The hepatitis A vaccine is given to people who are traveling to parts of the world where hepatitis A virus infections are common. The hepatitis A vaccine is also recommended for all children living in the United States.
The hepatitis A vaccine is given as a series of two shots — the second administered six to 12 months after the first. Children receiving the first shot should be at least 1 year old.
The threat of hepatitis A virus
Although the threat of hepatitis A virus infection is high in developing countries, the United States is not, by any means, hepatitis A virus-free. Each year, about 8,500 people in the United States, many of whom are children, contract hepatitis A virus. And every year about 50 people die from hepatitis A virus infection. As a result, the Centers for Disease Control and Prevention (CDC) recommends that all children between 12 and 23 months of age get the hepatitis A vaccine.
- The disease
What is hepatitis A virus?
Hepatitis A is a virus that causes hepatitis (inflammation of the liver). Symptoms include fever, jaundice (a yellowing of the skin), nausea and vomiting. Young children are much less likely to develop symptoms when they are infected with hepatitis A virus than adults.
How do you catch hepatitis A virus?
People infected with hepatitis A virus excrete the virus in their stools. You can catch the virus in a number of ways:
- Babies with hepatitis A virus will have diapers that are contaminated with the virus. Adults changing these diapers are likely to get infected if they don't carefully wash their hands with soap and water after handling the diaper.
- Because hepatitis A virus is present in the stools of people who are infected, countries or cities with low standards for the handling and disposal of sewage have an enormous problem with hepatitis A virus infections. The problem is that the virus quickly enters the water supply and contaminates anything that comes in contact with the water. It is probably not unrealistic to think about many developing countries as having a thin layer of hepatitis A virus that covers anything that you could put into your mouth.
- People working in the food industry who are infected and do not exercise appropriate hand washing techniques between using the restroom and handling food have also been known to spread the infection.
Unfortunately, people infected with hepatitis A can transmit the virus to others up to two weeks before they have symptoms, so they may be infecting others without even knowing they have hepatitis A themselves.
How can you avoid catching hepatitis A virus when traveling?
Anyone traveling to countries where hepatitis A virus infections are common should avoid the following:
- Ice and unbottled water
- Uncooked shellfish
- Uncooked or unpeeled vegetables and fruit
- Food from street vendors
Additional travel information is available in the CDC travel publication, Yellow Book.
- The vaccine
How is the hepatitis A vaccine made?
The hepatitis A vaccine is made by taking whole hepatitis A virus and killing it with the chemical formaldehyde. Because the virus is inactivated, it cannot possibly cause hepatitis (see How Are Vaccines Made?).
Does the hepatitis A vaccine have side effects?
The hepatitis A vaccine can cause pain, redness and tenderness where the shot was given. The vaccine can also cause headache in about 5 of every 100 recipients. The hepatitis A vaccine has been given to millions of people without serious side effects.
Who should get the hepatitis A vaccine?
The hepatitis A vaccine should be given to the following groups of people:
- Travelers to countries that have a high incidence of hepatitis A infections such as Asia, Central America, South America, the Mediterranean Basin, the Middle East, Southern Europe, the Caribbean and Mexico.
- All children living in the United States are recommended to get the hepatitis A vaccine.
- All household contacts of international adoptees. Those traveling to get the child should be immunized at least two weeks before departure.
- Anyone who wants to avoid infection with hepatitis A.
- Other questions you might have
Are infections caused by hepatitis A virus similar to those caused by hepatitis B virus?
Although hepatitis A virus sounds like it would be similar to hepatitis B virus, the viral infections are really quite different. Hepatitis B virus can cause long-term problems, such as cirrhosis (chronic liver damage) and liver cancer. On the other hand, hepatitis A virus doesn't cause long-term problems. Also, hepatitis B virus kills about 750 people every year, whereas hepatitis A virus kills about 50 people every year. Finally, hepatitis B virus is transmitted by coming in contact with someone who is infected, but hepatitis A virus is typically transmitted in contaminated food or water.
How long should I wait after getting the hepatitis A vaccine before I travel?
The hepatitis A vaccine is most effective if given at least four weeks before traveling, but the vaccine is still somewhat effective if given at least two weeks before traveling. If you are going to travel within two weeks of receiving the vaccine, it is probably better to get a shot of something called "immune serum globulin." This is a preparation of antibodies that also contains antibodies directed against hepatitis A virus. You don't develop long-lived protection by receiving "immune serum globulin," but at least it will get you through your trip. Protection afforded by immune serum globulin lasts several months.
Why was the hepatitis A vaccine recommended for all infants after it was given to only certain groups at first?
When the hepatitis A vaccine first became available, it was only recommended for specific groups that were at increased risk of getting hepatitis A. However, in 2006 the recommendation was extended to include all infants between 12 months and 23 months of age:
- The original version of the vaccine could not be given to children less than 2 years old. A newer version became available in 2005 that could be given to younger children.
- Disease rates had been controlled in parts of the country where the vaccine was recommended, yet cases of hepatitis A were still occurring, particularly in regions where children were not regularly getting the vaccine.
- Relative risks and benefits
Do the benefits of the hepatitis A vaccine outweigh the risks?
Hepatitis A virus infections are quite common throughout the world. So common, in fact, that it is really easier to list the countries where you are unlikely to catch the infection than countries where you are likely to catch it. Also, the United States still has about 8,500 cases of hepatitis A virus every year. Although hepatitis A virus infections do not cause long-term liver damage, about 50 people die every year from severe, overwhelming infections caused by the hepatitis A virus. Because the vaccine does not have serious side effects, the benefits of the hepatitis A vaccine clearly outweigh its risks.
- Inflammation of the liver
- Pain, redness, and tenderness at the injection site
- Headache (5 of 100)
Plotkin SA, Orenstein W, and Offit PA. Hepatitis A Vaccines in Vaccines, 6th Edition. 2012, 183-204.