There are 4 types of Hepatitis that travellers may be particularly exposed to. They occur world-wide and are all due to different viruses: Hepatitis A, Hepatitis B, Hepatitis C and Hepatitis E.
Hepatitis A and E are caught by ingesting food and water contaminated with human faeces. Both are common in areas where sanitation and water are inadequate. Hepatitis B and C are caught through contact with blood and body secretions of infected persons.
It is a virus infection of the liver. The course is variable. It is usually a mild illness, particularly in children, lasting 10-14 days, but sometimes it can be more severe, lasting some months. In adults over the age of 40 years, up to 2% of cases are fatal.
The risk of getting Hepatitis A is 1 in 200 per week of travel for off-tourist routes and backpackers: this approximates to a 1 in 50 chance. For those on tourist route or resort routes the risk is: 1 in a 1000 per week or, approximately a risk of 1 in 300.
Hepatitis A is spread through the oral-faecal (mouth-anus) route and through contaminated food and water. Shellfish such as oysters and mussels are frequently responsible but milk, cold meats and other food contaminated during preparation are potential sources. Rarely, it may be obtained through contaminated blood products.
21 – 30 days (range 14 – 60 days).
The following signs and symptoms are an indication of the disease: initially loss of appetite, tiredness and lethargy, nausea, and abdominal discomfort. This may be followed within a few days by jaundice (yellow eyes and skin), orange urine, pale bowel motions, and yellow “whites of the eyes”. A blood test for specific Hepatitis A antibodies is necessary to confirm the diagnosis.
There is no specific treatment. Cases usually either recover spontaneously or, very rarely, they may die.
Food and water precautions are important, and good long-term protection is available from Hepatitis A immunisation.
A course of Hepatitis A immunisations provides virtually 100% protection for 30 years. Adult dose is either 0.5 mls or 1.0 ml intramuscular with a booster dose 6 to 12 months later, depending on the type of vaccine. Time to immunity is 15 to 30 days after the primary injection and duration of cover is twenty to thirty years.
All children who are going to high risk areas should be immunised. It is suggested to commence this vaccination from 1 year of age. After 2 vaccinations protective efficacy is considered to be 100%. To date, many authorities would give immunoglobulin only to children under 2 years who are at significant risk for Hepatitis A. Hepatitis A immunisation is indicted for children from 1 year of age onwards. (See notes on Hepatitis A & B combined for children aged 12-24 months ). It should be noted that Hepatitis A in children under 2 years is usually mild, and only a minority become jaundiced.
This is possible with a vaccine called Twinrix , available in Ireland. 3-dose primary series of intramuscular injections at months 0, 1 and 6. An accelerated dose series is available, for those who are travelling urgently and will not have time for the routine series: at 0, 7 and 21 days, with a blood test at 1 year followed by a final booster dose.if required. Immunity is approximately 95% for both diseases at one month after the second dose. Duration of cover is 20-30 years for Hepatitis A and 15 years to life for Hepatitis B.
It is a virus infection of the liver. The course is variable. Recovery from the acute infection usually takes 28 days but is sometimes more prolonged.
Children under 1 year of age usually have no symptoms but virtually 100% of such children remain infected with the virus (i.e. are Hepatitis B carriers) for years, often for life. About 5% of adults remain carriers after getting the disease. hepatitis B carriers can infect other people, and are at risk of death from cirrhosis of the liver and liver cancer, years after the initial infection.
Hepatitis B may be acquired by: contact with contaminated blood (e.g. transfusion with infected blood, sharing needles and syringes with intravenous drug users, body piercers, and tattooists); sexual intercourse (homosexual and heterosexual) with an infected partner; from other body fluids and secretions e.g. the virus can be found in saliva, or maybe transmitted from an infected mother to her baby.
45 – 180 days.
The following signs and symptoms are an indication of the disease: tiredness and lethargy, loss of appetite, abdominal discomfort, dark yellow-orange urine, pale bowel motions, followed within a few days be jaundice ( yellow “whites of the eyes” and yellow skin ). The diagnosis is also suspected when there is a history of possible contact. Specific blood tests for Hepatitis B are necessary to confirm the diagnosis.
There is no specific treatment. Interferon may be used in some cases.
Avoid risky behaviour (see above “How do you catch Hepatitis B?”) and get vaccinated.
A complete course of Hepatitis B immunisation protects more than 95% of persons vaccinated. Hepatitis B vaccines are highly immunogenic, but have decreased immunogenicity associated with increasing age, obesity, smoking, male gender, older adults, presence of chronic disease. Once sero-conversion has been shown to occur it is not considered necessary to have any further doses. Memory seems to last for at least 15 years in immunocompetent individuals. To date there are no data to support the need for booster doses of Hepatitis B vaccine in immunocompetent individuals who have responded to a primary course on immunisation.
The main hepatitis vaccine is Energix-B . The adult vaccination course is a 3 primary series of 1.0 ml intramuscular: at 0, 1 and 6 months. . It is considered that this will last for life. An accelerated dose series is available, for those who are travelling urgently and will not have time for the routine series: at 0, 7 and 21 days, with a blood test at 1 year followed by a final booster dose.if required. Time to immunity is after the primary 2 doses and after boosters. Duration of cover is at least 15 years, and probably life.
Children who live in areas where Hepatitis B infection is highly endemic for 6 months or more, or who visit such areas for shorter periods during which close contact with local people is likely, should be immunized. Children infected with Hepatitis B at an early age are at high risk of becoming carriers, with the attendant risk of long-term complications. Almost all (90%) of infected new-borns, nearly 25 % of children, and 0.2% – 2% of adults become chronic carriers. Chronic carriers have a lifetime risk of 5-15% of hepatocellular carcinoma and a 5-10% risk of chronic hepatitis or cirrhosis.
It is a virus infection of the liver. Symptoms are usually not as obvious as with other types of hepatitis but the following signs and symptoms are an indication of the disease: general tiredness and lethargy, dark yellow-orange urine, pale bowel motions, yellow “whites of the eyes” and yellow skin, and pain in the liver area of the abdomen. Most infected persons have no symptoms.
It is estimated that about 0.3% of all blood donors in developed countries are infected with hepatitis C virus and thus are carriers. Hepatitis C carriers can infect other people and are at risk of death from cirrhosis of the liver and liver cancer years after the initial infection, however, the natural history of Hepatitis C virus infection is not fully understood.
Hepatitis C is caught the same way as you catch Hepatitis B, although Hepatitis B is much more easily transmitted than Hepatitis C. Cases of Hepatitis C in most developed countries are in intravenous drug users, but some countries have high rates in the general population also.
What is the incubation period (time from exposure to first symptoms)?
30 – 150 days. (Average 45 – 65 days.)
Specific blood tests for Hepatitis C are necessary to confirm the diagnosis.
There is no specific treatment. A medication called interferon may be used in some cases.
Avoid risky behaviour, as with Hepatitis B.
Currently, there is no vaccine available.
It is a virus infection of the liver. The following signs and symptoms are an indication of the disease: tiredness and lethargy, dark yellow-orange urine, pale bowel motions, yellow “whites of the eyes” and yellow skin.
Hepatitis E is spread through the oral-faecal (mouth-anus) route and through contaminated food and water.
15 – 65 days; average range 30 -40 days.
Specific blood tests for Hepatitis E are necessary to confirm the diagnosis. These are often only available in special reference laboratories.
There is no specific treatment.
Food and water precautions, as for Hepatitis A.
Currently there is no vaccine available.
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