TY - JOUR
T1 - Acute hepatitis A in international travellers
T2 - a GeoSentinel analysis, 2008-2020
AU - Balogun, Oluwafemi
AU - Brown, Ashley
AU - Angelo, Kristina M.
AU - Hochberg, Natasha S.
AU - Barnett, Elizabeth D.
AU - Nicolini, Laura Ambra
AU - Asgeirsson, Hilmir
AU - Grobusch, Martin P.
AU - Leder, Karin
AU - Salvador, Fernando
AU - Chen, Lin
AU - Odolini, Silvia
AU - Díaz-Menéndez, Marta
AU - Gobbi, Federico
AU - Connor, Bradley A.
AU - Libman, Michael
AU - Hamer, Davidson H.
N1 - Funding Information: GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine (ISTM), is supported by a cooperative agreement (U50CK00189) from the Centers for Disease Control and Prevention (CDC), as well as funding from the ISTM and the Public Health Agency of Canada. Publisher Copyright: © 2022 The Author(s). Published by Oxford University Press on behalf of International Society of Travel Medicine. All rights reserved.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - 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.
AB - 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.
KW - COVID-19
KW - endemicity
KW - epidemiology
KW - hepatitis A vaccine
KW - immunization
UR - http://www.scopus.com/inward/record.url?scp=85128000635&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/jtm/taac013
DO - https://doi.org/10.1093/jtm/taac013
M3 - Article
C2 - 35134210
SN - 1195-1982
VL - 29
JO - Journal of Travel Medicine
JF - Journal of Travel Medicine
IS - 2
M1 - taac013
ER -