Hepatitis A is one of the few travel vaccines that travel health professionals recommend for travellers to a broad range of destinations, and for good reason. The disease is unpleasant, can be severe, has no specific antiviral treatment, and is entirely preventable with a course of vaccination that confers long-term, possibly lifelong, protection. Despite this, misconceptions about the vaccine, about the risk it addresses, and about what ‘recovery’ actually looks like for adults, remain common in our consultations at Priory Pharmacy in York.
What Is Hepatitis A?
Hepatitis A is caused by hepatitis A virus (HAV), a picornavirus transmitted by the faecal–oral route. The primary route of transmission during travel is ingestion of contaminated food or water, particularly shellfish (which concentrate the virus from polluted water), raw produce, ice, and food handled by infected individuals. Person-to-person transmission through close contact also occurs, particularly in household settings.
The clinical presentation of hepatitis A varies considerably by age. In children under five, infection is usually asymptomatic or produces only mild symptoms. In adults, symptomatic infection is the norm. The incubation period is two to six weeks. Typical presentation begins with a prodromal phase of fatigue, nausea, vomiting, abdominal discomfort, and low-grade fever, followed by the icteric phase characterised by jaundice (yellow discolouration of the skin and sclera), dark urine and pale stools as bile excretion is impaired by hepatocellular inflammation.
For most healthy adults, hepatitis A is a self-limiting illness resolving over two to six weeks. However, ‘self-limiting’ understates the clinical reality. Fatigue can be severe and prolonged. Functional impairment preventing work, travel and normal activity for four to eight weeks is common. Hospitalisation occurs in a significant minority. Fulminant hepatitis A (acute liver failure) develops in fewer than one percent of cases overall but in up to 1.8 percent of those aged over 50, and has a high mortality rate without liver transplantation.
Who Is at Risk?
Hepatitis A is endemic across most of sub-Saharan Africa, South and Southeast Asia, Central and South America, the Middle East and parts of Eastern Europe. Transmission is most concentrated in regions with inadequate sanitation infrastructure, but HAV can be contracted even in relatively developed destinations if food hygiene standards are variable or shellfish from coastal waters are consumed.
Travellers who are at elevated risk include those staying in local accommodation rather than hotels (greater food exposure risk), backpackers and those eating extensively from street food or local restaurants, VFR (visiting friends and relatives) travellers to endemic regions, and longer-stay travellers. Immunocompromised individuals, those with chronic liver disease, and older adults who may not have had childhood exposure are at higher risk of severe disease if infected.
The Hepatitis A Vaccine: Exceptional Protection
The hepatitis A vaccine available in the UK is highly immunogenic and extremely well-tolerated. Two products are available as single-antigen vaccines: Havrix Monodose and Avaxim. Combination hepatitis A and typhoid vaccines (Hepatyrix, ViATIM) are also available and are highly practical for travellers who require both, reducing the number of injections.
A single dose of hepatitis A vaccine, given at least two weeks before travel, provides protection in the vast majority of immunocompetent recipients. Seroconversion rates exceed 95 percent after a single dose. A booster dose, given six to twelve months after the primary dose, extends protection for an estimated 25 years or more, possibly lifelong, based on mathematical modelling of antibody kinetics, although it is recommended for a further booster at 25 years if you are at ongoing risk. This exceptional duration is clinically important: after completing the two-dose schedule, the vaccination is effectively lifelong for most individuals, eliminating the need for repeated vaccination before subsequent travel.
| Duration of Protection After Hepatitis A VaccinationAfter single dose: protection for approximately 1 year in most recipientsAfter booster dose (at 6–12 months): estimated 25+ years, potentially lifelongImmunocompromised individuals may have lower seroconversion rates and should be assessed individuallyPre-vaccination serology testing is not routinely required but may be cost-effective in older adults who may have natural immunity from childhood exposure |
Hepatitis A and Combination Vaccines
For travellers who require both hepatitis A and typhoid vaccination, the combination vaccine is an efficient choice. ViATIM delivers inactivated hepatitis A antigen alongside Vi polysaccharide typhoid antigen in a single injection. This approach is both clinically appropriate and practically convenient, reducing the number of injections and administration visits.
Twinrix is a combination hepatitis A and hepatitis B vaccine, available as an accelerated schedule (0, 7, 21 days plus a booster at 12 months) when travel is imminent, or as a standard schedule (0, 1, 6 months). This combination is appropriate for travellers who require hepatitis B vaccination alongside hepatitis A, including those working in healthcare settings abroad or undertaking activities that increase the risk of blood-to-blood contact.
| A Note for Travellers Who Believe They Do Not Need Hepatitis A VaccinationA common response in travel consultations is that the traveller is ‘only going to a hotel’ or has ‘been to this destination before without problems.’ Neither provides reliable protection. HAV transmission in hotels is well-documented. Previous travel without infection does not indicate immunity. Only prior vaccination or documented seropositivity confirms protection. |
This article is for general information and does not constitute individual clinical advice. To discuss hepatitis A vaccination and your full travel vaccination requirements, please book a travel consultation at Priory Pharmacy in York.
Frequently Asked Questions
A Hepatitis A vaccination is recommended for travellers visiting countries where the infection is common, particularly if you are staying with friends or relatives, visiting rural areas, or travelling for extended periods. Your travel health consultation can determine whether vaccination is recommended for your destination.
Ideally, you should receive the Hepatitis A vaccine at least two weeks before you travel. However, even if your trip is sooner, vaccination can still provide valuable protection and may be recommended.
One dose of the Hepatitis A vaccine provides excellent short-term protection. A second dose, usually given 6 to 12 months later, can provide long-term protection lasting at least 20 years and often lifelong.