Questions & Answers

About hepatitis A and B

What are hepatitis A and B?

Hepatitis A and B are two serious liver diseases caused by the hepatitis A and B viruses. These viruses are endemic (constantly present) in much of the developing world. Popular holiday destinations such as the Caribbean are considered risk areas for unprotected travellers, and you could contract hepatitis A or B even at 5-star resorts.

How can I contract hepatitis A?

You can contract the hepatitis A virus by ingesting food or drinks that have been contaminated by human waste. That means, you could be exposed by:

  • Eating food handled by an infected worker who did not wash his/her hands properly
    after using the washroom
  • Eating raw or undercooked seafood and shellfish from sewage-polluted water
  • Eating produce (e.g. salad) that has been rinsed in contaminated water
  • Ingesting contaminated water while swimming or bathing

Since you can’t see the hepatitis A virus, you can’t tell by looking whether food is contaminated. Even microscopic amounts of contaminated human waste on food can put you at risk.

How can I contract hepatitis B?

You can contract hepatitis B by coming into contact with the bodily fluids (e.g. blood, semen, vaginal fluid or saliva) of an infected person. That means, you could be exposed by:

  • Getting a manicure, pedicure, tattoo, piercing or acupuncture with improperly
    sterilized tools
  • Having sexual contact with an infected partner
  • Giving first aid to, or receiving it from, an infected person
  • Having a medical or dental procedure with contaminated equipment
  • Sharing personal grooming items (e.g. nail clippers) with an infected person

Who is at increased risk for hepatitis A and B?

Certain people are at increased risk for hepatitis A and B.

You have an increased chance of contracting hepatitis A if you:

  • Travel to regions where hepatitis A is common (e.g. the Caribbean, South America)
  • Live with someone who is newly infected
  • Travel/return to your country of origin, a hepatitis A endemic country
  • Engage in sexual activity involving oral/anal contact
  • Share contaminated drug preparation/injection materials

NOTE: Since children do not generally have symptoms, daycare employees and teachers may also be at risk. Learn more here


You have an increased chance of contracting hepatitis B if you:

  • Travel to regions where hepatitis B is more common (e.g. certain parts of the Caribbean, Africa and Asia)
  • Have unprotected sex with new partners
  • Get a tattoo or piercing with contaminated tools
  • Have a job that exposes you to blood or bodily fluids, e.g. healthcare and emergency service workers, police, firefighters, staff of institutions for the developmentally-challenged or correctional facilities, etc.
  • Share contaminated drug preparation/injection materials
  • Share a household with an infected person

Where is hepatitis A most common?

Hepatitis A occurs worldwide. Regions with a heightened risk for hepatitis A infection include: South Asia, Sub-Saharan Africa, Central Asia, Latin America, North Africa, Middle East and Oceania. A map of countries and areas of risk for hepatitis A is available from the World Health Organization here. It’s important to know that while hepatitis A is most common in these areas, cases occur in Canada as well.

Where is hepatitis B most common?

According to the Centers for Disease Control and Prevention (CDC), the prevalence of chronic hepatitis B infection is:

High in certain parts of the Caribbean (the Dominican Republic and Haiti), Africa, Southeast Asia (including China, Korea, Indonesia and the Philippines), the Middle East (except Israel), South and Western Pacific islands, and the interior Amazon River basin

Intermediate in South, Central and Southwest Asia, Israel, Japan, Eastern and Southern Europe, Russia, most areas surrounding the Amazon River basin, Honduras and Guatemala

It’s important to know that while hepatitis B is most common in these areas, cases occur in Canada as well.

What are the symptoms and possible consequences of hepatitis A?*

The symptoms of hepatitis A can include fever, nausea, jaundice (yellowing of the skin and whites of the eyes), loss of appetite, vomiting, abdominal discomfort, feeling unwell, dark urine and fatigue. However, not all infected adults will experience them. That means you could contract hepatitis A and spread it to others, without realizing it.

Hepatitis A can range from a mild illness lasting 1-2 weeks to a severely disabling disease lasting several months. Chronic hepatitis and carrier states are not associated with hepatitis A. However, relapsing hepatitis, a condition where a person gets worse again after a period of improvement, can last up to a year in 15% of cases.

While most infected people recover, the older you are, the more severe hepatitis A can be. Approximately 25% of infected adults are hospitalized. The case fatality rate, the proportion of deaths per the number of people with a particular medical condition, is 0.1% to 0.3% and can reach 1.8% in adults 50 years and older.

*Twinrix® is not indicated to reduce the incidence of symptoms or serious consequences associated with hepatitis A and B.

What are the symptoms and possible consequences of hepatitis B?*

The symptoms of hepatitis B can include fatigue, nausea, jaundice (yellowing of the skin and whites of the eyes), loss of appetite, vomiting, abdominal discomfort, joint pain, dark urine and clay-coloured stool. However, not all infected adults will experience them. That means you could contract hepatitis B, and spread it to others, without realizing it.

While most recover, 10% of infected adults become lifelong “carriers”. If this happens, you can pass the virus on to others for the rest of your life without having symptoms yourself. Chronic hepatitis B can lead to severe liver damage and is the cause of up to 80% of liver cancers.*

*Twinrix® is not indicated to reduce the incidence of symptoms or serious consequences associated with hepatitis A and B.

I think I may have been exposed. What should I do?

If you suspect that you may have been exposed to hepatitis A or B, contact your healthcare provider right away.

About Twinrix®

What is Twinrix®?

Twinrix® is the only dual hepatitis A and B vaccine. It’s given as a series of shots (injections) by a healthcare professional. Twinrix® may be used in adults, adolescents and children at least 1 year of age.

Who is vaccination recommended for?

According to the Public Health Agency of Canada’s National Advisory Committee on Immunization (NACI), vaccination is recommended for all those who wish to decrease their risk of contracting hepatitis A and B.

Specifically, vaccination against hepatitis A is recommended for:

  • Travellers to countries where hepatitis A is endemic (constantly present)
  • Emergency relief workers, members of the Canadian armed forces and others likely to be posted abroad at short notice to areas with high rates of hepatitis A infection
  • Zookeepers, veterinarians and researchers who handle non-human primates
  • People with chronic liver disease
  • People who receive clotting factor concentrates
  • Populations or communities in which hepatitis A is highly endemic
  • Men having sexual contact with men
  • Household or close contacts of children adopted from hepatitis A endemic countries
  • People who engage in illicit drug use
  • Any person who wishes to decrease his or her risk of hepatitis A
  • People who work with hepatitis A virus in a laboratory or other research setting

Vaccination against hepatitis B is recommended for:

  • Travellers to countries where hepatitis B is endemic (constantly present)
  • All healthcare workers (including students) and others who are exposed to blood or bodily fluids, or who may be injured by instruments contaminated by blood
  • Staff and residents of institutions for the developmentally-challenged or correctional facilities
  • Those living with, or who have had sexual contact with, someone who has hepatitis B or who is a hepatitis B carrier
  • Men having sexual contact with men
  • Populations or communities in which hepatitis B is highly endemic
  • People who have unprotected sex with new partners or who have had more than 1 sexual partner in the previous 6 months
  • People with a history of sexually-transmitted infections (STIs) and those attending an STI clinic or who otherwise engage in risky sexual practices
  • Injection drug users
  • People with hemophilia (a condition in which the blood doesn’t clot normally) and those getting repeated blood infusions
  • Hemodialysis patients
  • Persons with congenital immunodeficiencies
  • HIV-infected persons
  • People who have chronic liver disease
  • Any person who wishes to decrease their risk of hepatitis B
  • All adults and children who have immigrated to Canada from high-risk areas and who may be exposed to hepatitis B carriers:
    • Through their extended families
    • When visiting friends and relatives in their country of origin
  • Children in childcare settings in which there is a hepatitis B-infected child

NOTE: It’s important to talk to your healthcare provider about whether vaccination is right for you.

How does Twinrix® work?

The Twinrix® vaccine works by helping your body produce its own protection (antibodies) against hepatitis A and B.

Where can I get Twinrix®?

You can get the Twinrix® vaccine from your healthcare provider, or at your local health or travel clinic. To find a travel clinic near you, visit www.phac-aspc.gc.ca/tmp-pmv/yf-fj/index-eng.php.

How many vaccine doses will I need?

The standard Twinrix® schedule consists of 3 vaccine doses. You choose the date for Vaccine Dose #1, #2 is 1 month after the first and #3 is
6 months after the first. For maximum protection against hepatitis A and B, make sure you complete all 3 vaccine doses.

If you’ll be travelling within a month or more of getting your first vaccine dose and don’t have time for the above schedule, a rapid schedule is also available for adults over age 19. In this schedule, you choose the date for Vaccine Dose #1, #2 is 1 week after the first and #3 is 3 weeks after the first. A 4th vaccine dose is then recommended 1 year after your first. Even if you’re a last-minute traveller, talk to your healthcare provider or visit your local travel clinic.

Will I need booster doses?

For long-term protection, all scheduled vaccine doses must be received. Booster doses may be required; ask your healthcare provider for more information.

What should I tell my healthcare provider before getting Twinrix®?

Before getting vaccinated, tell your healthcare provider if you:

  • Are pregnant or planning to be
  • Are breastfeeding
  • Have a poor immune system due to illness or drug treatment
  • Have a bleeding problem or bruise easily
  • Are taking any other medicine or have recently received another vaccine
  • Have any known allergies

Can children be vaccinated with Twinrix®?

Yes. For children and adolescents aged 1-18, the standard schedule uses the Twinrix® Junior vaccine and consists of 3 vaccine doses: you choose the date for Vaccine Dose #1, #2 is 1 month after the first and #3 is 6 months after the first. For maximum protection against hepatitis A and B, make sure your children complete all 3 vaccine doses.

For those aged 1-15, there is also an alternate schedule (using Twinrix® rather than Twinrix® Junior).This schedule consists of 2 vaccine doses - the second one is given 6-12 months after the first. This schedule is meant for settings where completion of the 2 vaccine doses can be assured, such as school-based vaccination programs.

I’ve already had at least one vaccine dose. How many more will I need?

If you’ve had your first Twinrix® vaccine dose, you will need 2 more injections to complete the series (1 month and 6 months after your first dose, according to the standard schedule). It’s very important to get all 3 vaccine doses. If you don’t, you may not be fully protected against hepatitis A and B. For maximum protection against these diseases, make sure to see your healthcare provider to receive your remaining Twinrix® vaccine doses.

NOTE: If you are following the rapid schedule, you will need an additional 3 vaccine doses – 1 week, 3 weeks and 1 year after your first vaccination, for a total of 4 injections.

I missed a vaccine dose according to my schedule. What should I do?

If you have missed a scheduled vaccine dose, talk to your healthcare provider and book another appointment.

What should I ask and bring with me to my appointment?

Being prepared can help you make the most of your pre-travel medical appointment. The following lists include questions you may want to ask, as well as important information to bring with you and share with your healthcare provider.

Questions to Ask

  • Is my destination a risk for hepatitis A and B?
  • What are the possible consequences of hepatitis A and B?*
  • Will I need any vaccinations or medications for my trip?
  • How many vaccine doses will I need? When should I have them?
  • Should my partner and/or children also be vaccinated?
  • Can I get the Twinrix® vaccine if I’m on other medications?

Things to bring

  • Your destination’s name (city/country, area, hotel/outdoors etc.)
  • Your anticipated length of stay
  • Your vaccination history
  • The names of any medications you are currently taking
  • A list of any allergies you have
Create your personal checklist

*Twinrix® is not indicated to reduce the incidence of symptoms or serious consequences associated with hepatitis A and B.

Should the people I’m travelling with get Twinrix®?

If you’re travelling with others to an area where hepatitis A or B is endemic (constantly present), encourage them to ask their healthcare providers about the Twinrix® vaccine. You can start by sending them a link to this website using the “Share” button.

What are the possible side effects?

Side effects that occurred in adults during clinical trials with the standard (3 dose) and the rapid (4 dose) Twinrix® vaccination schedule were as follows:

  • Adult: Very common (more than 10% of doses) – pain or discomfort, redness at the injection site, headache and tiredness.
  • Adult: Common (1-10% of doses) – swelling at the injection site, diarrhea, nausea, vomiting and generally feeling unwell.

Side effects that occurred in children who received the standard (3 dose) Twinrix® Jr. vaccination schedule were as follows:

  • Children: Very Common (more than 10% of doses) – pain and redness at the injection site.
  • Children: Common (1-10% of doses) – swelling at the injection site, fever (more than 37.5°C), irritability, drowsiness, headache, loss of appetite, diarrhea, nausea, vomiting and generally feeling unwell.

Side effects that occurred in children during clinical trials who received the alternate (2 dose) Twinrix® vaccination schedule were as follows:

  • Children: Very Common (more than 10% of doses) – pain and redness at the injection site, tiredness, headache, irritability and loss of appetite.
  • Children: Common (1-10% of doses) – swelling at the injection site, fever, drowsiness, stomach and digestive complaints.

Who should wait and get vaccinated later?

People who have a fever or anything more serious than a minor cold should postpone vaccination. Pregnant women should also delay vaccination, unless immediate vaccination is recommended by a healthcare provider.

NOTE: Those who have had a previous allergic reaction to Twinrix® or to any vaccine against hepatitis A or B, should not get vaccinated.

Can I get hepatitis from the vaccine?

No. Twinrix® does not contain living viruses, so it is impossible to get hepatitis A or B from the vaccine.

How should I store Twinrix®?

Store Twinrix® in a refrigerator (2 - 8°C), keeping it in the original package to protect it from light. Do not freeze Twinrix® as this will destroy the vaccine. Keep the package out of the reach and sight of children.

Talk to your healthcare
provider about Twinrix®

Twinrix® is the only dual hepatitis A and B vaccine.

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