Hepatitis A is a virus that will cause infectious inflammation of the liver. It is common in developing countries and transmitted through contaminated food and water.
Many people will have mild symptoms including nausea, vomiting and diarrhea. Active Hepatic disease may last up to 90 days. Some people may become jaundiced and rarely it is a cause of death more notably in older travelers. Infection with Hepatitis A has recently been suggested to be a risk factor for Arteriosclerosis. People who have grown up in developing countries where Hepatitis A was present, may already have an immunity built up to it. If a person has had Hepatitis A at any time in their life, they are felt to be immune to it. If there is any doubt whether a previous infection was actually Hepatitis A or not, a blood test can be done to determine this.
Hepatitis A may infect food and water. Uncooked shellfish (especially oysters) may cause Hepatitis A. Hepatitis A also affects children and a vaccination is recommended for children 1 year and over. Risk is estimated to be 3-6 per 1000 per month to 20 per 1000 per month in higher risk travelers. Individuals who are at high risk include: ethnic populations, homosexual or bisexual men, IV drug users, military personnel, individuals with liver disease, lab workers, primate handlers or people who routinely receive blood products.
One dose of the Hepatitis A vaccine will provide protection for up to twelve month. A booster can be given between 6 - 12 months after the initial shot. The second shot will boost the response for at least 10 years. Hepatitis A vaccine is also recommended and considered safe for pregnant women who plan to travel. Pregnant women are more likely to become very sick from a Hepatitis A infection.
Hepatitis E is similar to Hepatitis A although there is no immunization to protect against it yet. Hepatitis E is also transmitted through food and water.
Hepatitis B is a virus that infects the liver causing infectious Hepatitis, which may lead to liver disease and liver cancer. Hepatitis B is transmitted through blood products, IV drug use and sexual contact with infected partners.
Less commonly it can be transmitted through unclean medical and dental procedures as well as living closely with a person who has been infected. Children playing together with cuts and scrapes may also transmit this. Athletes have been known to transmit Hepatitis B through cuts in a game. Hepatitis B virus is more common and easier to transmit than AIDS. It also kills more people yearly.
Fortunately there is a vaccine available for people who are at potential risk. It is recommended that travelers have the Hepatitis B vaccine if they are traveling to a country where it is common or if a traveler is planning to spend three months or more in a certain area. People involved with medical centers, sanitation and sewage projects, or day care positions should consider being immunized. Although travelers often deny planning risky sexual behavior on vacation it is well known that many do so and therefore they should consider immunization.
The Hepatitis B vaccine is currently available to grade four students in Manitoba as part of their vaccination schedule. Adults and teens that have not yet been vaccinated should consider doing so. Younger children that may be traveling abroad for extended periods should also consider being vaccinated. The Hepatitis B vaccine is considered safe and there is no evidence to link it with Multiple Sclerosis, Diabetes, or Autism as been suggested by anti-vaccination groups.
These groups have issued many misleading statements about vaccinations. Health Canada and the World Health Organization advocate the use of vaccinations to prevent further spread of Hepatitis B.
Hepatitis B is available in several brands and is given on visit one, then again in one month and the final booster is given in six months. (0,1, 6 months). Two doses are necessary to initiate enough antibodies to provide adequate protection while traveling. After having the third dose the vaccine it is effective for at least ten years. There are no guidelines for boosting people past ten years, as it is believed they still have long-term immunity.
A variation of the vaccination schedule can be given during the initial visit, seven days later and then in twenty-one days. A final booster should be given in twelve months to provide coverage for the following ten years. (0,7d, 21d, 12mos). A sore arm and low-grade fever are the most common side effects of the vaccine and may last anywhere from 1- 3 days.
Often Hepatitis A and B are combined together (Twinrix) to give both vaccines at once in the same needle.
Hepatitis B infections may be almost asymptomatic or actively involving the liver. People may die from liver failure or they may be more prone to liver cancer in the future. People with diagnosed Hepatitis B should be under the care of a specialist and should do everything possible to avoid further liver damage. This may include avoiding alcohol and Tylenol (as well as other drugs that either effect the liver or are metabolized). People with Hepatitis B may also consider immunization with Hepatitis A since any further liver damage from a potential 2nd liver infection could be very serious. Conversely all individuals with any liver disease should consider vaccination for both Hepatitis A and B.
Hepatitis B should be considered for travelers when:
1) To cover accidents requiring medical intervention
2) Exposed to non-sterile medical equipment and unscreened blood or blood products
3) Cosmetic practices (body piercing) and tattoos
4) Casual sexual liaisons
5) Exposure to poor food, hygiene and sanitation
Estimated rate of infection of Hepatitis B in travelers .8-2.4/1000 per month Risk is dependant on exposure, destination and duration. In general people spending more than 6 months in or repeated visits to developing countries should consider vaccination.
Other information on the Hepatitis B vaccine:
General: Hepatitis B is a viral liver infection that is spread from person to person by blood and body fluids. To be immunized against it you will need a series of three injections.
SIDE EFFECTS:
These are reactions you may or may not experience after the injection. These generally last for 24-48 hours. At the injection site: swelling, redness, and tenderness.
Other: There is no proof that this causes autism, diabetes, multiple sclerosis or other autoimmune diseases. A recent study showed the incidence of multiple sclerosis less in people vaccinated with Hepatitis B.
Muscular activity increases these side effects; avoid strenuous activities for 24-48 hours after injection. No other change in normal activity is needed. Wash site as usual.
TREATMENT FOR SIDE EFFECTS:
-Tylenol, as directed on label.
-Cool compress to site may be soothing.
BOOSTER: Not required after completion of three shot series.
Hepatitis C
Hepatitis C is another virus that is similar to Hepatitis B in its transmission. At present there is no available vaccination for Hepatitis C since the virus frequently mutates. Travelers going to areas where Hepatitis C is common are advised to be careful when coming in contact with blood and other body fluids.
Hepatitis D
Hepatitis D is a plant virus that can infect only people who are positive with Hepatitis B. The Hepatitis D infection will make their liver disease much worse. There is currently no vaccine for this type of Hepatitis.
