Richard comes in to the pharmacy. “I’ve just moved jobs and I’ve got to go to China next month,” he says. “The only injection the surgery said I need is hepatitis A, which I’ve just had, and they said it would last a year."
"I’m going to be doing a lot of travelling to China in this new role, so am I going to need a jab every year?" he asks. "I’m not going off the beaten track – it’s really the big cities I’ll be visiting, though I guess I might do the odd bit of tourism if I get a chance.”
How do you respond?
Currently, hepatitis A is the only additional immunisation routinely advised for visiting China. Richard has been sensible by receiving the vaccination a month before his trip, because the antibodies can take 12-15 days to become detectable (although some protection is conferred even if the injection is administered on the day of departure).
Protection from the primary course – in this case, a single shot of a monovalent product – lasts at least one year, but a booster dose given at six to 12 months after the initial dose increases immunity to at least 10 years. A further booster is rarely considered necessary until 25 years later, and then only for those with an ongoing risk.
Is there any other advice you can give?
It is important that Richard understands that there are measures he can take to reduce his exposure to hepatitis A, despite having received the vaccination.
The viral infection is spread through contaminated food and water, as well as person-to-person through the faecal-oral route. The risk is considerably higher in areas where sanitation and personal hygiene levels are poor. Richard should therefore take care to wash his hands before eating and after using the toilet. He should also avoid high-risk foodstuffs such as shellfish, salads, unwashed fruit and vegetables, and undercooked meat.
Richard should understand that he needs to check vaccination requirements with a healthcare professional each time he has a work trip looming, and make sure he states exactly where he is travelling to, as the risk of disease changes over time and according to location.