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Thomas S. May, M.A.Medical Writer |
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Traveler, Beware! Hepatitis A & B Await
Thomas S. May, Medical Writer
Introduction An alarming number of US travelers are not well enough informed about the risk of getting hepatitis A and B and can unknowingly expose themselves to these diseases, according to a recent survey of over 6,000 US travelers. Nearly 75% of those who responded had not asked for advice from their healthcare providers before departing, and almost half (47%) of all travelers to regions where a large percentage of the population has hepatitis B were not vaccinated against the disease. "Most people don't have a very good perception of the transmission of hepatitis," says Thelma King Thiel, chair and CEO of Hepatitis Foundation International, the nonprofit organization that conducted the survey. In fact, nearly 70% of those surveyed mistakenly believed that hepatitis A is transmitted by blood or other body fluids. More than 30% of the travelers surveyed also incorrectly believed that hepatitis A is a sexually transmitted disease (STD), and nearly as many did not think that hepatitis A could be contracted at a five-star restaurant. Moreover, about a quarter of the respondents failed to realize that both hepatitis A and B can be fatal. "Hepatitis, quite simply put, is an infection of the liver," says Bradley A. Connor, MD, a clinical assistant professor of medicine at Cornell University's Weill Medical College and director of the New York Center for Travel and Tropical Medicine. Hepatitis A is caused by a virus that can spread through contaminated food or water, and hepatitis B is a viral disease that is transmitted through blood or other body fluids. Hepatitis A can be a very serious, acute infection, and it can last for many months, with symptoms including extreme fatigue and listlessness. Hepatitis B can make you a lifelong carrier of the virus. It's quite likely that you will develop cirrhosis (scarring of the liver) and even liver cancer, Connor says.
Who's at Risk? Hepatitis A is, globally speaking, quite common. Exceptions are
Almost anywhere else, a traveler is at high risk, according to Connor. He is also quick to point out that even if it is less common, hepatitis A exists even in highly developed countries: "In the US, for example, there are 200,000 infections of hepatitis A each year," he says. Even more people get Hepatitis B. According to statistics from the US Centers for Disease Control and Prevention (CDC), up to 320,000 new cases of hepatitis B are reported each year, and a total of 1.25 million people now have chronic (long-term) hepatitis B in the United States alone.
Many of these people may have gotten the disease in a foreign country, according to Connor. But because the incubation period--the time between infection and the development of symptoms--is very long (2-6 months), "Many people may come back not knowing that they have hepatitis B, and they can unknowingly spread the virus to others."
Like hepatitis A, hepatitis B can also be acquired anywhere in the world, but there are certain areas where travelers are at especially high risk, Connor says. These include
Because hepatitis A is spread through contaminated food and water, travelers can minimize their risk of getting this disease by watching what they eat and drink, says Michele Barry, MD, professor of medicine and public health and director of the International Health Office at Yale University School of Medicine. "Eat only well-cooked foods and drink only boiled or bottled water," Barry says. She also recommends washing all fruits and vegetables only using water that is known to be free of infectious agents.
Get Vaccinated! Since you can get hepatitis A even if other preventive measures are taken, Barry says that each person traveling to countries where the disease is common should be immunized against it. Regarding hepatitis B, Barry recommends immunization only if a traveler is planning to stay in such an area for a long time. "I don't routinely immunize for hepatitis B," she says.
But according to Maureen M. Jonas, MD, an expert on viral hepatitis at Harvard Medical School, travelers should still be vaccinated against hepatitis B if they plan to engage in high-risk activities like
Because the disease is acquired through blood or other body fluids, "you must participate in some sort of risk behavior to get this infection," according to Jonas. Connor argues that even though most travelers don't plan to expose themselves to blood or body fluids, they may put themselves at risk unwittingly through many of the activities they participate in. "For example, any trauma or accident requiring medical attention in a country where the blood supply may not be properly screened can increase your chances of getting infected. With travelers nowadays going to very exotic locations, participating in all sorts of adventure travel, this is becoming a very real risk," he says. Unplanned sexual contact can also put travelers at risk, according to Connor. Furthermore, in certain parts of the world, even getting a manicure or a shave can be risky, because the instruments may have traces of infected blood on them. "So, I would tell travelers to get vaccinated against both hepatitis A and B for this reason."
Thomas S. May is a medical
journalist based in Toronto, Ontario, Canada. He has a master's degree in
psychology from Simon Fraser University in Burnaby, British Columbia. Source: Medscape Health
Reprinted from Medscape Health for Consumers.
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