Acute hepatitis A in international travellers: a GeoSentinel analysis, 2008–2020

Abstract

Background: Non-immune international travelers are at risk of acquiring hepatitis A. Although hepatitis A vaccination is recommended for unvaccinated travelers to high or intermediate hepatitis A virus endemicity, compliance with this recommendation is not universal. Objective: To describe the demographic and travel characteristics of international travelers infected with hepatitis A during travel. Methods: Available data on travelers with confirmed (positive molecular test) or probable (symptomatic individuals with a single positive IgM test) hepatitis A diagnosed during and after travel from January 2008 to December 2020 were obtained from the GeoSentinel Surveillance Network database. We analyzed demographic and travel characteristics of infected travelers. Results: Among 254 travelers with hepatitis A (185 confirmed and 69 probable), the median age was 28 years (interquartile range: 19—40), 150 (59%) were male, and among 54 travelers with information available, 53 (98%) were unvaccinated. The most common reasons for travel included tourism (n = 120; 47%) and visiting friends or relatives (VFR) (n = 72; 28%). About two-thirds of VFR travelers with hepatitis A (n = 50; 69%) were younger than 20 years old. Hepatitis A was acquired most frequently in South-Central Asia (n = 63; 25%) and sub-Saharan Africa (n = 61; 24%), but 16 travelers (6%) acquired hepatitis A in regions with low endemicity including Western Europe (n = 7; 3%), the Caribbean (n = 6; 2%), and North America (n = 3; 1%). Median duration from illness onset to GeoSentinel site presentation was approximately 7 days (IQR: 4–14 days). Among 88 travelers with information available, 59% were hospitalized. Conclusion: Despite availability of highly effective vaccines, travelers still acquire hepatitis A, even when traveling to low-endemicity destinations. Providing pre-departure hepatitis A vaccine to susceptible travelers is crucial to reducing travel-associated hepatitis A and should be offered to all travelers as part of the pre-travel consultation, regardless of destination.

Decreasing parvovirus B19 and hepatitis A nucleic acid test positivity rates in Canadian plasma donors following the initiation of COVID‐19 restriction in March 2020

“…It is likely that these public health mandates may have reduced B19V (respiratory secretions) and HAV (faecal-oral route) transmission in the general community. As HAV is mainly transmitted via the enteric route, it is suspected that social gathering restrictions and travel restrictions may have reduced opportunities for Canadians to be infected with HAV [19,20]. Public health communications on the importance of hand hygiene may have additionally reduced the opportunity for faecal-oral transmission in the community, schools and facilities [21].…”

The provision of sexual and reproductive health information and services to travellers: an exploratory survey of Australian travel medicine clinicians

“…40 Additionally, travel medicine provides an opportunity for improving coverage of vaccinations for infections linked to sexual behaviour such as Hepatitis A and B, which are found to be suboptimal among travellers. 44,45 Therefore, while PrEP and PEP might be notable areas for up-skilling, there is a need to provide wider STI/BBV and SRH training. Consideration needs to be given on how to best achieve effective education and dissemination of sexual health information and the development of consistent, clear tools that allow for streamlined access to up-to-date clinical guidelines and important information about emerging changes in STI trends, such as the current ongoing increases in infectious syphilis occurring in Australia and other high income countries to help improve service delivery.…”

Reiseimpfungen – Hinweise und Empfehlungen

“…Nach der zweiten Dosis liegt bei fast 100 % der Geimpften ein Hepatitis-A-Schutz vor. In einer GeoSentinel-Studie an 254 Reiserückkehrern mit Hepatitis A waren 98 % nicht oder nicht vollständig geimpft [67].…”