Contagious Diseases Series: Hepatitis A

Contagious Diseases Series: Hepatitis

Hepatitis is an illness that causes inflammation and damage to the liver.  It affects liver function and is usually caused by an infection.

Whilst there are several types of Hepatitis, there are 5 viral types – Hepatitis A, B, C, D and E.

Lets take a look at each type to see where they are most prevalent and how best you can protect yourself against infection whilst travelling.

Hepatitis A

This type can be contracted when infected faecal matter enters the mouth.  Hepatitis A is an acute infection and although short term can be quite severe.  The virus can survive on hands for several hours and even longer within contaminated food that has been left at room temperature.  Hepatitis A is mildly resistant to detergents.

Hepatitis A is found worldwide but is prevalent in developing countries, usually due to poor sanitation.

Symptoms of Hepatitis A include fever, weakness, fatigue, loss of appetite, nausea, joint pain, vomiting and jaundice.  Whilst death from Hepatitis A is rare, acute infection usually lasts a matter of month/s and a person can only suffer this condition once.

Transmission most commonly occurs when infected faeces are put in the mouth.  For instance;

  • Consuming infected food or drink
  • Using infected utensils
  • Touching nappies, linen or towels that have been soiled by a person suffering this disease
  • Direct contact with an infected person

Hepatitis is diagnosed by a blood test.  The incubation period for Hepatitis A is between 15 and 50 days with the average being 30 days.  There is no medical treatment for this condition with symptoms being relieved by rest and an adequate fluid intake.  Medical advice is to also limit consumption of alcohol and unnecessary medication to reduce the load on the liver.

Hepatitis B

Hepatitis B is the most common form of liver infection in the world.  Once in the bloodstream, the Hepatitis B virus travels to the liver and multiplies thereby triggering the body’s immune response.  Untreated, it can lead to cirrhosis of the liver, liver cancer or liver failure.

It is reported that two billion people worldwide have been infected with Hepatitis B.  It is most prevalent in sub-Saharan Africa and South East Asia.  Incidence is also high in the Amazon, Pacific islands, Mediterranean countries and parts of eastern Europe.  Infection rates are lower in the Middle East and India with Hepatitis Australia reporting that 2-5% of these populations are infected.

Symptoms of Hepatitis B include fatigue, nausea, loss of appetite and pain in the upper right abdomen.  Sufferers may also experience joint pain, rash, jaundice and dark urine.  The typical incubation period for Hepatitis B is 10 weeks but can range from 2-6 months.

As a blood borne virus, transmission of Hepatitis B usually occurs via sexual contact, intravenous drug use and close contact with infected individuals.  Exposure to blood products and needles (eg tattoos, piercings, acupuncture and dental work) also increases the risk.   Travelling to areas where the incidence of Hepatitis B carriers is high will also intensify the risk of contracting the virus.

Hepatitis C

Like Hepatitis B, Hepatitis C is also a blood borne virus.  It is most commonly contracted via contaminated needles or receipt of infected blood products (eg transfusions).  It can also be transmitted via non-medical procedures and activities that involve exposure to blood – eg tattooing, piercings, intravenous drug use and sexual contact.

Hepatitis C is most prevalent in Africa, Middle East, Asia and Latin America.

Symptoms of Hepatitis C are similar to those of other strains (eg fatigue, loss of appetite, nausea, dark urine, abdominal pain and jaundice).  According to the Center for Disease Control and Prevention, travellers’ risk for contracting Hepatitis C is generally low but caution is recommended.  There is presently no vaccination available for Hepatitis C.

Hepatitis D

The Hepatitis D virus needs the Hepatitis B virus to exist.  Therefore, it is only diagnosed in people who already suffer from Hepatitis B.  These two viruses can co-exist or Hepatitis D can be contracted by someone already suffering from the B virus.

Infection with this virus can be prevented by the Hepatitis B vaccine.  There is currently no medication or vaccine specifically for the treatment or prevention of Hepatitis D.

Hepatitis E

Like Hepatitis A, Hepatitis E is transmitted through oral consumption of infected faeces.  It is most commonly found in developing countries – notably India, Asia, Africa and Central America.    The most likely method of transmission is consumption of contaminated food and drink due to poor sanitation.  Symptoms and the lifecycle of Hepatitis E mimic those of Hepatitis A.   There is presently no treatment or vaccine available for Hepatitis E and prevention is the most effective approach.

So what you can do you to minimize the risk of contracting Hepatitis while travelling?

As the saying goes, “prevention is better than cure”.  So how can you protect yourself against Hepatitis while travelling?

Vaccination

For Hepatitis A and B, the No 1 preventative is pre-travel vaccination.     According to Hepatitis Australia, clinical trials have shown that the Hepatitis A vaccine is effective in preventing infection in about 95% of people.  Vaccination against Hepatitis B offers 90% immunity.

Vaccination against Hepatitis A usually involves 2 doses / injections, 6 months apart.  Vaccination against Hepatitis B usually involves 3 doses over 6 months.  It is also possible to have a combined (3 dose) vaccination to guard against both Hepatitis A and Hepatitis B.

Given that the vaccination course takes 6 months, it is best to plan a trip well in advance.  If you will be travelling in less than 6 months, partial immunity can be gained through the first dose.  Speak to your doctor about this and also the potential that you can have the course over a shorter timeframe.

Partial protection against Hepatitis A usually commences within 14-21 days of the first dose and immunity lasts for at least 10 years.  Immunity against Hepatitis B following vaccination is life-long.

Presently, there is no vaccine available for prevention of Hepatitis C, D or E.

What else?

There are also a lot of measures you can take while travelling to reduce the potential of infection:

Destination

Where are you going?  Are you travelling to developing countries or well developed countries which enjoy high quality sanitation and living standards?  The risk of contraction if travelling to the UK or Canada will be less than if you are travelling to Asia or the sub-continent.

If you need some help working out the risk of your destination/s, the Center for Disease Control and Prevention publishes world maps to highlight the prevalence of Hepatitis:

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis E

Food and drink

  • Eat food that is cooked and served hot. Do not eat food served at room temperature including salads.
  • Wash and peel fruit and vegetables in clean water prior to consumption. Doing this yourself will reduce the potential that your food has been handled by an infected person.
  • Only consume pasteurized dairy products.
  • Avoid food sold by street vendors.
  • Avoid raw meat, fish and partly cooked eggs.
  • Avoid unwashed and unpeeled fruit and vegetables.
  • Drink bottled (and sealed) water. If not possible, ensure that water is boiled, filtered and treated prior to consumption.
  • Avoid ice cubes and any drink which could have been made with tap water (eg cordial and reconstituted fruit juice).

Hygiene

  • Wash your hands and wash them often – particularly after visiting the toilet and/or before eating or drinking.
  • Carry (and use) hand sanitizer.
  • Avoid contact with people who are sick.
  • Avoid touching your face – mouth, eyes and nose. If you need to, ensure your hands are clean.
  • Don’t share utensils, cups or plates.
  • Do not share personal care items (eg toothbrushes).
  • Practice safe sex.
  • Avoid intravenous drug use and/or any activity which involves needles unless medically necessary (eg tattoos, piercings, acupuncture).
  • Avoid high risk activities which may increase the likelihood of injury thus necessitating medical treatment / exposure to blood and blood products.
  • Limit bodily contact with strangers (eg kissing and hugging).

Hepatitis is an illness to which many travellers are exposed.  Fortunately there are measures you can take to minimize the risk of infection.  Please speak to your doctor to find out how best to protect yourself while travelling.  Take care too when it comes to travel insurance – many policies wont cover you if you fail to obtain recommended vaccinations so best to check with your chosen provider.