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Hepatitis B

Hepatitis B is a potentially life-threatening acute infection of the liver caused by the hepatitis B virus that is spread through infected blood or bodily fluids. It is a major global health problem. Hepatitis B is up to 100 times more infectious than HIV36. It can cause chronic liver disease with a high risk of death from liver cirrhosis, and cancer. Hepatitis B occurs worldwide, although prevalence ranges from 5-10% in sub-Saharan Africa and East Asia to under 1% in Western Europe and North America[32]. Areas where there is a higher risk of exposure to hepatitis B include: Eastern Europe, Russia, India, China, South and Central America, Africa, South East Asia and many South Pacific islands.


How is contracted?
It is usually spread through contaminated blood via sexual intercourse, blood transfusions, dental and surgical procedures, injections and needle sharing including drug use, tattooing, body piercing and acupuncture. The virus can also be passed from mother to baby and in early life through bites, lesions, and poor sanitary habits [37]. The primary method of transmission reflects the prevalence of chronic HBV infection in a given area. In moderate prevalence areas, which include Eastern Europe, Russia, and Japan (where 2–7% of the population is chronically infected), the disease is predominantly spread among children. In high-prevalence areas such as China, West Africa and South East Asia, transmission during childbirth is most common.  

Who is at risk
Outbreaks are common in slums, refugee camps and areas affected by natural disasters. Every year, there are an estimated 4.5 million new cases, a prevalence of 240 million and 780,000 deaths worldwide due to Hepatitis B [32]

Signs and symptoms
The incubation period of the hepatitis B virus is 75 days on average, but can vary from 30 to 180 days [32]. Most people do not experience any symptoms during the acute infection phase. However, some people develop symptoms that last several weeks, including: jaundice (10% of younger children and in 30-50% of adults), dark urine, extreme fatigue, nausea, vomiting and abdominal pain [34]

Outcome
More than 90% of healthy adults who are infected with the hepatitis B virus will recover and have resolved the infection within 6 months [32]. However, some people become chronically infected, and up to 25% of these ‘carriers’ develop progressive liver disease which can cause cirrhosis and cancer of the liver. Children under 6 years are the most likely to develop chronic infections [32].

Treatment
Treatment is mainly supportive with treatment of symptoms, and individuals are usually monitored closely for any signs of liver failure.

Recommendations for travellers
The risk to the traveller is low and is linked to behaviour. Individuals should avoid: unprotected sex, tattoos, piercings, visiting traditional barbers, along with dental and surgical procedures in high risk destinations. There are two classes of products available for immunisation against hepatitis B: a vaccine that confers active immunity and a specific immunoglobulin that provides passive and temporary immunity while awaiting response to vaccine. Several effective hepatitis vaccines, including combined Hepatitis A vaccines are available in the UK.  There are many different immunisation regimes but the schedule for hepatitis B or combined hepatitis A and hepatitis B vaccine generally consists of three doses, with or without a fourth booster dose.

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Hepatitis B vaccination. Here’s the point...

The risk of contracting Hepatitis B is low in the UK, where the prevalence of chronic hepatitis B infection is 0.3% and transmission is mainly through injecting drug use and sexual activity. In 2003 (the last complete year of records), there were 671 confirmed cases of acute hepatitis B reported in England and Wales [35]. However, in some countries more than 10% of the population may have chronic hepatitis B infection and vaccination is therefore highly recommended for travellers [38].

More than 12% of cases in the UK are thought to result from people travelling to, and working in, countries where there is increased risk of hepatitis B infection [39].