Prevent hepatitis (at home or away)

by Laurie Sullivan

Monday (July 28) was World Hepatitis Day. When a disease has its own special day, you know that it’s serious and we should know more about it.
Sadly, we don’t. Hepatitis remains largely ignored, undiagnosed, and stigmatised, according to the World Health Organisation.
Viral hepatitis is not one but a group of infectious diseases – Hepatitis A, B, C, D, and E. 
Transmitted via food and water (Hep A and E) or through infected blood, body fluids, or unprotected sex (Hep B, C, and D), they affect hundreds of millions of people worldwide, causing acute and chronic liver disease. On average, 1.4 million people die each year from hepatitis.
Most developing countries have a high burden of disease, which is why Australians heading overseas should be aware of the risks of infection and consider getting vaccinated against the two most common types – Hep A and B.

Challenges ahead in Australia

Of course, hepatitis is not only a concern for travellers. Released this week, our national ‘Hepatitis Report Card’ for 2014 highlights major current and looming public health challenges in Australia, including:
* Around 225,000 Australians have hepatitis B, transmitted via blood-to-blood contact or unprotected sex.
* Another 233,000 have hepatitis C, which is transmitted via infected blood, with the vast majority of existing and new cases being the result of unsafe injecting drug use.
* Untreated hepatitis is a leading cause of liver cirrhosis, liver failure and liver cancer, yet just 5% of Australians with Hep B, and 1% of those with Hep C, have received treatment.
* An estimated 250,000 Aussies aged over 40 don’t realise they are infected with one or other of the two viruses and, if they remain untreated, risk serious liver damage in the years ahead.

Hepatitis’ ‘stigma’ a hurdle to treatment

Commenting on the report, Associate Professor Ben Cowie, of Royal Melbourne Hospital, said: “Most people don’t display symptoms until the liver is severely damaged. There is no such thing as a healthy carrier of hepatitis B.”
One reason Australians with hepatitis don’t seek treatment is the stigma and discrimination they face in the community, he added.
The Western Pacific bears a ‘disproportionately high burden’ of hepatitis B virus (HBV), the WHO says. The region is home to about one quarter of the world’s population, but accounts for about half of chronic hepatitis B infections, and a similarly high burden of hepatitis C virus (HCV). 
More than 130 million people from 11 Asian countries carry Hep B and C – a quarter of the world’s estimated burden of 520 million. The viruses are among the leading causes of preventable deaths in Bangladesh, Bhutan, Burma, East Timor, India, Indonesia, Maldives, Nepal, North Korea, Sri Lanka, and Thailand.

Travellers at higher risk of infection

Because these countries are among the favourite holiday destinations for Australians, we should be more aware of the risk of infection while travelling in Asia and other high-risk developing regions, said Dr Eddy Bajrovic, Medical Director of Travelvax Australia.
“Anyone travelling in Asia – indeed, anywhere in the developing world – should be vaccinated against hepatitis A,” he said.
“That goes even for short stays. Hepatitis A is easily passed on through contaminated food and water, or by faecal-oral transmission through touching common, everyday objects, making it difficult to avoid.
“In fact, the Hep A virus is so pervasive that virtually every person born in a developing country contracts the disease in childhood, when the illness is usually mild or without any symptoms at all.
“However, adults are likely to have a more severe illness, and that severity often increases with age. All of which makes Hep A a significant risk for western visitors who’ve never been exposed to it before.”

Health risks can come with holiday sex

Switching to a more relaxed ‘holiday mode’ can bring with it the potential for casual sexual encounters, which can significantly raise the risk of infection by the blood-borne hepatitis viruses, as well as other sexually transmitted infections.
“For travellers, particularly young people, it’s easy to forget that unprotected sex and other holiday activities can have consequences that can be life-long and even life-threatening,” Dr Bajrovic said.
“Something as innocuous as getting a holiday tattoo or body piercing can have a lifelong impact if unsterile equipment contaminated with hepatitis is used. Riding motor scooters, trekking, white-water rafting, and other activities also carry a higher risk of hepatitis by virtue of the potential for injury.”

Travel with sterile equipment – just in case

This chance of injury on holiday is why Travelvax Australia recommends that travellers – regardless of age – include basic sterile equipment in a first-aid kit tailored to the type of activities they’re planning.
“Accidents can happen easily to anyone of any age engaging in physical activities in unfamiliar surroundings overseas,” Dr Bajrovic added.
“Even a fall or minor accident may require medical treatment. In many developing countries, blood supplies are not adequately screened and medical equipment is reused.
“It is very comforting to know you have sterile equipment in your kit if you or a travelling companion needs treatment in a developing country.”

Hepatitis prevention starts with vaccination

Fortunately for travellers, there are very effective vaccines offering high-level protection against Hep A and B. There’s also combined vaccines: Hep A-B, and Hep A-Typhoid.
Hep A vaccination provides almost total immunity (around 99%) after the full course of two doses (6 - 12 months apart). Protection remains effective for at least 20-30 years –life-long for most people.
To avoid Hep A and other food- and water-borne pathogens, travellers should follow the guidelines for safe food and water and adopt strict hygiene protocols. Most important is washing hands thoroughly and regularly, especially after using the toilet and before eating.
As well as young adults, long-stay travellers, expatriate workers and volunteers (particularly healthcare and aid workers) typically are at higher risk of Hepatitis B. The complete course of 3 doses of the Hep B vaccine provides high levels of protection that once again, for most recipients, is life-long.

For Australians, the message from World Hepatitis Day should be: Avoid the risk of infection – at home or away.