So, did you get lucky (and avoid hepatitis)?

"So, any holiday romances? Did you get lucky?" asks the not so subtle friend.

"Well, there was this one guy..." the still-sunburnt Rhonda replies, recalling her recent holiday to Bali when a handsome young Indonesian man approached her on the beach. Later, over a 'Flaming Rhonda' cocktail, our besotted Aussie utters the now-immortal line: "Kiss me, Ketut!"

We never learn if Rhonda found true luck, er love, or not (although her dreamy smile says plenty). We only know that it was 'lucky' that her friend was with AAMI as a truck rear-ends her car moments later in the memorable television ad for car insurance.

But, how often do travellers take opportunities for casual sex when they present themselves far from home? There are no reliable statistics but, anecdotally at least, holiday romances are not uncommon.

The downside of holiday hijinks
And, sexual trysts aren't the only holiday impulses travellers give in to. Who hasn't been tempted to climb on one of the resort's motor scooters or jet-skis? Doesn't that look like fun?
What about getting some 'ink' or a shiny new tongue piercing? You know, to remember the trip?
Nothing, it seems, is off the agenda when you're time-rich and cashed up in some foreign playground. And, as with our Rhonda, the spur is often alcohol.
But, experts say any of these holiday hijinks could have a downside – hepatitis.
And, not just any hepatitis. Rather the two most dangerous strains – hepatitis B (HBV) and C (HCV). Both can be transmitted through contacted with blood and other body fluids, and both could potentially lead to long-term chronic illness and premature death.
They can also be contracted from other seemingly harmless activities – sharing a razor or toothbrush, accidental blood transfer while playing a contact sport or giving first aid, getting an injection during a medical or dental procedure, having a pedicure or manicure at the resort or receiving a transfusion.

Hepatitis risk often not anticipated
Dr Bernie Hudson, an infectious disease specialist at Sydney's Royal North Shore Hospital, says most Australians underestimate the risks that these often unanticipated holiday activities can pose – even on short trips.
Writing in the Australian medical journal, Medical Observer last week he said that doctors are more aware of the risk of hepatitis A infection in travellers, and often downplay the risk of hepatitis B and C during pre-travel health consultations. That's despite very effective vaccines being available for both hepatitis A and B, including a vaccine which combines the two. (As yet, there is no vaccine for hepatitis C.)
But, it's not only long-term or frequent short-stay travellers visiting countries of medium or high risk for HBV who should consider vaccination. Travellers who take the occasional short trip are candidates too because of the potential for them to engage in one or more of the many activities that could expose them to the virus.
"A study of 309 Australian travellers to South-East Asia and East Asia found that 49% had participated in at least one activity that carried the risk of HBV during their most recent trip," Dr Hudson wrote.
He believes even those travellers with no immediate travel plans should prepare for future journeys by getting vaccinated against HBV– even those who might not normally be expected to engage in unprotected casual sex or other risky behaviour.

Teens and adults at higher risk
Rates of HBV infection in travellers are similar to those for typhoid. (On average, around 110-120 Aussies return from overseas with typhoid each year.) However, HBV and HCV can have a much greater impact by virtue of the potential for chronic infection and the long-term illness that follows.
Unvaccinated Australians born before 2000 (when hepatitis B vaccination was added to the national childhood immunisation schedule) are particularly susceptible to infection during overseas travel – especially when visiting countries where rates of the disease are much higher than in Australia.
The authors of a recently published Australian study that examined the risk of hepatitis B and C in international travel also concluded that vaccination should be considered in all travellers visiting countries with a moderate to high HBV prevalence.

All agree expatriates living in endemic countries are at the highest risk of acquiring hepatitis. Studies reveal that the incidence of infection among expats is as high as 420 per 100,000.

Massive global burden
Worldwide, an estimated 350 to 400 million people are living with chronic HBV infection and some 170 million are chronically infected with HCV.
The dramatic surge in international travel in recent decades has ramped up the risk of infection for travellers. In the last decade alone the number of international arrivals rose from 435 million a year in 1990 to 983 million in 2011.
To increase awareness and understanding of viral hepatitis for those living in high risk countries and travellers alike, the WHO has designated July 28 as World Hepatitis Day.
This year's theme is 'This is hepatitis. Know it. Confront it'. Ironically, most of those infected don't know it and may unwittingly transmit the virus to other people, including 'unlucky' travellers.
"Most (infected) people do not develop any symptoms – often for decades – until they develop chronic liver disease," said the WHO in launching this year campaign. "These factors have resulted in the silent epidemic we are experiencing today."
(You can read the facts on hepatitis and more on the WHO's work to combat the disease)

A profile of Hep B and C
Here's a brief overview of hepatitis B and C.
WHAT, WHO, WHERE: Hepatitis B is a viral disease of the liver spread through the blood, semen or vaginal fluid of an infected person. A major global health problem, the virus is the leading cause of chronic hepatitis, cirrhosis, and liver cancer worldwide. An estimated 2 billion people are infected, resulting in 500,000 to 1.2 million deaths per year. In Asia, it's estimated that as many as 1-in-10 people are chronically infected, while the figure is as many as 1-in-20 in the Middle East and the Indian subcontinent. High rates of chronic infections are also found in the Amazon region of South America, and in southern parts of eastern and central Europe. In contrast, less than 1% of people living in Western Europe, North America and Australia-New Zealand have the disease.
PREVENTION: Vaccination is the mainstay of prevention and the full course of 3 doses over a period of 6 months (at least 2 a month apart, prior to travel) provides highly protective antibody levels lasting at least 20 years – life-long for most. At least 2 shots are needed for travel. (Intending travellers can get effective protection in as little as 3 weeks through a shortened hepatitis B immunisation schedule with 3 doses) A combined Hep A-B vaccine is also available. Read more about hepatitis B, the vaccine, and schedules.

WHAT, WHO, WHERE: In contrast, hepatitis C is rarely transmitted through sex: It's mainly spread through blood transfusions, contaminated syringes or medical equipment, and IV drug use. Severity can range from a mild illness to a serious, lifelong disease. Rates are rising: about 150 million people are chronically infected worldwide, there are 3-4 million new cases each year, and an average 350,000 deaths. High rates of chronic infection occur in Egypt (22%), Pakistan (4.8%), and China (3.2%).
PREVENTION: Because there is no vaccine, travellers should practice safe sex, avoid sharing razors, and ensure only sterile instruments or equipment is used for an injection, acupuncture, body piercing, pedicures, or tattooing. Read more about hepatitis C.

Find out more about the risk of hepatitis before your next overseas trip. Call Travelvax Australia for obligation-free, country-specific advice from travel health specialists by calling our advisory service on 1300 360 164 (toll-free from landlines). You can also book an appointment to obtain recommended vaccinations, medication, and personalised advice at a pre-travel medical consultation.

- Laurie Sullivan.