R. Steffen et al., EPIDEMIOLOGY AND PREVENTION OF HEPATITIS-A IN TRAVELERS, JAMA, the journal of the American Medical Association, 272(11), 1994, pp. 885-889
Objective.-To assess the risk of hepatitis A in international traveler
s and to recommend preventive measures. Data Sources.-Index Medicus, 1
974 through 1983; MEDLINE, 1984 through 1993; and unpublished data of
the Centers for Disease Control and Prevention. Study Selection.-Revie
w of all retrospective and cohort studies on hepatitis A and other vac
cine-preventable diseases in travelers, of seroepidemiologic surveys o
f hepatitis A virus (HAV) antibodies in travelers, of data on the vari
ous hepatitis A vaccines, of economic analyses, and of recommendations
of recognized organizations. Data Extraction.-Independent analysis by
multiple observers. Data Synthesis.-The incidence rate for unprotecte
d travelers, including those staying in luxury hotels, is estimated to
be three per 1000 travelers per month of stay in a developing country
. Persons eating and drinking under poor hygienic conditions have a ra
te of 20/1000 per month. This makes hepatitis A the most frequent infe
ction in travelers that may be prevented by immunization. In many indu
strialized countries persons born after 1945 have an HAV antibody sero
prevalence (immunity) of less than 20%. New inactivated HAV vaccines i
nduce protective antibodies in more than 95% of recipients and offer p
rotection estimated to last for 10 years or more, whereas protection b
y immune globulin lasts only 3 to 5 months. Conclusions.-Hepatitis A v
accine, or immune globulin where HAV vaccine is not available, is reco
mmended for all nonimmune travelers visiting developing countries. Pre
screening for antibodies to HAV in travelers living in countries with
low prevalence is usually not necessary in persons born after 1945.