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DHS information: www.dhs.vic.gov.au/phb/
Overseas information:
www.cdc.gov/ncidod/diseases/Index.htm
WHO year book www.who.int/ith/chapter05_04.html#hepatitis

HEPATITIS A, B & E

Hepatitis A
Hepatitis A is a viral infection of the liver. In adults, it causes jaundice which usually lasts from 1 to 3 weeks and is followed by slow recovery. In children it may cause no symptoms or only mild diarrhoea. In the Over 60 age group it is usually more severe and can be fatal.

How is it transmitted ? The virus is passed in faeces, and can be passed to other people through hand contact, consumption of food contaminated by food handlers or sewage, or swimming, bathing or drinking sewage contaminated water. Incubation period 2 to 7 weeks.

The risk of catching Hepatitis A is approximately 2% per month of travel among backpackers, and 6 per 1000 per month even among travellers staying in high class hotels for short periods. It is common in most Asian, African, Mediterranean and Eastern European countries.

A safe and effective vaccine against Hepatitis A (Havrix) or VAQTA (CSL)  is available. It contains inactivated hepatitis A virus and is not a blood product. Two doses of Havrix 720 vaccine 1 month apart or 1 dose of Havrix 1440 (or equivalent of VAQTA) provide excellent protection for up to one year. (95% conversion with 1 injection and 98% conversion after second injection). A booster of  vaccine (either 720 or 1440) 12 months later provides protection for about 10 years.

Recent studies have shown that Hepatitis A vaccine given in the early stages of hepatitis A incubation can abort or significantly modify the disease. This is now preferred to gamma Globulin*. Hence it is reasonable to give Hepatitis A vaccine to travellers even on the day of departure in preference to Gamma Globulin.
  (WHO year book 2000 p64 & *CSL literature on VAQTA).

Alternatively, an injection of gamma globulin given just prior to departure can provide approximately a 70% protection rate for between 6 weeks and 6 months depending on the dose.

Hepatitis B
Hepatitis B can cause acute hepatitis (jaundice), but in many cases infection occurs without any symptoms. After infection, most adults recover completely, but 5 - 10% become chronic carriers, with hepatitis B virus circulating in their blood for many years.

In blood spills the hepatitis B virus can remain infectious for up to 7 days at room temperature. It is not transmitted by mosquito or insect bites.

In infants and small children, especially under age 5 years, there is rarely any sign of infection, but there is a high risk of becoming a chronic carrier after infection (25 to 90%)*.

In older children and adults, there is an incubation period of 45 to 180 days. Chronic carriers may remain healthy for many years (20 +), but have a 25% risk of eventually developing chronic liver disease, and a 10% risk of developing liver cancer (primary hepatocellular cancer).

There is no risk of transmission through ordinary contact with hepatitis B carriers eg eating together, sharing bathrooms etc. However items which could be contaminated with blood, such as tooth brushes, razor blades, nail clippers etc should not be shared. ... see also NYHD Hep B sheet

Side-effects and contra-indications.

  • The vaccine is prepared from yeast, and is not a blood product.
  • Mild side effects include soreness at the injection site (10%) and fever (2%). There have been recently a few reports of more serious neurological side-effects. (3 cases).
  • Safety in pregnancy has not been confirmed; it should be given only if indicated.

Hepatitis B vaccination

  • Three doses of vaccine are required, at 0, 1month and 6 month intervals.
  • Between 50 and 80% are protected after 2 doses, and 95% after 3 doses.
  • However about 5% do not develop immunity after vaccination.
  • Adults receive 1ml (20 mcg). Children under 10 years 0.5ml (10mcg).

Follow up after vaccination.

  • Those at high risk (occupational risk). Check serum HBsAb 3 months after last dose.
  • If low, consider 4th dose.
  • A booster dose can be considered after 5 years for those at continuing risk.

List of countries with Hepatitis B carrier rates over 2%

  • Australia - Aborigine
  • New Zealand - Maori
  • Pacific Islanders - Melanesian, Micronesian, Polynesian
  • Central Europe - Romania,Yugoslavia
  • Mediterranean - Crete, Cyprus, Greece, Italy, Malta
  • Middle East - Egypt, Iran, Jordan, Lebanon, Turkey
  • Africa - (except white South African)
  • South America - Chile
  • South Asia - India, Bangladesh, Pakistan, Sri Lanka
  • East Asia - China, Hong Kong, Korea, Taiwan
  • SE Asia - Cambodia, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand, Vietnam.

In most of these areas 5 to 15% of the population are chronically infected carriers, and in some areas may also carry the Hepatitis D virus(delta virus), which may lead to severe liver damage. Infected children rarely develop acute disease, BUT 25-90% become chronic carriers. Approximately 25% of carriers will die from liver cirrhosis or primary liver cancer. Child to child transmission is very common.*

Hepatitis E
Hepatitis E, formerly called non-A, non-B hepatitis is generally a similar illness to hepatitis A It is especially serious in pregnant women (particularly in the 2nd & 3rd trimesters of pregnancy). Epidemics have occurred in Afghanistan, Bangladesh, western China, Eritrea, Ethiopia, India, Indonesia, Iran, Kenya , Mexico, Myanmar, Nepal, Pakistan, Somalia, Sudan, and the Asian republics of the former USSR. It is probably widespread in Asia, north and sub-Sahara Africa, and the eastern Mediterranean area.

There is no treatment available and 15-20% of women will die from fulminant hepatitis. *. As it is spread in the same way as Hepatitis A (ie. by contaminated food or drink) the need to eat and drink safely and observe good hygiene is paramount. Again reconsider the need to travel whilst pregnant.

Information mostly taken from: "International Travel and Health" (WHO year book - internet only)
Australian Immunisation Handbook, 8th Edition - 9/2003 - Part1 - Part 2 & Part 3 (large pdf files)
Centre for Disease Control, USA -  www.cdc.gov/travel Travel Health Seminar Oct 96, June 97,Feb 98, March 99, May 2000, August 2002 & March 2005 - Victorian Medical Postgraduate Foundation.
Manual of Travel Medicine, Melbourne, Oct 2004. Updated 06/09/2006.  Additional references & disclaimer.

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North East Valley Division General Practice, Victoria, Australia, Disclaimer 
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