Hepatitis A is a food and water borne disease. Risk of contraction is higher in areas of poor sanitation and hygiene. An epidemic can occur in Australia, where hygiene standards are excellent, therefore travellers to developing nations such as South-East Asia, India, South America, Africa and the islands should certainly be vaccinated prior to departure. Seafood is often a carrier for this viral disease. It is wise to avoid eating seafood, raw or cooked, while travelling to these areas.
The symptoms of Hepatitis A are general malaise, fatigue, achy muscles, arthralgia (aches in the limbs and joints), runny nose, extreme sore throat, loss of appetite and dramatic weight loss. Fever is normally of a low grade. Nausea and vomiting commonly occur, as can either diarrhoea or constipation. Mild abdominal pain also occurs, mainly in the right upper quadrant. Chills mark the onset of an acute case. The infection of the liver leads to jaundice (yellowing of the skin and whites of the eyes) and when this develops the fever reduces.
The mortality rate with this disease is quite low. Symptoms will persist for 2-3 weeks, but recovery can take up to 6 months, quite sufficient to ruin a holiday and delay a return to work post-travel. Once exposed to the disease, the patient acquires lifelong immunity.
Hepatitis A vaccination is administered in a course of two injections, the first will provide 95%+ coverage against Hepatitis A infection and lasts 6-12 months. The second booster vaccination gives lifetime cover. The vaccine is extremely effective. Side effects are rare with this vaccination. A mild fever and headache may occur, but this dissipates quickly, and can be relieved with Panadol.
The vaccine is also available in combination with Typhoid or Hepatitis B, reducing the required number of injections needed.
Hepatitis B is a disease transmitted via blood products, or body fluids (sexual contact). The disease exists throughout the world. Some 4 billion people have been exposed to the virus. Medical professionals, intravenous drug users and homosexuals are considered at greater risk of contracting the condition, however travellers are at the mercy of substandard medical care if they fall ill or injure themselves, and blood can be splashed into an individual’s eye in the event of an accident or explosion, plus there is the risk of sexual or other assault. Infection with Hepatitis B causes a more severe version of the symptoms described above for Hepatitis A. The fatality risk is greater, and convalescence lasts approximately 13 weeks after symptoms subside, though some carry the virus for life. Treatment for this condition is not very effective, therefore prevention by vaccination is the logical approach.
The vaccine is recommended for all Australians and is part of the Australian Childhood Immunisation Schedule. Those born in 1985 or after should have already received this vaccine.
Hepatitis B vaccination is administered in a course of three injections, the first two given one month apart and the third six months after. This full course of Hepatitis B vaccination gives lifetime cover. The vaccine is extremely effective. There have been no cases of a vaccinated individual having contracted the disease. Vaccination is therefore recommended for all travellers. Due to the length of time involved in the course, travellers often do not have enough time to complete the course before travelling. For those travellers a rapid course can be administered, but this will mean an extra dose.
A vaccination that provides coverage for both Hepatitis A and B is available. This "Twinrix" vaccination is administered on the same schedule as the Hepatitis B vaccine, but provides more than 95% coverage for both of the diseases for lifetime with only three injections.
Hepatitis C is a rarer strain of the virus. Transmitted usually by contaminated needles either accidentally (intravenous drug users, shared needles) or in a medical facility. In 2016, direct acting antivirals became available seeing most people living with Hepatitis C cured within 8 - 12 weeks. This is a debilitating and potentially fatal disease, if untreated, for which there is no vaccine so it is best as a traveller not to put yourself at risk.
To help prevent a Hepatitis C infection, avoid medical services in developing countries. You can do this by having a pre-travel consultation with a travel health clinician to discuss safe travel practices and having recommended vaccinations. Additionally, always avoid unprotected sexual contact, getting tattoos done and never share needles.