Definition of Disease...
MODE OF TRANSMISSION:
Hepatitis A is an enterically transmitted viral disease which
is highly endemic throughout the developing world but of low
endemicity in developed countries such as the United States
(U.S.). In developing countries, hepatitis A virus (HAV) is
usually acquired during childhood, most frequently as an asymptomatic
or mild infection. Transmission may occur by direct person-to-person
contact, from contaminated water, ice, or shellfish harvested
from sewage-contaminated water; or from fruits, vegetables
or other foods which are eaten uncooked, but which may become
contaminated during handling. Hepatitis A virus is inactivated
by boiling or cooking to 85° C (1 minute); cooked foods
may serve as vehicles for disease if they are contaminated
after cooking.
THE RISK:
The risk of hepatitis A for U.S. citizens traveling abroad
varies with living conditions, length of stay, and the incidence
of HAV infection in areas visited. In general, travelers to
northern and western Europe, Japan, Australia, New Zealand
and North America (except Mexico) are at no greater risk of
infection than they would be in the U.S. Areas of the world
with intermediate or high rates of hepatitis A do pose an
increased risk for travelers (Please see the chart at the
bottom of this page).
For travelers to developing countries, risk of infection
increases with duration of travel and is highest for those
who live in or visit rural areas, trek in back country, or
frequently eat or drink in settings of poor sanitation.
Recent studies have shown that many cases of travel-related
hepatitis A occur in travelers with "standard" tourist
itineraries, accommodations, and food and beverage consumption
behaviors. In developing countries, travelers should minimize
their exposure to hepatitis A and other enteric diseases by
avoiding potentially contaminated water or food. Travelers
should avoid drinking water (or beverages with ice) of unknown
purity and eating uncooked shellfish or uncooked fruits or
vegetables that are not peeled or prepared by the traveler.
RECOMMENDATIONS:
Hepatitis A vaccine or immune globulin (IG) is recommended
for all susceptible travelers to or for persons working in
countries with intermediate or high rates of HAV infection.
Vaccination of children 2 years of age and older, adolescents
and adults with the age-appropriate dose of hepatitis A vaccine
is preferred for persons who plan to travel repeatedly or
reside for long periods in intermediate or high risk areas.
Because of the current IG shortage, vaccine is also preferred
for travelers 2 years of age and older desiring only short-term
protection.
Immune globulin is recommended for travelers less than 2
years of age.
FIGURE 1:
Endemicity patterns (low, intermediate and high) of hepatitis
A virus infection worldwide. The risk of hepatitis A for travelers
to areas of the Caribbean is greater where questionable sanitation
is anticipated. (Note: this map generalizes available data
and patterns may vary within countries)
All content courtesy of the Center
For Disease Control (c) 1998
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