Highland Travel Medicine

Hepatitis B

Hepatitis B

 is a viral infection that affects the liver. A person infected with the Hepatitis B Virus (HBV) can show a range in severity of symptoms from mild fever, decreased appetite, abdominal pain, and nausea followed by yellowing of the skin, called jaundice, to death. The virus is transmitted through activities that involve contact with blood or body fluids (i.e. sharing needles for injections, having unprotected sex, working in a healthcare setting that exposes one to body fluids, receiving blood transfusions with infected blood and direct contact with open sores of a person infected with HBV). The prevalence of chronic HBV infection in general is low in Northern and Western Europe, North America, Australia, New Zealand, Mexico and the Southern parts of South America. There is an intermediate prevalence in South Central and Southwest Asia, Israel, Japan, Eastern and Southern Europe, Russia, and the surrounding areas of the Amazon basin. The highest incidence is noted in the middle and southern parts of Africa, Southeast Asia (including China and Korea), countries of the Middle East and parts of the Caribbean. The overall risk for international travelers is considered low except in those countries deemed intermediate or high risk.

Prevention
Hepatitis B is preventable with vaccination and/ or avoiding risky behaviors (i.e. sharing needles, using contaminated health care equipment or having unprotected sex). In the United States, the CDC recommends all healthcare workers, all children and adolescents younger than 19years, and anyone how participates in risky behaviors have the vaccination. Furthermore, if one is traveling to a country considered an intermediate or high risk, a Hepatitis B vaccination is highly encouraged.

Vaccination
The Hepatitis B vaccination is a three shot series. It is usually administered on the first day, one month later, and then 6 months after the initial injection. There is also a Twinrix vaccination available for people 18years of older that combines the Hepatitis A and B vaccinations so that travelers can get vaccinated against both viruses at the same time. This, too, is a series of 3 injections, given at day 1, one month later and then 6months after the first injection. If the series is not completed by the time of travel, there is some degree of immunization after the first two doses; however, one is not considered fully immunized until the series is finished. If time is an issue, there is an accelerated schedule for the Hepatitis B vaccination. This series consists of 4 shots, including day 1, day 7 and day 21, followed by a fourth injection 12 months later. The Hepatitis B vaccination is considered safe in pregnancy and in breastfeeding mothers. The most common side effect is pain at the injection site and a slightly elevated temperature. The traveler should remember that behavioral preventative measures should be practiced while traveling abroad. These measures include avoiding unsterile tattooing and piercing, unsterile hospital equipment, sharing needles and having unprotected sex.