World TB Day - March 24thAugust 17th, 2015 Read More »
Dr Deborah Mills MBBS ASM
Hepatitis means infection of the liver. There are many types of hepatitis: A, B, C, D, E, F and G at last count. Hepatitis may also occur as part of another illness such as Glandular Fever, or as a side effect from a drug. Hepatitis E is particularly serious in pregnant women.
Vaccines are only currently available against Hepatitis A and B
Types of Hepatitis
- Hepatitis A – Contracted from food and water
- Hepatitis B – Contracted from blood and blood products
- Hepatitis C – Contracted from blood and blood products
- Hepatitis D – Only occurs with Hep B
- Hepatitis E – Contracted from food and water
The disease Hepatitis A usually causes symptoms of fever, tiredness, loss of appetite, and stomach discomfort. A few days later the person develops yellowing of the whites of the eyes and skin (jaundice). The urine becomes dark and the motions become pale. On average, the sufferer loses a month off work, and alcohol may not allowed for up to one year (!) The likelihood of having symptoms varies with age. In children less than 6 years of age, 70% of infections cause no obvious symptoms. In adults, Hepatitis A can cause tiredness for months afterwards. The disease is seldom fatal, though it is more likely to be so in persons over 40 years of age.
Hepatitis A is also known as ‘Hep A’ or ‘Yellow Jaundice’. This jaundice is quite different to baby jaundice. Baby jaundice is caused by immaturity of the liver and develops in the first few days of life.
Hepatitis A virus is shed in the faeces of infected persons. Transmission occurs through exposure to contaminated water, ice, shellfish, fruit, vegetables, or other foods. Hepatitis A is quite contagious and can be easily spread to others within a household setting. The incubation period is 2-6 weeks, so victims often come down with symptoms after they arrive home.
This disease is most common in third world countries because sanitation is poor. In developing countries most locals contract the disease in childhood. Even in the developed world there are small outbreaks of Hep A though these are seldom reported in the press. Once someone has had Hepatitis A they cannot catch it again. Persons over 60 years of age who live in developed countries e.g. US, UK, Australia, NZ may have had the disease in childhood as the disease was more common at that time. It may be worth testing persons in this age range to see if they have had the disease, as it would mean they don’t need to be vaccinated.
Travellers are more at risk if they live in or visit rural areas, or frequently eat or drink in settings of poor sanitation. Adult travellers to developing countries should be vaccinated against Hepatitis A.
Backpackers in particular are more prone to Hepatitis A (about one case per 50 backpackers per month of stay in the developing world). Travellers staying in five star hotels are not always safe however.
Travellers should be vaccinated against Hepatitis A. Protection against Hepatitis A can be given as either:
- Avaxim/ Vaqta / Havrix: These excellent manufactured vaccines give long-term protection (20 years) after two doses with few side effects.
- Twinrix: This gives long-term protection against both hepatitis A and B viruses.
- Gamma Globulin / Immune Globulin: This is a blood product. It is seldom used now, however it was used safely for many years. It has been carefully investigated and shown not to transmit AIDS or Hepatitis B. It cannot be proven 100% safe from diseases as yet undiscovered. It is less effective than the manufactured vaccines. There have been reports where a person developed severe Hepatitis A disease, despite having a recent Gamma Globulin.
The disease Hepatitis B causes symptoms of tiredness, nausea, loss of appetite, rash, muscle and joint pains. Symptoms develop two to six months after exposure to the virus. The skin and whites of the eyes turn yellow, the urine may become tea coloured and the bowel motions turn whitish. The acute illness lasts several weeks. 1.4% of sufferers will die during the acute attack. 6-10% of adult sufferers remain chronically infected or infectious to others, and one fifth of those chronically infected will die from the infection. Chronic Hepatitis B carriers are 94 times more likely than average to develop a primary liver cancer.
Hepatitis B virus is fragile and cannot survive long outside the body. It must travel from person to person through blood or other body fluids i.e. transfusions, sharing contaminated needles or sexual contact. Acupuncture, tattoos, and dental procedures can also transmit the disease. The virus uses the same route as AIDS although Hepatitis B is more contagious than AIDS. Hepatitis B is present all over the world, including UK, Europe, USA, Australia and NZ, but it is more common in developing countries.
Hepatitis B vaccination is now part of the ‘standard’ childhood vaccination schedule.
Vaccination is recommended for many travellers, especially long-term travellers (greater than 3 months), those working with blood or blood products and those anticipating sexual contacts overseas. Children may be at risk if they play with infected children. Minor injuries are common during play and the virus could pass from one to the other via broken skin.
Note that the Hepatitis B virus and the Hepatitis A virus are very different. Vaccination against one does not protect you from infection with the other, however there is now a combined vaccine (Twinrix) which does give protection from both.
Author of the book, Travelling Well, Brisbane based Dr Deborah Mills works with organizations that want invincible expatriate personnel, and with people who want to enjoy good health when they travel.