Information on Hepatitis B
Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). HBV is one of several types of viruses that can cause hepatitis. There is a vaccine that will prevent HBV infection.
Hepatitis B virus infection may occur in 2 phases. The acute phase occurs just after a person becomes infected, and can last from a few weeks to several months. Some people recover after the acute phase, but others remain infected for the rest of their lives. The virus remains in their liver and blood, and they become "chronic carriers."
Acute hepatitis B usually begins with symptoms such as loss of appetite, extreme tiredness, nausea, vomiting, and stomach pain. Dark urine and jaundice (yellow eyes and skin) are also common and skin rashes and joint pain can occur. More than half of the people infected with HBV never develop these symptoms, but some may later have long-term liver disease from their HBV infection.
HBV is passed from one person to another in blood or certain body secretions (including wound-clotting fluids, semen, vaginal discharge, saliva, tears and urine). People can acquire the disease during sexual relations or when sharing things like toothbrushes, razors, or needles used to inject drugs. Because of the virus' ability to survive on objects for a week or more, household contacts and childhood playmates of infected persons are at high risk.
Those people infected with HBV who become chronic carriers can spread the infection to others throughout their lifetime. They can also develop long-term liver disease such as cirrhosis (which destroys the liver) or liver cancer.
Risk to travelers
Risk of HBV infection occurs worldwide throughout the year, but the risk varies significantly in various parts of the world. In developed areas, such as the United States, Western Europe, and Australia, there is a relatively low risk of HBV infection, with only 0.2 to 0.9% of the population being chronically infected. By contrast, there is a significantly greater risk of HBV infection in developing areas such as China and Southeast Asia, most of Africa, most Pacific islands, Haiti and the Dominican Republic, parts of the Middle East, and in the Amazon Basin. In these areas, approximately 8 to 15% of the population is chronically infected. In other parts of the world, there is a moderate risk of HBV infection, with 2 to 7% of the population being HBV carriers. Of the reported cases, approximately 1.4% ends in death.
Good personal hygiene, which includes using only safe syringes for injections and using condoms during sexual activity.
Vaccines are about 95% effective, and both provide long-term protection against HBV infection after a series of three injections. A combination hepatitis A/hepatitis B vaccine is available under the name Twinrix.
In Canada hepatitis B is now given as three injections in the first year of life. Previously it was given in grade 6.
Who should consider vaccination?
Travelers who visit areas that have a higher rate of hepatitis B infection should consider vaccination if they are in one of the following groups: those staying for 3 months or longer (especially if they will be staying in rural areas, having daily physical contact with local populations, or may be receiving medical, dental or similar treatment in local facilities), those who anticipate direct contact with blood or sexual contact with residents, and health care providers traveling for purposes of work. Travelers engaging in tattooing, body piercing, or acupuncture are also at risk for hepatitis B infection.
Ideally, hepatitis B vaccination should begin at least 6 months before travel to allow for completion of the series.
Standard 3-dose vaccine series (Day 0 – 30 – 6months). However, if there is not enough time for this schedule, the schedule can be accelerated for hepatitis B vaccine and the combined hepatitis A and B vaccine.
This consists of 4 doses: Day 0- Day 7 or 14 – Day 21- 12months. This schedule can be used for both pediatric and adult travelers who are departing imminently.
TWINRIX: This consists of 4 doses. The second dose is given 7 days after the first dose, and the third dose is given 21 days after the first dose (14 days after the second dose); a fourth dose is given 12 months after the first dose.