Travellers

Travel Health Information Sheets

Updated January 2011

Hepatitis B

What is Hepatitis B?

Hepatitis B is a virus that can damage your liver and cause serious health problems. It can be fatal. Hepatitis B virus (HBV) spreads the same way as HIV but is 100 times more infectious.

Where is it found?

HBV is one of the most common blood borne viruses: worldwide approximately 350 million people are believed to be infectious.

HBV is found all over the world, but some places have higher levels of infection:

 

 Figure 1. Map of prevalence of hepatitis B virus chronic infection, 2006

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Map from: Health Information for Overseas Travel, 2010

You can look at NaTHNaC’s: Country Information Pages for advice about the risk of HBV in individual countries.

Signs and symptoms

If you get infected with HBV you might have mild or no symptoms, or less often, you could develop a severe, life-threatening illness.

More serious symptoms occur in less than 10% of children and in 30% to 50% of adults infected with HBV.

These include:

  • Loss of appetite.

  • Mild fever (temperature).

  • Nausea and vomiting.

  • Stomach pain.

  • Yellow skin and eyes (called jaundice).

  • Dark urine and pale stools (faeces).

You can go on to develop liver problems - either immediate liver failure (which is usually fatal) or long term liver disease.

Even if you have a mild illness and appear to fully recover, you are at risk of developing liver failure or cancer in the future. Also, you can remain infectious for years, which means you can pass HBV on to sexual partners.

What’s my risk?

If you are a tourist or short term traveller, your risk is low. However, remember risk is linked to behaviour – any activity causing contact with blood or body fluids can put you at risk.

This can be via:

  • Any penetrative sex (anal, oral or vaginal) without a condom.

  • Treatment using medical and dental equipment contaminated with HBV or with infected blood products.

  • Injecting drugs and sharing needles/syringes.

  • Any activity that pierces your skin – acupuncture, body piercing and tattoos.

  • Sports like rugby, which increase risk of injury and contact with other people’s blood/body fluids.

  • Any job with a risk of exposure to blood/body fluids, such as healthcare work.

Infected mothers can pass HBV onto their babies during birth.

If you are living or working long-term in countries with high rates of HBV, your risk of exposure is usually higher. HBV can also spread between children via normal childhood contact.

How can I reduce my risk?

  • Never have unprotected sex.
  • Avoid tattooing, piercing and acupuncture.

  • Don’t share needles or injection drug equipment.

  • Carry a sterile medical kit in higher risk regions.

  • Find out if you need to be vaccinated and make sure you complete your vaccine course.

  • Follow infection control guidelines (universal precautions) if your job increases your risk of exposure.

Sexual contact is the most important risk for travellers. UK research showed that 48% of travellers diagnosed with HBV in England, Wales and Northern Ireland in 2003 had unprotected sex abroad. Asia, particularly Thailand, was the most common destination. Protecting yourself against HBV also helps reduce your risk of other blood/body fluid-borne viruses, like HIV and hepatitis C.

Is there a vaccine?

There is a safe, effective vaccine against HBV. The vaccine is a course of three injections, usually given over six months, although shorter courses can be administered. It does not contain live virus – any reactions are usually mild.

HBV vaccine is recommended if:

  • Your behaviour increases your risk.

  • You and your family live or spend long periods in higher risk areas (see NaTHNaC Country Information Pages).

  • You play contact sports like rugby or are involved in any activities that increase your chance of injury.

  • You are travelling with a medical condition or are pregnant, as you may need emergency treatment while abroad.

  • Your job increases your risk of exposure to blood/body fluids or blood products, such as work in healthcare.

  • Your young children go to nursery or school in a higher risk country.

Your GP, nurse or travel clinic can give you more information about the HBV vaccine.

There are no vaccines to prevent HIV or Hepatitis C.

Can Hepatitis B be treated?

For a small number of people, HBV causes sudden, severe liver failure. This needs immediate emergency hospital treatment and has a high death rate. A liver transplant may be needed, but is not always possible, either because of medical complications or because a suitable donor liver is not available. There is no way of predicting who will develop severe liver failure after catching HBV.

More often, people infected with HBV appear to make a full recovery. They can then gradually, over many years, develop liver problems that eventually result in liver failure or cancer. Again, a liver transplant could be required, but may not be possible.

If you have long-term (chronic) HBV infection, medicines such as interferon or anti-viral drugs like tenofovir, can be prescribed by a specialist liver doctor (usually a hospital consultant). This is to try and stop serious liver damage and cancer developing by preventing HBV from multiplying inside your body. It is not a cure. These drugs are not suitable for everyone with HBV and can only be given with careful medical supervision.

Unfortunately, many people aren’t diagnosed with HBV until they experience symptoms many years after their original infection. These symptoms are caused by cirrhosis (scarring and damage to the liver), end stage liver disease or cancer. At this point, it is too late for interferon or anti-viral medicines.

Remember: risk is linked to behaviour, certain activities, like unprotected sex and injecting drugs, increase your risk.

Links:

British Liver Trust: Hepatitis B

U.S. Centers for Disease Control and Prevention: Hepatitis B

Health Protection Agency: Bloodborne Viruses and Occupational Exposure

NaTHNaC: Country Information Pages

NHS Choices: Hepatitis B Treatment.

NHS Choices: Preventing Sexually Transmitted Infections

World Health Organization: Hepatitis B