Hepatitis B: information for travellers
Hepatitis B is a viral infection of the liver, causing loss of appetite, nausea, joint pain and jaundice (yellowish discoloration of the eyes and skin) in the acute phase, but sometimes producing no symptoms at all, or only mild symptoms. 'Hepatitis' means 'inflamed liver'. In a very small percentage of cases, the infection may lead to progressive liver failure.
In adults, between one and 10 per cent of those infected will remain persistently infected and infectious. This is also true of up to 90 per cent of those infected as newborn babies. The risk of persistent (chronic) infection is higher in adults if their immune system is not working properly and can't fight off the virus. Being a chronic carrier of hepatitis B virus infection may eventually lead to liver cirrhosis and liver cancer.
Hepatitis B is transmitted primarily through behaviours that result in the exchange of blood or body fluids such as semen or vaginal secretions. Such behaviours include heterosexual or homosexual contact or sharing needles or drug paraphernalia with a person infected with the hepatitis B virus.
Unscreened or improperly screened blood or blood products may also transmit the hepatitis B virus. The use of unsterilised medical instruments or needles (such as in acupuncture, piercing or tattooing), or contact with potentially infected people who have open skin lesions due to impetigo, scabies and scratched insect bites, may increase the risk of hepatitis B virus transmission in persons who travel to areas with high rates of hepatitis B.
Hepatitis B carrier rates are high (greater than 10 per cent) in many Sub-Saharan African, South-east Asian, and Pacific Island populations. Carrier rates are one to 5 per cent in parts of Eastern Europe, the Mediterranean countries, China, Central and South America and some Australian Aboriginal populations, but rates are low (less than one per cent) in the US, northern Europe, Australia and New Zealand.
The risk of acquiring the disease is greater if the traveller has contact with blood or secretions containing blood, has sexual contact with an infected person, or remains in the country for longer than 6 months and has close contact with the local population.
Hepatitis B vaccination should be considered for those travellers to countries with high to intermediate rates of hepatitis B. Travellers who will be providing healthcare and have a reasonable risk of exposure to blood or body fluids containing blood should be vaccinated.
Immunisation should ideally begin 6 months before travel, in order to complete the full series of vaccinations. In certain circumstances where more rapid protection is required, an ‘accelerated’ course of vaccinations is available with injections at 0, 7 and 21 days, with a booster dose necessary at 12 months.
Vaccination is recommended for any of the following people:
- any healthcare worker (medical, dental or laboratory) whose activities might result in blood exposure;
- any traveller who may have intimate sexual contact with the local population or is considering a tattoo or body piercing;
- any person travelling to regions of intermediate or high levels of endemic hepatitis B virus transmission, either for a long-term visit or for frequent short visits (including those people intending to spend a month or more in Central and South America, Africa, Asia or Oceania); or
- any traveller who is likely to seek either medical, dental, or other treatment in local facilities during their stay.
Travel vaccination for hepatitis B
Hepatitis B vaccination is not required for travel to any country, however, it would be wise to have it in certain circumstances. Your doctor or travel vaccination centre will be able to advise you according to your particular destination and circumstances. Ideally, immunisation should begin 6 months before travel to allow time to complete the full series of vaccinations, however, there is an accelerated schedule available for either hepatitis B alone or for combined hepatitis A and hepatitis B vaccination to give more rapid protection.
Australia's domestic vaccination policy for hepatitis B
Australia has implemented a long-term strategy to eliminate hepatitis B from Australia. This has involved the introduction of a universal hepatitis B vaccination programme for infants and adolescents. Hepatitis B vaccine is recommended for all infants at birth, as part of the National Immunisation Program Schedule. It is also recommended that 3 further doses are given at 2, 4 and 6 or 12 months. A catch-up dose at age 10 to 13 years is recommended for those who have not received a primary course of vaccinations.
2. Centers for Disease Control and Prevention [website]. Travelers health Yellow Book. Hepatitis B (updated 2009, Jul 27). http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/hepatitis-b.aspx (accessed 2009, Oct 29)
3. Australian Government Department of Health and Ageing, National Health and Medical Research Council [website]. The Australian Immunisation Handbook, 9th Edition. 2.2 Vaccination for international travel (updated 2008, Mar 26). http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-hepatitisb (accessed 2009, Nov 19)