Hepatitis Prevention for Travelers to Brazil
All travelers to Brazil should receive hepatitis A vaccination before departure, and hepatitis B vaccination should be administered to those at risk based on anticipated exposures during travel. 1
Hepatitis A Vaccination
Standard Recommendations
Brazil is classified as a country with high to intermediate hepatitis A endemicity, making vaccination essential for all susceptible travelers. 1 The epidemiological pattern of hepatitis A in Brazil has been changing, with declining seroprevalence particularly in younger populations and urban areas, meaning travelers can no longer rely on natural immunity patterns. 2
Timing and Administration
- The first dose of hepatitis A vaccine should be administered as soon as travel is considered, regardless of departure date. 1
- For healthy travelers under age 40, a single dose of hepatitis A vaccine administered at any time before departure provides adequate protection. 1
- The vaccine series should be completed with a second dose 6-12 months later for long-term protection. 1
Special Populations Requiring Additional Protection
For travelers departing within 2 weeks who fall into high-risk categories, immune globulin (IG) should be considered in addition to vaccine: 1
- Adults over age 40 (due to more severe disease manifestations and unknown vaccine performance in this age group)
- Immunocompromised persons
- Persons with chronic liver disease
- Those with other chronic medical conditions
The IG dose is 0.02 mL/kg administered intramuscularly at a separate injection site from the vaccine. 1
Hepatitis B Vaccination
Risk-Based Approach
While hepatitis B was historically considered lower risk for travelers, the overlap of high-endemicity areas and increasing international travel patterns warrant vaccination for those with anticipated risk exposures. 3, 4 Brazil has areas of medium endemicity for hepatitis B, particularly in the Amazon region. 1
Who Should Receive Hepatitis B Vaccine
Travelers to Brazil should be vaccinated against hepatitis B if they anticipate: 4
- Sexual contact with new partners
- Medical or dental procedures abroad
- Extended stays (>6 months)
- Contact with blood or body fluids through their work
- Adoption of children from endemic areas
Vaccination Schedules
Standard 3-dose schedule (0,1,6 months): Provides optimal long-term protection but requires advance planning. 5
Accelerated 4-dose schedule (days 0,7,21-30, plus booster at 12 months): Recommended for travelers needing rapid protection who are departing soon. 5, 4 This schedule provides excellent rapid seroconversion, though the 12-month booster is critical for long-term immunity. 5
Combined Hepatitis A/B Vaccine (Twinrix)
When to Use
The combined vaccine is particularly useful for travelers to Brazil who need protection against both viruses, as it simplifies the vaccination schedule and improves compliance. 5, 3
Schedules Available
Important Caveats
Do not use Twinrix for post-exposure prophylaxis to hepatitis A, as the hepatitis A antigen concentration is half that of single-antigen vaccine and no data support its use in this setting. 1
Critical Pitfalls to Avoid
- Never restart an interrupted vaccine series—simply continue where you left off to avoid wasting doses and delaying protection. 5
- Do not assume travelers need revaccination before each trip—the primary series provides decades of protection without routine boosters. 5, 6
- Do not delay vaccination waiting for the "optimal" schedule—starting immediately is more important than completing the full series before departure. 1
- For the accelerated Twinrix schedule, do not skip the 12-month booster dose, as it is essential for long-term immunity. 5
Additional Preventive Measures
Beyond vaccination, travelers should practice standard hygiene precautions: 1
- Avoid consuming untreated water and ice
- Practice safe food handling (avoid raw or undercooked foods, especially shellfish)
- Practice safe sex and avoid blood exposures
- Ensure sterile equipment for any medical/dental procedures