Hepatology Hepatitis
Hepatitis A and B Vaccination in Elderly Travellers Pierre Van Damme,1
Roman Chlibek2 and Emmet B Keeffe3
1. Faculty of Medicine, Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp; 2. Faculty of Military Health Sciences, University of Defense, Hradec Kralove; 3. Stanford University Medical Center, Palo Alto
Abstract
Hepatitis A and hepatitis B viruses (HAV and HBV, respectively) are associated with significant morbidity, linked with acute illness, a substantial healthcare burden and potential mortality. An increasing number of people, with increasing median age, travel from areas of low endemicity to countries that have intermediate or high endemicity for HAV and HBV and are consequently susceptible to infection. Pre-travel vaccination is, therefore, warranted, but the response to HAV and HBV vaccination in elderly individuals could be compromised by senescence of the immune system, thus potentially increasing the vulnerability of the elderly to these infections. Studies with monovalent hepatitis A and B vaccines or combination hepatitis A and B vaccine show good efficacy in adults in general but only a limited number of studies have assessed the immune response in older adults. This article presents an overview of the risk factors for acquisition of HAV and HBV in the elderly traveller and evaluates the present literature available on HAV and HBV vaccination in this population.
Keywords Hepatitis A and B vaccination, seroprotection, elderly travellers, immunisation, seroprevalence
Disclosure: Pierre Van Damme has received research grants and speaker fees from vaccine manufacturers. Speaker fees for presentations on vaccines are paid directly to an educational fund held by the University of Antwerp. Roman Chlibek has received research grants from vaccine manufacturers and speaker fees from various pharmaceutical companies. Emmet B Keeffe has no conflicts of interest to declare. Acknowledgements: The authors wish to thank Touch Medical Communications for professional writing support, Marc De Ridder (GlaxoSmithKline Biologicals, Belgium) for review of the manuscript and Luise Kalbe (GlaxoSmithKline Biologicals, Belgium) for editorial assistance. Received: 10 February 2011 Accepted: 24 March 2011 Citation: European Gastroenterology & Hepatology Review, 2011;7(2):84–92 Correspondence: Roman Chlibek, Faculty of Military Health Sciences, University of Defense, Trebesska 1575, 500 01 Hradec Kralove, Czech Republic. E:
chlibek@pmfhk.cz
Support: The publication of this article, including writing and editorial assistance from Touch Medical Communications, was funded by GlaxoSmithKline Biologicals, Belgium. The authors were fully responsible for all content and editorial decisions and received no financial support or other form of compensation related to the development of the manuscript.
The hepatitis A and hepatitis B viruses (HAV and HBV, respectively) account for the majority of acute viral infections of the liver and are associated with significant morbidity, linked with acute illness, a substantial healthcare burden and potential mortality.1,2
Both viruses
Despite this, HAV and HBV are two of the most common vaccine-preventable diseases for which travellers are at risk.5
have a substantial global prevalence and the likelihood of infection is particularly high in developing regions such as Latin America, the Caribbean, Africa, Asia and parts of Eastern Europe (see Figures 1 and 2). Active immunisation against HAV and HBV is well established, and the respective monovalent vaccines are efficacious and have an acceptable safety profile.3 available.4
A combined hepatitis A and B vaccine is also
and this trend is likely to continue (see Figure 3). In the early half of 2010, Europe as a tourist destination experienced the slowest growth in tourism, at only 2%, compared with Asia and the Pacific (14%), the Middle East (20%) and Africa (7%).7
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Hepatitis A and B becomes a problem to a susceptible international traveller when undertaking a journey from a low endemic to a high endemic area. Rates of global travel to countries that have intermediate or high endemicity for HAV or HBV have increased in recent years,6
Thus, the
Older adults participating in tourism make the most frequent trips and tend to have a longer duration of stay than younger tourists, whose length of stay is often influenced by work commitments. Among EU residents 15 years of age or over, those in the age group 45–64 years and those ≥65 years of age constitute 32 and 17% of the total number of tourists, respectively.14
A considerable proportion of the travel market is composed of older adults.13
Furthermore, the number of
older travellers is expected to increase owing to the exponential growth of the elderly population of many industrialised countries.15 HAV infection is associated with worse complications and increased mortality in older adults compared with infections in younger persons,
© TOUCH BRIEFINGS 2011
incidence of travel-related HAV or HBV infection can be expected to increase unless preventative measures are taken to minimise infection rates. The problem is compounded by the general lack of awareness among travellers and travel advisers about the risks of viral hepatitis infection together with a lack of awareness of or compliance with vaccination and preventative behaviour recommendations.6,8
A significant proportion of those visiting
high/intermediate-prevalence regions therefore wittingly or unwittingly expose themselves to the risk of HAV or HBV infection.9–12
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