Hepatitis A in Taiwan - a spike in cases but their vaccination strategy will make a difference in the future.

According to the Centres for Disease Control (CDC) in Taiwan, four hundred and forty-seven cases of hepatitis A have been notified in 2025. This is the highest figure since 2017. More than 50% of cases were in those aged between 20 and 39.

Hepatitis A is transmitted through contaminated food or water and is common in areas where water and environmental sanitation are poor.

Most adults in low and low middle-income countries have already acquired the disease in childhood and are immune for life. They are usually unaware of exposure, as the disease can have no symptoms in young children.

Why high-income countries are now vulnerable

Taiwan is a high-income country which has had good water and sanitation for many years.

Childhood disease is unlikely so the percentage of non-immune individuals in the population has steadily grown over the last 20 years.

A study undertaken in 2020 showed an overall population immunity of just 30% and only 10% in those aged 21 to 40.

Taiwan's introduction of hepatitis A vaccination

In 2018, Taiwan introduced hepatitis A vaccination into its childhood immunization schedule.

Two doses (separated by 6 months) are given between 12 and 24 months of age. This strategy is likely to make an impact in the future. While the disease is mostly benign in childhood it is often more severe as an adult. A case fatality rate of 3% has been demonstrated over 40 years.

Severity can also be increased in the immunosuppressed or those with pre-existing health issues. Recuperation after a bout of the disease can also be prolonged.

How does this affect international travellers?

Travellers from countries like Australia and New Zealand are unlikely to have natural immunity to the disease and are generally advised to consider Hepatitis A vaccination if travelling to risk areas.

Defining risk areas is becoming more difficult particularly when travellers are mostly dependent on others in the preparation of food. This was highlighted in a previous communication concerning the Hepetatis A outbreak in Czechia - another outbreak of over 1,500 cases has been reported in Prague in late 2025.

Hepatitis A vaccination policy in Australia

In Australia it is recommended and funded for Aboriginal and Torres Strait islands children living in the Northern Territory, Queensland, South Australia and Western Australia but not for the wider childhood immunisation program. Hopefully this will change in the future.

The hepatitis A vaccine has been available in Australia since 1994. It should not be confused with Hepatitis B vaccination which was first offered in the 1980’s.

Standard Hepatitis A vaccination

Two doses of hepatitis A vaccine given 6 months apart will provide good protection for many years. The first dose is often given prior to a trip and then the booster dose 6 to 12 months later.

The vaccine can be given from 12 months of age, but consideration might also be offered to children aged 6-12 months visiting high risk locations (Africa, Indian subcontinent etc). While the disease is likely to be mild (not all) in this age group, there is a possibility they can return infected and start an outbreak in a childcare centre or school.

Combination Hepatitis A and B vaccination (Twinrix)

The vaccine is also available as a combination with hepatitis B. This vaccine is called Twinrix. This is usually given as a course 0, 1 and 6 months. If the traveller is intending to be away for a lengthy period, a rapid course of the vaccine can be given at 0,1 and 3 weeks.

A booster dose should be given after 12 months for long term protection.

Gammaglobulin - historical protection against hepatitis A

Hepatitis A protection has also been offered in the form of an antibody.  It is called gammaglobulin and was the mainstay of protection for travellers to high-risk areas prior to the introduction of the vaccine.  It is not a vaccine and is rarely given now. 

Gammaglobulin provided short term protection for 3-6 months. It would have prevented many cases of hepatitis A in backpackers travelling in India and Nepal and was still being used in the late 90’s. It should not be confused with vaccination.

Current Hepatitis A situation in Australia

Two hundred and twenty-six cases of hepatitis A have been reported in Australia year to date (to 23 November, 2025). 

(Just 19 cases were recorded for a similar period in 2021 – when Australia’s borders were closed!).

It is never too late to give a hepatitis A vaccination prior to travel!