The incidence of hepatitis A in NSW has declined in recent years, but the relative importance of risk factors remains unclear. Methods: We analysed case data from the NSW Notifiable Diseases Database from 1991 to 2006. Results: Hepatitis A notification rates fell from 18.9 to 1.4 cases per 100 000 between 1991 and 2006. International travel to endemic areas was the likely exposure for 50 per cent of cases between 2002 and 2006. Rates were five times higher in travellers born in countries where hepatitis A is endemic compared with those born in Australia. Conclusion: Travellers born in endemic countries should be carefully assessed for vaccination before departure.