Hepatitis A Immunisation

What is hepatitis A?

Hepatitis A is an illness caused by a virus. It mainly causes inflammation of the liver. Symptoms include: generally feeling unwell, jaundice, sometimes vomiting and a raised temperature. Some people who are infected do not develop any symptoms (a 'subclinical illness'). The illness is not usually serious and full recovery is usual. However, the symptoms can be quite unpleasant for a while. Hepatitis A can be spread by eating contaminated food or drink.

Hepatitis A occurs in the UK but is more common in other countries in areas of poor sanitation. If you catch hepatitis A, the illness would not usually be serious, but it may ruin a holiday or business trip. (Note: hepatitis A should not be confused with hepatitis B or C. Hepatitis B and C are caused by different viruses and are more serious diseases.)

Who needs immunising against hepatitis A?

Travellers to countries outside Western Europe, North America, and Australasia should consider being immunised. The highest risk areas include the Indian sub-continent, Africa, Central and South America, parts of the Far East, and the Middle East. Your doctor or practice nurse can advise if you should be protected against hepatitis A for your travel destination.

Contacts. Occasional outbreaks of hepatitis A occur in the UK in institutions or in families. Contacts (for example, family members or other members of the institution) may be offered immunisation. This only happens rarely. The most important measure when dealing with anybody with hepatitis A is good personal hygiene. In particular, washing hands after going to the toilet or before eating. The virus is passed in the faeces (motions).

People with chronic liver disease. If you have a chronic (persistent) liver disease (for example, cirrhosis) you should have this vaccine. Hepatitis A can cause a more serious illness in people with chronic liver diseases.

People exposed to hepatitis A at work. Laboratory workers who are exposed to hepatitis A at their work and sewage workers should be immunised against hepatitis A.

Staff of some large residential institutions. Outbreaks of hepatitis A have been associated with large residential institutions for people with learning difficulties, where standards of personal hygiene among clients or patients may be poor. Immunisation of staff and residents of some institutions is often recommended.

Injecting drug users, haemophiliacs and homosexual men may also benefit from having the hepatitis A vaccine.

Note: If you have been infected with hepatitis A in the past, you are likely to be immune and not need further immunisation. A blood test can detect antibodies to check if you are already immune. This may be worthwhile doing if you have had a history of jaundice in the past or come from an area which has a high incidence of hepatitis A.

Hepatitis A vaccine

A single injection of vaccine protects against hepatitis A for about one year. The vaccine causes your body to make antibodies against the virus. These antibodies protect you from illness should you become infected with this virus. Ideally, you should have an injection at least two weeks before travel to allow immunity to develop. However, the vaccine may still be advised even if there is less than two weeks before you travel.

A booster injection 6-12 months after the first injection gives protection for beyond 10 years. A further booster at 20 years can be given for those people still at risk of hepatitis A.

A combined vaccine against hepatitis A and typhoid fever is also available. This may be useful if you require protection against both diseases. The hepatitis A component gives protection for one year and the typhoid component gives protection for three years. (You can still have a booster with the hepatitis A vaccine after 6-12 months to give protection against hepatitis A for beyond 10 years.)

A combined vaccine against hepatitis A, hepatitis B and typhoid fever is also available. This is given as three doses, the second dose one month after the first and the third 6 months after the second dose.

Are there any side-effects from the vaccine?

Some people develop a temporary soreness and redness at the injection site. Much less common is a mild fever, tiredness, headaches and feeling sick for a few days. Severe reactions are extremely rare.

Who should not receive hepatitis A vaccine?

• If you have an illness causing a high temperature it is best to postpone immunisation until after the illness.
• You should not have a booster if you have had a severe reaction to this vaccine in the past.
• Children under the age of one. The risk of hepatitis A in children under the age of one is very low. The hepatitis A vaccine is not licensed for this age group.

The vaccine may be given if you are pregnant or breastfeeding and immunisation against hepatitis A is necessary.

Other points

Remember - immunisation for travellers is only one aspect of preventing illness. No immunisation is 100% effective. So when travelling to 'at risk' areas you should have very good personal hygiene, only drink water or other drinks that are known to be safe (bottled water, sterilised water, etc) and only eat foods that have been cleaned and/or prepared properly.

Further information

Health Advice for Travellers - from the Department of Health

You can get a free copy from main post offices.

Information on immunisation

Web: www.immunisation.org.uk
From the NHS aimed at the general public.

Patient UK Travel Health Page

Web: www.patient.co.uk/showdoc/38/
Has a large list of links to UK websites on travel health.