Alan M Spira1. 1. The Travel Medicine Center, Beverly Hills, California 90211, USA. travelmed@earthlink.net
Abstract
BACKGROUND: Hepatitis A virus (HAV) and hepatitis B virus (HBV) are the 2 most common vaccine-preventable diseases for which travelers are at risk. These viruses are a significant public health concern, as both HAV and HBV cause substantial morbidity and both can be fatal. OBJECTIVE: This article provides the practitioner with the facts about hepatitis and travel, including why travelers are at risk, which travelers are at greatest risk, and how travelers can protect themselves from both HAV and HBV through vaccination. METHODS: A review of the English-language literature published from 1966 to 2002 was conducted through the PreMedline and MEDLINE databases with the search terms hepatitis A, hepatitis B, and travelers. Reference lists from relevant articles were also searched, and abstracts presented at recent conferences were evaluated. Articles containing information from the past 2 decades were used to reference this article. RESULTS: Travelers need protection against both hepatitis A and B. In addition to making travelers aware of a number of behavior modifications, vaccination should be provided. Tolerable and effective monovalent vaccines are available that can prevent these viruses. In addition, a combination HAV/HBV vaccine is available that is well tolerated and decreases the time to immunity. CONCLUSIONS: Travelers are often unaware of the risk factors for acquiring hepatitis A and B while traveling, such as the degree of endemicity at the travel destination, the length of stay in the endemic area, and the extent and frequency of contact with the local population. Because these risk factors and areas for endemicity of both hepatitis A and hepatitis B overlap, health care providers can protect travelers from both of these diseases by providing a combination vaccine, thus affording a lifetime of protection against both diseases.
BACKGROUND:Hepatitis A virus (HAV) and hepatitis B virus (HBV) are the 2 most common vaccine-preventable diseases for which travelers are at risk. These viruses are a significant public health concern, as both HAV and HBV cause substantial morbidity and both can be fatal. OBJECTIVE: This article provides the practitioner with the facts about hepatitis and travel, including why travelers are at risk, which travelers are at greatest risk, and how travelers can protect themselves from both HAV and HBV through vaccination. METHODS: A review of the English-language literature published from 1966 to 2002 was conducted through the PreMedline and MEDLINE databases with the search terms hepatitis A, hepatitis B, and travelers. Reference lists from relevant articles were also searched, and abstracts presented at recent conferences were evaluated. Articles containing information from the past 2 decades were used to reference this article. RESULTS: Travelers need protection against both hepatitis A and B. In addition to making travelers aware of a number of behavior modifications, vaccination should be provided. Tolerable and effective monovalent vaccines are available that can prevent these viruses. In addition, a combination HAV/HBV vaccine is available that is well tolerated and decreases the time to immunity. CONCLUSIONS: Travelers are often unaware of the risk factors for acquiring hepatitis A and B while traveling, such as the degree of endemicity at the travel destination, the length of stay in the endemic area, and the extent and frequency of contact with the local population. Because these risk factors and areas for endemicity of both hepatitis A and hepatitis B overlap, health care providers can protect travelers from both of these diseases by providing a combination vaccine, thus affording a lifetime of protection against both diseases.