Hepatitis A vaccination should be considered for individuals aged ≥1 year who are travelling to countries or areas with moderate to high risk of infection. Those at high risk of acquiring the disease should be strongly encouraged to be vaccinated regardless of where they travel.
Two types of HAV vaccines are currently available internationally:
1) Formaldehyde-inactivated hepatitis A virus vaccines. Inactivated HAV vaccines are used in most countries. Monovalent inactivated HAV vaccines are available in paediatric dose (0.5 ml) for children aged >1 year to 15 years, and in adult dose (1 ml).
2) Live attenuated vaccines (based on H2 and LA-1 HAV strains). These vaccines are manufactured and used mainly in China and sporadically in the private sector in India.
Inactivated hepatitis A vaccines are safe and highly effective. Two doses are necessary to promote long-term protection. Results from mathematical models indicate that, after completion of the primary two-dose series, anti-HAV antibodies may persist for 25 years or more. Serological testing to assess antibody levels after vaccination is not indicated. The Chinese live attenuated hepatitis A vaccines have been shown to be safe and highly protective (95%) against clinical infection for at least 3 years.
A combination hepatitis A/typhoid (Vi CPS ) vaccine, administered as a single dose, confers high levels of protection against both these waterborne diseases.
A combination vaccine that provides protection against both hepatitis A and hepatitis B should be considered for travellers who may be exposed to both organisms (see under Hepatitis B vaccines).
People born and raised in developing countries, and those born before 1945 in industrialized countries, have usually been HAV-infected in childhood and are likely to be immune. For such individuals, it may be cost-effective to test for antibodies to hepatitis A virus (anti-HAV) so that unnecessary vaccination can be avoided.
Type of vaccine: Inactivated or live, both given i.m.
Number of doses: Inactivated vaccine: two; live vaccine: one
Schedule: Inactivated vaccine: two doses, the second dose normally 6 months after the first. If needed, this interval may be extended to 18–36 months).
Live vaccine: one dose. Minimum age for HAV vaccination is 1 year.
Boosters: May not be necessary
Contraindications: Hypersensitivity to previous dose
Adverse reactions: Inactivated vaccine: mild local reaction of short duration, mild systemic reaction.
Live vaccine: few reported
Before departure: Inactivated and live vaccines: protection is achieved 2–4 weeks after first dose. Given the long incubation period of hepatitis A (average 2–4 weeks), the vaccine can be administered up to the day of departure and still protect travellers.
Recommended for: All non-immune travellers to countries or areas at risk
Special precautions: None