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02/08/2006

Hepatits

Medical Matters » Hepatitis


Hepatitis A

Infection
Hepatitis A is highly contagious and is transmitted through food, drinks or objects having had contact with infected stools. It is not transmitted through sex contrary to Hepatitis B.
Chances of getting infected
- Prevalence is low in Middle and Northern Europe, Australia/NZ and the USA. It is intermediate in Southern and Eastern Europe and high in the other countries.
- If you travel with a backpack and don't mind eating in cheap restaurants, it's easy to catch Hepatitis A. Chances of getting infected range from 1/300 to 1/50 per month depending on your standard of travelling.  It's not dangerous, but you will be sick for some weeks.
Vaccination
- There is a good vaccination for Hepatitis A nowadays, so ask your doctor. You need 2 shots (used to be 3 shots) at 0 and 6 months, although if you can it's even better to postpone the second shot till after 12 months. Best is to get your first shot 2 weeks before departure, but a "last-minute shot" is always possible. They are expensive, but they protect you for 10 years.
- Another possibility is to get an injection wth immunoglobulines. However, I advise against this because it's less effective (85%), and you need a new shot each time you go on holidays since it stops working after 3 to 6 months depending on the dose you've taken.
Who should get a vaccination?
Everyone travelling in bad hygienical circumstances and everyone travelling regularly to countries where hepatitis A is endemic even when hygienical circumstances are good.
Who should NOT get a vaccination?
Everyone who has already had hepatits A is protected for life and does not need the vaccination anymore.For persons having lived longer then 1 year in the tropics, it might be worthwile to get your blood tested on hepatitis A IgG antibodies (NOT IgM). If they are postive, you've already had the infection and you don't need the vaccination anymore.
Side effects
The vaccine is extremely well tolerated. It is a dead vaccine and can be given to pregnant women, also in combination with other vaccines or malarial drugs if necessary.

Hepatitis B

> Infection
You can only get this through sex, blood transfusion or contaminated needles. Contrary to Hepatitis A, this is a dangerous infection, sine about 5 to 10% of patients will get a chronic hepatitis giving liver cirrhosis in the long run, and sometimes even liver cancer. In 0,1 to 1% of patients the disease can be fatal immediately after infection.
Chances of getting infected
The risk of getting infected depends of course entirely upon the fact whether you have sex with an infected person, or whether you get infected bloodtransfusion or a shot with an infected needle.Prevalence of the disease is distributed as follows:
- < 2% in Central and Northern Europe, USA, Canada (except in the upper North and Alaska), Central America (except Guatemala and Honduras), Argentina, Chili, Uruguay, Paraguay and most of Bolivia.
- 2-7%: Southern Brasil, Guatemala, Honduras, North Africa, Southern and Eastern Europe and Russia, India, Pakistan, Iran and the Middle East.
- > 8%: The rest of the world, meaning most of Africa, SE Asia but also Northern Canada and Alaska.
Vaccination
There are 2 schemes:
- Get your shots at 0, 1 and 6 months, protection will start from 6 months onwards.
- If you need earlier protection, take an accelerated scheme: 0, 1, 2 months with a recall after 1 year. This scheme offers protection from 2 months onwards.
It is effective in 90 to 95% of patients.It can be used in combination with any other vaccination.They are equally expensive as hepatitis A.
Who should get a vaccination?
Anyone who will engage in risky behaviour:
- Medical personnel
- People going to high risk areas for longer then 6 months
- Travellers who will engage in sexual activity with locals"Accident-prone" travellers like motorcyclists, but also IV drug abusers
- Children living for longer periods in high risk areas.

Hepatitis C

Hepatitis C is spread like hepatitis B. It is also dangerous giving rise to liver cirrhosis and cancer in some patients. However, untill now there's no vaccine available yet.

 

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