ISSN 1481-8531 (On-line)
Committee to Advise on Tropical Medicine and Travel (CATMAT)Footnote *
Viral hepatitis is considered the most common travel-related, vaccine-preventable disease. All non-immune travellers to developing countries should consider vaccination with inactivated Hepatitis A (HA) virus vaccine and recombinant Hepatitis B (HB) virus vaccine. Inactivated HA and recombinant HB vaccines are safe, have few side effects and are effective in providing long-lasting protection. All monovalent HA and HB vaccines available for use within Canada are equally effective, and each can be used interchangeably. HA Ig (immune globulin) should be used to prevent HA only in those for whom active HA vaccines are contraindicated, in immunocompromised individuals who may not respond adequately to the active vaccines or in infants less than one year of age. All travellers should practise routine protective measures when abroad. HB virus carriers travelling to Hepatitis D virus-endemic countries should be particularly vigilant in avoiding high-risk activities such as skin piercing and unsafe sexual practices.
Hepatitis A is the most common-travel-related illness for which there is an effective vaccine. A map of countries and areas of risk for Hepatitis A (HA) virus and Hepatitis B (HB) virus is available from the World Health Organization. Detailed information about HA and HB, including the epidemiology in Canada, available vaccines, recommendations for use in Canada and precautions and contraindications can be found in the Canadian Immunization Guide. A full summary of the background of risks of HA and HB among travellers and recommendations are available in the Committee to Advise on Tropical Medicine (CATMAT)’s statement on hepatitis vaccines for travellersFootnote 1.
Inactivated HA and recombinant HB vaccines are safe, have few side effects, and are effective in providing long-lasting protectionFootnote 2,Footnote 3. Both are considered safe in pregnancy and lactationFootnote 3,Footnote 4. All monovalent HA and HB vaccines available for use within Canada are equally effective and each can be used interchangeably against its respective target virusFootnote 3,Footnote 5.
For travellers who have no or an incomplete history of HB vaccination, completion of a vaccination series is recommended before departure. One or two doses of HB vaccine administered before travel will still provide some protection and may initiate an HB vaccination series that can be completed after travel for those who cannot complete the full series before departureFootnote 1.
For travellers presenting less than 21 days before departure, monovalent HA and HB vaccines should be administered separately, with completion of both immunization series after travelFootnote 1.
Travellers already infected with Hepatitis C should receive HA and HB vaccines, if not already administered by their primary care providerFootnote 1.
HA, HB and HAHB vaccines may be administered concomitantly with other vaccines at different injection sites using separate needles and syringesFootnote 3.
Vaccine is the preferred agent for pre-exposure prophylaxis for HA, therefore Ig should be used to prevent HA only in those for whom active HA vaccines are contraindicated, in immunocompromised individuals who may not respond adequately to the active vaccines or in infants under one year of ageFootnote 1,Footnote 3.
Co-administration of Ig and HA vaccine is not necessary (except possibly in immunocompromised individuals) and may result in an attenuated immune response to the HA vaccineFootnote 10,Footnote 12,Footnote 13.
For individuals with a high likelihood of prior exposure (e.g. long-term residence in a highly endemic region or history of a compatible illness) and for whom cost is a significant issue, it may be reasonable to assume immunity. It may be cost-effective to test adults who grew up in developing countries or Canadian-born adults born before 1945 for anti-HA IgG prior to travel, if time permits, and immunize only those susceptibleFootnote 3,Footnote 19,Footnote 20.
Routine serologic testing after HA or HB vaccination is unnecessary except for HB among health care workers and immunocompromised travellers, who should confirm their seroprotectionFootnote 3,Footnote 21,Footnote 22. Refer to the Canadian Immunization Guide for additional risk groups recommended to have pre-immunization serologic testing for HB.
Routine serologic testing of previously immunized travellers for anti-HBs (antibody to Hepatitis B surface antigen) IgG is not necessary unless they are health care workers who have never had their anti-HBs titres verifiedFootnote 3.
Travellers should be advised to do the following:
HB carriers travelling to Hepatitis D-endemic countries should be particularly vigilant in avoiding high-risk activities such as skin piercing and unsafe sexual practicesFootnote 1.
Human immunoglobulin does not provide protection against Hepatitis C, Hepatitis D or Hepatitis E, and currently no vaccines targeting these infections are available.
This summary was prepared and reviewed by Teitelbaum P, Libman M, Crockett M, McCarthy A and Geduld J (Public Health Agency of Canada).
CATMAT members: Boggild A, Brophy J, Bui YG, Crockett M, Ghesquiere W, Greenaway C, Henteleff A, Libman M, Teitelbaum P and McCarthy A (Chair).
Liaison members: Hui C (Canadian Paediatric Society) and Gershman M (US Centers for Disease Control and Prevention).
Ex-officio members: Marion D (Canadian Forces Health Services Centre, Department of National Defence), McDonald P (Division of Anti-Infective Drugs, Health Canada), Schofield S (Directorate of Force Health Protection, Department of National Defence) and Tepper M (Directorate of Force Health Protection, Department of National Defence).
Member Emeritus: Jeanes CWL.