Hepatitis – letters that can spell life-long illness

Many travel-related diseases can cause serious illness, but the unlucky traveller can usually expect to recover with no lasting effects. Hepatitis can be the exception.

Hepatitis is actually a family of viruses – hepatitis A, B, C, D, and E – and its members can strike in a variety of ways during your holiday, putting your long-term health at risk.
You can do all the right things to avoid one ‘letter’, only to be ‘blindsided’ by another.
Hepatitis affects 1-in-12 people worldwide and to raise awareness of its global impact, the World Health Organisation (WHO) has designated July 28 as World Hepatitis Day.
Despite its ‘staggering toll on health’, hepatitis remains largely ‘unknown, undiagnosed and untreated’ in much of the world, according to the WHO.
The highest risk for travellers is hepatitis A, the most common vaccine-preventable food- and water-borne disease among people visiting developing countries.
Like hepatitis E, the A virus is typically caused by consuming contaminated food or water.
 
Adults at risk of more severe illness
“Essentially, anyone who is travelling in the developing world is recommended to get the protection of the hepatitis A vaccine – regardless of how long they stay,” said Dr Ed Bajrovic, medical director of Travelvax Australia.
“The Hep A virus is so pervasive that virtually every person born in a developing country contracts the disease in childhood, when the illness is usually milder or even asymptomatic.
“That makes it a significant risk for western visitors who’ve never been exposed to it before. Adults are especially likely to have a more severe illness.”
On the other hand, hepatitis B, C and D have nothing to do with food or water; they are spread through blood or body fluid.
For travellers, infection with hepatitis B, C or D usually comes from unprotected sex with an infected person, IV drug use using a contaminated needle, or the use of contaminated medical equipment, such as during acupuncture, body piercing or tattooing. Injury or illness resulting in hospital treatment requiring surgery or blood transfusion is an additional risk.
 
Travel increases risk of exposure
However, even for those who do not engage in risky behaviours, travel itself can increase the risk of exposure to this trio.
“When you are in unfamiliar surroundings and engaging in physical activities, accidents can happen easily,” Dr Bajrovic said.
“Even a minor accident or injury may require medical treatment and, in some countries, medical facilities are not to the high standard we enjoy at home. You may find blood supplies are not adequately screened and medical equipment is reused – one reason why we recommend the travellers always pack a first-aid kit.”
All the hepatitis viruses can cause varying degrees of liver damage.
At best, there may be no symptoms and patients can fully recover, usually after a period of convalescence.
 
The risk of chronic, long-term illness
However, hepatitis can also lead to chronic, long-term illness and premature death.
Hepatitis B kills 600,000 people a year and some 2 billion are already infected, while there are around 150 million people chronically infected with hepatitis C, of whom an average 350,000 will die each year from cirrhosis or liver cancer.
And, hepatitis is not only a health risk in developing countries. The blood- and body fluid-borne viruses occur in developed countries, too.
Fortunately, there are extremely effective vaccines offering high-level protection against Hep A and B (there’s also a combined Hep A-B vaccine). While there is no vaccine for the other three, treatment for hepatitis C has becoming increasingly effective in recent years.
On the eve of the World Hepatitis Day this Saturday, we profile the three principal hepatitis viruses, how they are transmitted, and how to avoid them.
 
HEPATITIS A
WHAT: An acute viral infection of the liver which causes mild to severe illness.
HOW: By consuming contaminated food or water, close personal contact with an infected person, or handling contaminated objects.
WHERE: All developing regions of the world. There are an estimated 1.4 million new cases of hepatitis A each year.
WHO: Everyone travelling to a developing region.
PREVENTION: Follow safe food and water guidelines and practice good hand hygiene. Vaccination provides a 99%-plus level of immunity, and after a full course of two doses (6 - 12 months apart), remains effective for 20-30 years, or possibly even life-long.
Read more about hepatitis A and the vaccine.

HEPATITIS B
WHAT: The most serious viral hepatitis and a major global health problem. An estimated 2 billion people are infected, an average 600,000 die each year.
HOW: From direct blood-to-blood contact, or semen and vaginal fluid via an infected person.
WHERE: Throughout Asia (8–10% of adults chronically infected); The Amazon; Areas of eastern and central Europe; The Middle East and Indian subcontinent (2–5% of population chronically infected). In North America, Western Europe, Australia, and New Zealand less than 1% are chronically infected.
WHO: Travel raises the risk of Hepatitis B for most people. Long-stay travellers, health care, and aid workers are at higher risk.
PREVENTION: Practice safe sex. Vaccination is the mainstay of prevention and the full course of 3 doses (at least 2 prior to travel) provides highly protective antibody levels lasting at least 20 years – possibly for life for the vast majority. Read more about hepatitis B and the vaccine.
 
HEPATITIS C
WHAT: A contagious liver disease. Severity can range from a mild illness to serious, lifelong illness.
HOW: Blood transfusions, contaminated syringes and medical equipment, and IV drug use. Rarely through sex.
WHERE: Worldwide. High rates of chronic infection in Egypt (22%), Pakistan (4.8%) and China (3.2%). About 150 million chronically infected worldwide, some 350,000 deaths each year.
PREVENTION: There is no vaccine. Practice safe sex, don’t share razors, and avoid the use of any potentially contaminated instruments for injection, acupuncture, piercing or tattooing.
Read more about hepatitis C.


Find out more about hepatitis and other potential health risks for overseas travel by calling Travelvax Australia’s free advisory health service on 1300 360 164.