Last Minute Travelers and Hepatitis Prevention!

Abstract & Commentary

Synopsis: Travelers presenting 3 to 4 weeks in advance for travel to areas with high prevalences for hepatitis A and B can benefit from an accelerated dosing schedule using either monovalent or combined hepatitis A and B vaccines. Those who present 2 weeks in advance can be fully protected against hepatitis A; they should be encouraged to begin the vaccine series for hepatitis B even though optimal levels of hepatitis B immunity cannot be provided.

Source: Nothdurft HD, et al. Accelerated Vaccination Schedules Provide Protection Against Hepatitis A and B in Last-Minute Travelers. J Travel Med. 2004;11:260-262.

Although excellent vaccines for prevention of hepatitis A and B are available, and accelerated schedules for prevention of hepatitis A and B in travelers have been described since 1995, up to 50% of confirmed cases of hepatitis A and B in Europe are still acquired during travel. Travel clinics are increasingly working with larger numbers of last minute travelers. Even individuals who have advanced plans for travel rarely seem to come for consultation sooner than 4 weeks prior to departure. This recently published article elaborates upon additional data to support use of the accelerated hepatitis vaccination schedules.

The safety and efficacy of 2 different approaches to accelerated Hepatitis A and B protection were described and compared (see table and figure). A single dose of hepatitis A vaccine rapidly conveys immunity for nearly all who will acquire hepatitis A antibodies within 2 weeks; a second dose given between 6 and 18 months after the first dose confers long term protection. The accelerated schedule for monovalent hepatitis B vaccine administered on days 0, 7, and 21 rapidly induces long lasting immunity (> 12 months), as well as high rates of seroconversion and protection. A booster dose (dose 4) at 12 months provides long-term protection.

Combined hepatitis A and B vaccine is usually administered as 3 separate doses on day 0, at 1 month, and at 6 months. Data obtained from a large, randomized trial compared an accelerated dosing schedule of the combined hepatitis A and B vaccine (administered on day 0, 7, 21, and at 12 months) with the monovalent hepatitis A and B vaccine (single dose hepatitis A on day 0 and the monovalent hepatitis B given on days 0, 7, and 21, with boosters of each at 12 months). They were essentially equivalent in the sense that both were effectively administered and well tolerated by all subjects. Compared to standard schedules, those who receive the accelerated schedules achieve greater than 80% seroconversion and protection rates for anti-hepatitis B antibodies at month 1, compared with only 33% in those on the standard schedule.

Comment by Maria D. Mileno, MD

While an exhaustive review of this topic regarding a last minute traveler can be equivalent to trying to get a hot air balloon to rise. A case can often be made that all newborns and teens have already completed this highly protective vaccine (thus informing the age groups who have escaped the pediatricians that they are way behind and out of touch). Even 1 dose of monovalent hepatitis B vaccine brings them a step closer to completing the series, perhaps in time for their next trip. The benefits could last during a lifetime of future travel plans.

Maria D. Mileno, MD, Director, Travel Medicine, The Miriam Hospital, Associate Professor of Medicine, Brown University, Providence, RI. is Associate Editor of Travel Medicine Advisor.