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Hepatitis A Country Specific Vaccine Recommendations Review

31 October 2017

The hepatitis A vaccine country specific recommendations on TRAVAX have been revised and updated. Previous recommendations were based upon the World Health Organization (2010) publication “Global Hepatitis A prevalence and susceptibility” with two categories of advice being developed. To take account of the changing global epidemiology and recent outbreaks among high risk groups three categories of advice are now considered appropriate. The risk assessment was again based on the above report but secondary data from the WHO and UNICEF joint report on the “Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment” were also considered. Countries were assigned a risk score according to their hepatitis A status. This was adjusted according to data on their rural sanitation. Further adjustments were made after considering nearest neighbour analysis, and uncertainty.

The three categories of risk and advice on TRAVAX are:

Low risk (Vaccination Selectively Advised)

Who Should I Vaccinate for Hepatitis A?

Consider vaccinating:

  • Those at occupational risk of disease (e.g. laboratory workers, staff in residential institutions, sewage workers).
  • Men who have sex with men.
  • People who inject drugs.
  • Those with chronic liver disease.
  • Those with haemophilia.

Low-medium to medium risk (Vaccination Sometimes Advised)

Who Should I Vaccinate for Hepatitis A?

In addition to those at low risk mentioned above, consider vaccinating:

  • Travellers visiting smaller villages, cities and rural areas where access to adequate sanitation and safe water may be limited.
  • Those who will be unable to take sufficient care with food and drink including young children.
  • Men who have sex with men.
  • Those visiting friends and family.
  • Long stay travellers

Medium to high risk (Vaccination Usually Advised)

Who Should I Vaccinate for Hepatitis A?

  • All travellers who are non-immune to hepatitis A.

The most notable changes to TRAVAX hepatitis A vaccine recommendations are:

Dominican Republic, Philippines, Turkey, Vietnam:

  • Hepatitis A vaccine no longer recommended for all travellers, but only for those at increased risk due to characteristics of their travel, occupation, lifestyle or underlying medical conditions (Sometimes Advised).

Thailand, Cuba:

  • Hepatitis A vaccine no longer recommended for all travellers, but only for those at increased risk due to occupation, lifestyle or underlying medical conditions (Selectively Advised).

When advising travellers about hepatitis A transmission it is important to give advice on food and water precautions and good hand hygiene practices. This is especially important during periods where hepatitis A vaccine is in short supply, see hepatitis A FAQs.

These changes are currently being updated on www.fitfortravel.nhs.uk and a news item will be posted on fitfortravel when this update is complete.