Public Health

Hepatitis A, B booster not needed to protect most travelers

Last Updated: 2005-10-11 10:33:26 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A single course of hepatitis A and B vaccination is enough to protect most immunocompetent travelers from contracting these infections, and current evidence suggests this protection is lifelong, a team of travel medicine experts concludes.

While the benefit of primary hepatitis A and B vaccination is well established, recommendations on the use of booster vaccines vary around the world, Dr. Jane N. Zuckerman of the Royal Free and University College Medical School in London and colleagues write in the October 1st issue of Clinical Infectious Diseases.

In light of this variation, recent research-based recommendations were issued on the use of hepatitis A and B boosters. Both concluded that boosters are not necessary for non-immunocompromised individuals who respond to the primary course of vaccination.

In the current report, Dr. Zuckerman and her team reviewed these reports and other relevant, more recent literature to develop recommendations on vaccination specifically for travelers.

For immunocompromised travelers, they write, monitoring antibody levels remains necessary to determine if boosters are required. The researchers recommend checking hepatitis A antibody titers to gauge immunity, with additional doses of the vaccine given as needed.

A similar, but more targeted, approach should be used for hepatitis B in patients for whom seroconversion cannot be established, such as immunocompromised individuals, the elderly, those with chronic disease and people facing an occupational risk of exposure.

Any traveler unsure of his or her immunization history may be given an additional dose of hepatitis A vaccine immediately before travel, but people older than 40 who are frequent travelers or who have lived abroad may have acquired immunity, the researchers note, so their antibody titers should be checked so vaccine is not given unnecessarily.

Accelerated primary courses of hepatitis B vaccine are available, the researchers note, at 0, 1 and 2 months or 0, 7, and 21 days rather than the standard 0, 1 and 6 months. For both shortened courses, a fourth dose is recommended at 12 months. Studies have found, Dr. Zuckerman and her colleagues add, that these shortened courses are effective in protecting against the disease.

The researchers conclude: "Current evidence and recommendations suggest that, after completion of a primary vaccination course, the vast majority of travelers are protected for many years from both hepatitis A and B, with this protection most likely being lifelong."

Clin Infect Dis 2005;41:1020-1026.