Last-Minute Hepatitis A Protection

Travelers bound for countries where the viral liver infection hepatitis A is prevalent--Mexico, Southeast Asia and much of the Caribbean are among the popular destinations--are advised to get vaccinated against the disease at least two weeks before leaving home. That time window is believed best to achieve peak antibody production and thus protection.

But many travelers make spur-of-the-moment plans or learn too late about the need for hepatitis A vaccinations. Some of them will look for an injection of immune globulin, previously recommended for hepatitis A protection and still recommended in lieu of the vaccine for children under 2. But immune globulin is extremely difficult to find because of an ongoing nationwide shortage.

What to do? Some travel medicine doctors say they will call around to find immune globulin for patients with short lead times for travel, and give it along with the first dose of vaccine. Vaqta, manufactured by Merck & Co., and Havrix, made by SmithKline Beecham, are the two hepatitis A vaccines on the market. (A booster dose is recommended for adults after six months; Havrix users have up to a year for the booster.)

Other doctors suggest that getting the immune globulin shot in addition to the hepatitis A vaccine is excessive.

Travelers with compromised immune systems due to HIV infection or cancer treatment probably would be advised to avoid high-risk areas if they were not vaccinated in time.

“It takes a little doing [to find immune globulin],” said Dr. John Horton, a Westlake Village internist with a special interest in travel medicine. “Sometimes the [public] health department has it.”

True, said Cheryl Jamerson, program manager of immunization services at the Pasadena Public Health Department, whose inventory usually includes some immune globulin. “We try to save it for outbreaks,” she said.

Dr. J. Paul Sanders, a Dallas internist with a special interest in travel medicine, usually skips the immune globulin for short-term adult travelers and instead gives the hepatitis A vaccine, even if the trip is less than two weeks away. “Hepatitis A is survivable,” he tells travelers. “It’s just a bad illness.”

Hepatitis A is spread by consuming contaminated food or drink or by person-to-person contact. The incubation period--the time between infection and the onset of symptoms--is two weeks or longer. Symptoms are flu-like and can include fatigue, nausea, vomiting, fever, jaundice, dark urine, light-colored stools and abdominal pain. Treatment includes rest and drinking liquids.

Areas where hepatitis A is prevalent include Africa, Asia (except Japan), the Mediterranean, Eastern Europe, the Middle East, Central and South America, Mexico and parts of the Caribbean.

Even with the vaccine, travelers in risk areas should be vigilant about precautions against hepatitis A. “Avoid anything that might be contaminated,” Sanders advised. “Avoid brushing your teeth in tap water.” When taking a shower, he added, don’t allow water to enter the mouth, the eyes or open cuts--all possible routes of transmission if the water is contaminated with hepatitis A virus.

Overall, Horton said, the risk of contracting hepatitis A is minimal for typical short-term tourist travel, especially if travelers eat in restaurants and stay in comfortable hotels.

He encourages travelers to plan ahead. “I would so much rather give people hepatitis A [vaccine] at this point [than immune globulin],” Horton said. Immune globulin usually provides protection for three to five months; the vaccines are believed to confer protection for about 10 years.

While studies have shown that it takes two weeks to obtain full antibody protection against hepatitis A, “the antibody production begins right away,” said Dr. Bradley Connor, a New York gastroenterologist with a special interest in travel medicine.

Connor is analyzing data from recent hepatitis A outbreaks in California and Tennessee, in which public-health officials administered hepatitis A vaccine after the fact and minimized the person-to-person transmission. He’s trying to determine if antibody production might be protective in less than two weeks.

Even if a traveler becomes infected the first day of a trip, some antibodies will be present, Connor said, and the illness is likely to be a mild case.

Healthy Traveler appears the second and fourth Sundays of every month.

Times Travel Writer Susan Spano is on assignment. Her World will return next week.