Hepatitis A: Do you need the vaccine before you travel?

Hepatitis A is one of the most common vaccine-preventable infections in travellers. It is caught from contaminated food and water, so it’s a risk in much of the world where sanitation and food hygiene are not as strong as in the UK. The good news is that a simple vaccine gives excellent protection, and it is free on the NHS in England for travel.

This guide explains what hepatitis A is, where it’s a risk, who should be vaccinated, how early to get the vaccine, and what to do if you think you’ve been exposed.

What is hepatitis A?

Hepatitis A is a viral infection of the liver. It is spread by the faecal-oral route, which means swallowing the virus from:

• Contaminated food or drink, such as raw or undercooked shellfish, salads, fruit washed in unsafe water, and ice
• Contaminated water, including tap water, and sometimes swimming water
• Close contact with someone who is infected, including sharing food or utensils, or through poor hand hygiene
• Sexual contact, which has been linked to outbreaks in some groups

   

Unlike hepatitis B and C, hepatitis A doesn’t become a long-term infection. However, it can make you very unwell for weeks or months, and in rare cases it can be serious.

Symptoms

Symptoms usually appear two to six weeks after infection. They can include:

• Tiredness and feeling generally unwell
• Loss of appetite, nausea and vomiting
• Pain or discomfort in the upper right of the tummy
• A high temperature
• Dark urine and pale stools
• Yellowing of the skin and eyes (jaundice) and itchy skin

   

Children are often mildly affected, and may have no symptoms at all, but they can still spread the virus. Older adults and people with existing liver disease are more likely to become seriously ill. Most people recover fully within a few weeks to a couple of months, and they usually have lifelong immunity afterwards. There is no specific treatment, so care focuses on rest, fluids and looking after yourself while the infection clears.

Symptoms can start after you’ve returned home, so tell your doctor where you’ve been if you become unwell.

Where is hepatitis A a risk?

Hepatitis A occurs worldwide, but the risk is highest in countries with poorer sanitation and food hygiene. Vaccination is recommended for most travellers going to:

• Africa
• Asia, including the Indian subcontinent and South-East Asia
• The Middle East
• Central and South America and parts of the Caribbean
• Parts of Eastern Europe

   

The risk is generally lower in Northern and Western Europe, North America, Australia and New Zealand, but it can depend on where you’ll stay and what you’ll do. Advice for individual countries changes, so check TravelHealthPro or ask your pharmacist.

You can be at risk even in comfortable hotels and resorts, as food can be contaminated at any stage. Risk is higher if you:

• Eat street food, buffets or raw salads
• Stay for a long time or travel off the beaten track
• Visit friends and relatives, where you may eat home-prepared food and have close contact with family
• Travel with children, who may not always wash their hands

Do you need the hepatitis A vaccine?

For most trips to Africa, Asia, the Middle East and Central and South America, the answer is yes. The vaccine is recommended for almost all travellers to these regions, and it is one of the most commonly recommended travel vaccines.

The vaccine is also advised for people at higher risk in the UK, including those with chronic liver disease or certain bleeding disorders, and some other groups. Your pharmacist or GP can advise if this applies to you.

What if I’ve had hepatitis A before?

If you’ve definitely had hepatitis A, you’re likely to be immune for life. If you grew up in a country where the virus is common, you may have been infected as a child without knowing. A blood test can check your immunity if you’re unsure, but in practice many people simply have the vaccine, as it is safe and quick.

How does the vaccine work?

The hepatitis A vaccine is made from an inactivated (killed) virus. It can’t cause hepatitis A.

• First dose: gives good protection from about two weeks after the injection, and can be given even shortly before you go, though earlier is better

   

• Booster dose: given 6 to 12 months after the first, which gives long-term protection that is thought to last for at least 25 years, and possibly for life

   

• Combined vaccines: hepatitis A is also available in combination with typhoid, or with hepatitis B, which means fewer injections

   

• If you’ve missed your booster, you usually don’t need to start again, and can simply have the booster dose

   

The vaccine is suitable for most adults and children from the age of one year. It can be given in pregnancy if you need it, but speak to a healthcare professional first.

Side effects

Most people have no problems, or only mild effects, such as a sore or red arm, a headache, tiredness or a mild temperature. Serious reactions are rare. Tell your pharmacist or nurse if you’ve had a severe reaction to a vaccine, have a weakened immune system, or are unwell on the day.

How early should you get vaccinated?

Ideally at least two to four weeks before you travel, and as soon as you’ve booked your trip. But if you’re leaving sooner, don’t skip it: one dose given even a few days before you go gives some protection, and travel health professionals often recommend it for last-minute travellers.

Plan your booster for 6 to 12 months after the first dose, and keep a record of your vaccines.

Cost

The hepatitis A vaccine for travel is free on the NHS in England, usually through your GP practice. Many pharmacies also offer it privately, which can be more convenient, particularly if you need other vaccines at the same time. 

Other ways to protect yourself

Vaccination is only one part of the picture. Good food and water habits matter too, particularly as hepatitis A is just one of many illnesses that can be caught this way.

• Drink bottled or treated water, and avoid ice if you’re unsure about it
• Eat food that is freshly cooked and served hot
• Be careful with raw salads, unpeeled fruit, and shellfish
• Wash your hands with soap and water before eating and after using the toilet
• Carry alcohol hand gel for times when soap isn’t available

   

See our guide to travellers’ diarrhoea for more advice.

If you think you’ve been exposed

If you’ve had close contact with someone who has hepatitis A, or have eaten food linked to an outbreak, speak to your GP or local health protection team as soon as possible. In some cases, the vaccine given within about two weeks of exposure can help prevent infection. Hepatitis A is a notifiable infection in the UK, so health professionals report cases to protect others.

If you develop symptoms, particularly jaundice or dark urine, see your GP promptly, and tell them about any recent travel. While you’re unwell, stay at home, wash your hands thoroughly, and don’t prepare food for others.