From the Guidelines
Before traveling, it's essential to update your hepatitis A and B vaccinations at least 2-4 weeks prior to departure, especially if traveling to regions with higher prevalence of these diseases. For hepatitis A, adults typically receive two doses of either Havrix or Vaqta, with the second dose given 6-12 months after the first, as recommended by the advisory committee on immunization practices 1. The vaccine schedule can be accelerated if necessary, but the standard schedule is preferred. For hepatitis B, the standard adult regimen includes three doses of Engerix-B or Recombivax HB (0,1, and 6 months), though an accelerated schedule (0,1, and 2 months, with a booster at 12 months) is available for those with limited time before travel. Alternatively, Twinrix combines both vaccines and is given in three doses over 6 months, or in an accelerated four-dose schedule (0,7,21-30 days, and 12 months) 1.
Some key points to consider when updating hepatitis A and B vaccinations prior to travel include:
- Traveling to countries with high or intermediate endemicity of hepatitis A or B increases the risk of infection 1
- Certain individuals, such as those with chronic liver disease or who receive clotting factor concentrates, are at higher risk of complications from hepatitis A or B infection 1
- Vaccination provides the most effective protection against hepatitis A and B, especially when traveling to areas with poor sanitation or higher disease prevalence 1
- A blood test can check antibody levels to determine if boosters are needed for those who have previously been vaccinated but aren't sure of their immunity status 1
The most recent and highest quality study recommends that the first dose of the 2-dose hepatitis A vaccine series should be administered as soon as possible, ideally 2 or more weeks before travel to a high-risk area 1. This allows for optimal protection against hepatitis A infection. Similarly, the hepatitis B vaccine series should be completed as soon as possible, with the option for an accelerated schedule if necessary. By following these recommendations, individuals can reduce their risk of hepatitis A and B infection and protect themselves against serious liver damage.
From the FDA Drug Label
For hemodialysis patients, in whom vaccine-induced protection is less complete and may persist only as long as antibody levels remain above 10 mIU/mL, the need for booster doses should be assessed by annual antibody testing. 40 mcg (2 × 20 mcg) booster doses with ENGERIX-B should be given when antibody levels decline below 10 mIU/mL. Persons Who May Be Exposed to the Hepatitis B Virus by Travel to High-Risk Areas (See ACIP Guidelines, 1990.)
The Hepatitis B vaccine dosing schedule for travelers to high-risk areas is not explicitly stated in the provided drug labels, but it can be inferred that a booster dose may be necessary for individuals who have previously received the vaccine and are traveling to high-risk areas.
- The usual immunization regimen for Hepatitis B vaccine consists of 3 doses given at 0,1, and 6 months.
- Booster vaccinations are recommended for certain populations, including adult hemodialysis patients, when antibody levels decline below 10 mIU/mL 2. However, the Hepatitis A vaccine label does not provide information on updating the vaccine prior to travel 3.
From the Research
Hepatitis A and B Vaccination Prior to Travel
- Hepatitis A and B vaccinations are recommended for travelers to high or intermediate endemic countries 4, 5
- Studies have shown that vaccination coverage for hepatitis A and B is low among adult travelers to these areas 4, 5
- Factors associated with higher likelihood of hepatitis A and B vaccination among travelers include younger age, higher education level, and more frequent physician contacts 4, 5
Vaccination Strategies
- Tailored vaccination strategies are needed for different endemicity levels, with universal infant vaccination recommended for high and intermediate endemic regions 6
- Combined hepatitis A and B vaccine has been shown to be effective and safe, with satisfactory long-term immunogenicity rates and duration of protection 7
Travel-Associated Hepatitis A
- International travelers are at risk of acquiring hepatitis A, particularly if they are unvaccinated 8
- Hepatitis A can be acquired in low-endemicity destinations, highlighting the importance of pre-departure vaccination for all travelers 8
- Pre-departure hepatitis A vaccine should be offered to all travelers as part of the pre-travel consultation, regardless of destination 8
Key Findings
- Hepatitis B vaccination coverage among adult travelers to high or intermediate endemic countries was 38.6% in 2015 4
- Hepatitis A vaccination coverage among adult travelers to high or intermediate endemic countries was 26.6% in 2010 5
- Combined hepatitis A and B vaccine has been shown to be effective in preventing both diseases, with anti-HAV seropositivity rates ranging from 96.2% to 100% and anti-HBs seroprotection rates from 82% to 100% 7