Hepatitis A vaccination is recommended for people age 6 months or older who are traveling to or working in an area of the world at intermediate or high risk of hepatitis A transmission. Areas of low risk include the United States, Canada, Japan, New Zealand, Australia and Western Europe. Visit the CDC’s Traveler Health website for more information about specific destinations and current outbreaks or travel notices (https://wwwnc.cdc.gov/travel/). When in doubt, vaccinate.
Ask the Experts: Hepatitis A: International Travel
For details on preexposure protection of international travelers age 12 months and older, refer to Appendix A on page 35 of the current ACIP recommendations for the prevention of hepatitis A: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.
Healthy people age 12 months through 40 years who are planning travel to an area with high or intermediate HAV endemicity and have not received HepA vaccine should receive a single dose of HepA vaccine as soon as travel is considered and should complete the 2-does series according to the routine schedule.
People with chronic liver disease as well as adults older than 40 years of age, immunocompromised people, and people with other chronic medical conditions planning to depart to an area with high or intermediate HAV endemicity in less than 2 weeks should receive the initial dose of HepA vaccine and may also simultaneously be administered immune globulin (IG) at a separate anatomic injection site (for example in separate limbs).
ACIP revised its recommendations for preexposure hepatitis A vaccination for travelers in 2018 to include vaccination of infants 6 through 11 months of age. All infants of this age traveling internationally should be given a dose of measles, mumps, rubella vaccine (MMR) before travel. Due to the potential interference of hepatitis A IG with MMR vaccine effectiveness, an off-label dose of HepA vaccine is recommended instead of IG in this situation. The travel-related dose for infants 6–11 months of age should not be counted toward the routine 2-dose series. The routine 2-dose HepA and MMR vaccination series should be initiated at age 12 months according to the routine, age-appropriate vaccination schedule.
Infants younger than 6 months and travelers who elect not to receive vaccine or for whom vaccine is contraindicated should receive a single 0.1 mL/kg dose of IG before travel when protection against HAV is recommended. If travel is for more than 1 month, a dose of 0.2 mL/kg should be administered. A 0.2 mL/kg dose can be repeated every 2 months for travel of more than 2 months duration.
Yes. If time allows, use the standard Twinrix schedule of 3 doses given intramuscularly on a 0-, 1-, and 6-month schedule. If travel is imminent the accelerated 4-dose Twinrix schedule can be used, which is 3 doses given on days 0, 7, and 21-30 days and a booster dose at 12 months.
No. There is no recommendation for a booster dose of HepA if a patient has completed the 2-dose series at any age.
Yes. Data have shown that people acquire hepatitis A virus infection even in such places as 4-star hotels located in Latin America.
No. Just give the final dose of HepA vaccine prior to travel.
Possibly. Since IG protects against hepatitis A infection for only 1 to 2 months, depending on the dosage given, additional IG may be needed if the infant is not yet age 6 months. Once the child has reached six months of age, HepA vaccine should be given.
Yes. ACIP recommends that all children age 1 year through 18 years should be vaccinated against hepatitis A. VFC HepA vaccine may be administered to any eligible child, including those recommended for vaccination at 6 through 11 months of age as a result of travel to an HAV-endemic area.
It depends on whether that person has a history of HAV infection. Unless there are medical records that document prior HAV infection, serologic testing for immunity (positive test for total anti-HAV) is the only way to determine if vaccination is necessary. For people from countries with high rates of HAV infection, such as Vietnam and Mexico, serologic testing might be done to prevent unnecessary vaccination. The cost effectiveness of serologic testing, however, should be balanced against the possibility of delaying needed vaccination while awaiting test results.
No, as long as there are medical records that document that the person was previously infected with HAV (i.e., positive test for total anti-HAV). If there is any doubt that the person actually was infected with HAV, HepA vaccine and/or IG should be given. The vaccine or IG will not harm a person who is already immune.