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Hepatitis A

Definition of Disease...

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 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.

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.

Hepatitis A Chart.

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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