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. 2022 Mar 21;29(2):taac013.
doi: 10.1093/jtm/taac013.

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

Oluwafemi Balogun  1   2 , Ashley Brown  3 , Kristina M Angelo  3 , Natasha S Hochberg  4   5 , Elizabeth D Barnett  6 , Laura Ambra Nicolini  7 , Hilmir Asgeirsson  8 , Martin P Grobusch  9 , Karin Leder  10 , Fernando Salvador  11 , Lin Chen  12 , Silvia Odolini  13 , Marta Díaz-Menéndez  14 , Federico Gobbi  15 , Bradley A Connor  16 , Michael Libman  17 , Davidson H Hamer  4   18
Affiliations

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

Oluwafemi Balogun et al. J Travel Med. .

Abstract

Background: Non-immune international travellers are at risk of acquiring hepatitis A. Although hepatitis A vaccination is recommended for unvaccinated travellers to high or intermediate hepatitis A virus endemicity, compliance with this recommendation is not universal.The main objective was to describe the demographic and travel characteristics of international travellers infected with hepatitis A during travel.

Methods: Available data on travellers 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 analysed demographic and travel characteristics of infected travellers.

Results: Among 254 travellers 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 travellers 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 travellers 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 travellers (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 ~7 days (interquartile range : 4-14 days). Among 88 travellers with information available, 59% were hospitalized.

Conclusions: Despite availability of highly effective vaccines, travellers still acquire hepatitis A, even when traveling to low-endemicity destinations. Providing pre-departure hepatitis A vaccine to susceptible travellers is crucial to reducing travel-associated hepatitis A and should be offered to all travellers as part of the pre-travel consultation, regardless of destination.

Keywords: COVID-19; endemicity; epidemiology; hepatitis A vaccine; immunization.

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