Hepatitis B is a viral infection of the liver spread by direct contact with the blood or body fluids of an infected person. It occurs worldwide with the highest rates reported in parts of East Asia and Sub Saharan Africa. Higher rates of infection are also found in the Amazon, southern parts of Eastern and Central Europe, the Middle East and the Indian subcontinent. The rates of infection in Western Europe and North America are low.
Risk for travellers is low although certain behaviours or activities put individuals at higher risk, particularly when these occur in areas where hepatitis B is more common.
These behaviours and activities include:
– unprotected sex
– exposure to blood or blood products through occupation, such as healthcare work
– exposure to contaminated needles through injecting drug use, or as a result of accessing medical or dental
– participation in contact sports
– adoption of children from risk countries
– long stay travel
In the majority of cases of hepatitis B symptoms do not occur. Symptoms more commonly occur in adults than children and may include: jaundice (yellowing of the skin and eyes), loss of appetite, fever and abdominal pain. Persistent hepatitis B infection develops in 80 to 90 percent of those infected in the first year of life and in only five percent of those infected in adult years. Persistent infection may lead to liver failure or liver cancer.
All travellers should avoid contact with blood and bodily fluids by:
– avoiding unprotected sexual intercourse.
– using appropriate protective precautions where contact is unavoidable e.g. due to occupation
– avoiding tattooing, piercing and acupuncture (unless sterile equipment is used)
– not sharing needles or other injection equipment.
– not sharing shaving equipment
– Any traveller can be at risk of an accident or require emergency treatment. Travellers should be aware that using precautions will also help protect against other blood and body fluid-borne viruses, such as HIV and hepatitis C, for which there are currently no vaccines. A sterile medical equipment kit may be helpful when travelling to resource-poor areas.
Several well-tolerated inactivated hepatitis B vaccines, including combined hepatitis A/B products, are available and vaccination is recommended for all travellers considered at risk. The initial hepatitis B vaccination schedule involves 3 injections completed over differing time scales depending on how quickly they are required.
Public Health England advises that for travellers who have completed a hepatitis B vaccine course, a single booster dose of vaccine at five years is not required unless they are considered at continuing risk of infection. A blood test to check immunity (hepatitis B surface antibody levels) is only recommended for people with kidney failure or those at risk of occupational exposure particularly healthcare and laboratory workers.