regions carry risk if you will eat at local restaurants, visit rural areas, or stay with local families rather than in high-end international hotels. Your travel medicine clinician uses current CDC and WHO destination data to tailor advice to your specific itinerary 1Ref 1Centers for Disease Control and Prevention (2023).CDC Yellow Book 2024: Health Information for International Travel.Destination-specific hepatitis A risk levels, food and water safety precautions for travelers, and the recommendation for hepatitis A vaccination before travel to higher-risk regions.

How does the hepatitis A vaccine work and when should you get it?

The hepatitis A vaccine is an inactivated virus vaccine — it contains killed virus particles that train your immune system without causing infection. For most adults, a single dose provides protective antibody levels within two to four weeks 2Ref 2Nelson NP, Link-Gelles R, Hofmeister MG, Romero JR, Moore KL, Ward JW, Schillie SF (2018).Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel.ACIP recommendations on hepatitis A vaccination for international travel, timing of doses, two-dose series for long-term protection, and indications for immune globulin.

A second (booster) dose given roughly six to twelve months after the first is associated with very long-term protection 2Ref 2Nelson NP, Link-Gelles R, Hofmeister MG, Romero JR, Moore KL, Ward JW, Schillie SF (2018).Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel.ACIP recommendations on hepatitis A vaccination for international travel, timing of doses, two-dose series for long-term protection, and indications for immune globulin. The ACIP recommends the hepatitis A vaccine for all unvaccinated travelers to higher-risk countries 2Ref 2Nelson NP, Link-Gelles R, Hofmeister MG, Romero JR, Moore KL, Ward JW, Schillie SF (2018).Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel.ACIP recommendations on hepatitis A vaccination for international travel, timing of doses, two-dose series for long-term protection, and indications for immune globulin.

Timing guidance: - Ideally, receive the first dose at least two weeks before departure to allow time for protective immunity to develop. - If your trip is imminent (under two weeks away), a single dose is still recommended — partial protection is better than none. Ask your clinician whether hepatitis A immune globulin makes sense as an additional step in certain situations. - There is also a combination hepatitis A and B vaccine (Twinrix) for travelers who need both.

Who especially needs to confirm their status before travel?

Several groups have particular reason to verify hepatitis A vaccination before any international trip:

• People with chronic liver disease (including hepatitis B or C carriers) — hepatitis A superinfection on an already-compromised liver can cause much more severe illness.
• People who are immunosuppressed — the vaccine may produce a weaker immune response; a clinician may check antibody levels after vaccination.
• Adults born before roughly 1945 — may have naturally acquired immunity from childhood exposure and can be tested before vaccination to avoid unnecessary re-vaccination.
• Children over age one can receive the vaccine; a travel medicine or pediatric clinician can advise on timing.
• Frequent travelers to higher-risk regions — ensuring the full two-dose series is complete provides very long-lasting protection 2Ref 2Nelson NP, Link-Gelles R, Hofmeister MG, Romero JR, Moore KL, Ward JW, Schillie SF (2018).Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel.ACIP recommendations on hepatitis A vaccination for international travel, timing of doses, two-dose series for long-term protection, and indications for immune globulin.

If you received the vaccine in childhood or previously, your vaccination records or a blood antibody titer (anti-HAV IgG) can confirm whether you are already protected.

What else reduces hepatitis A risk while traveling?

The vaccine works alongside — not instead of — safe food and water practices 1Ref 1Centers for Disease Control and Prevention (2023).CDC Yellow Book 2024: Health Information for International Travel.Destination-specific hepatitis A risk levels, food and water safety precautions for travelers, and the recommendation for hepatitis A vaccination before travel to higher-risk regions. General guidance while traveling:

• Drink only bottled or purified water; use it for ice and tooth brushing.
• Eat cooked foods that are still hot.
• Avoid raw shellfish, unpeeled raw fruit, and raw salads washed in tap water.
• Wash hands thoroughly before eating, or use an alcohol-based hand sanitizer.

These practices also reduce risk from other waterborne and foodborne illnesses not covered by the hepatitis A vaccine, including typhoid — for which a separate vaccine is available 3Ref 3Jackson BR, Iqbal S, Mahon B; CDC (2015).Updated recommendations for the use of typhoid vaccine — Advisory Committee on Immunization Practices, United States, 2015.Typhoid vaccine as a separate option for travelers to higher-risk regions, alongside hepatitis A, for food- and water-borne pathogen protection.