Hepatitis is an inflammation of the liver; it has a number of causes from drinking too much alcohol to infection by a virus. There are various forms of hepatitis virus of which the most common are known as hepatitis A, B and C. In some parts of the world hepatitis infection is common and as it is highly infectious it can be easily transmitted to expats. Dr Jace Clarke provides some basic guidance on the risks of contracting hepatitis and the preventive measures expats should consider.
Hepatitis is a much misunderstood disease. Due to a high level of hepatitis C infections among drug users (as a result of transmission through infected blood) it has become viewed as a socially unacceptable condition. This has unfortunately limited understanding of hepatitis and the fact that it can be contracted in a number of other ways, particularly in less developed parts of the world where it can be far more common. This means that expats can innocently expose themselves to risk of infection. Different hepatitis viruses can easily be passed on through poor sanitation, contaminated water, unprotected sex, blood transfusions or through tattoos and body piercing in unhygienic condition. It is quite possible to be a carrier of a hepatitis virus without knowing and without ever having experienced any symptoms; however, severe infection from certain types of hepatitis virus can cause serious illness and may even be lethal if left untreated.
While there are many causes of hepatitis this article will focus on the most common hepatitis viruses, known as hepatitis A, B and C, however as there are other hepatitis viruses and other causes of hepatitis, anyone with any concerns about their liver health should consult their medical practitioner immediately.
Hepatitis A is a highly infectious virus which is common in areas of poor sanitation and poor water supplies. It is common in Asia and Africa, parts of the Middle East and parts of Eastern Europe. Infection can be passed by drinking contaminated water or eating uncooked food or shellfish caught in contaminated water.
The incubation period of hepatitis A is 2-6 weeks after which symptoms will include flu-like fever, aches and headaches. Sufferers will also feel tired and may also experience vomiting and diarrhoea and will also suffer from jaundice. Symptoms will last for a week or so with the jaundice gradually fading after. There is no specific treatment for infection by hepatitis A, however serious illness is extremely rare. After contracting hepatises A, sufferers will develop an immunity which should protect them from future infections.
Expats living in or travelling to countries where hepatitis A is common can be immunised against hepatitis A. They should also practice good personal hygiene and try to avoid drinking water if the source is unknown or eating uncooked foods prepared in contaminated water. It is also prudent to avoid unpasteurised milk.
Hepatitis B is transmitted from person to person in bodily fluids and is easily caught by having unprotected sex with an infected person, or through infection from infected blood. Infection used to be common from blood transfusions and other blood products; however in most parts of the world blood is now screened for hepatitis so the risk is greatly reduced. Hepatitis B is also transmitted by people sharing needles to inject drugs. In developed western countries up to 1 in 550 people are carriers of hepatitis B, but in parts of Asia and Africa where many expats live and travel the infection is far more common and more than 1 in 10 people may be carriers.
The incubation period for hepatitis B is between 1 and 6 months after which sufferers experience similar flu-like symptoms to those experienced with hepatitis A. Some people who have been infected experience virtually no symptoms at all and may not even know they have been infected. In the majority of cases the immune system clears the virus from the body within 3 to 6 months after which sufferers are no longer infectious and will have developed immunity. Unfortunately around I in 10 people develop a chronic version of the infection with the virus remaining active in their system in the long term. These people may or may not experience symptoms; however they remain infectious and can easily pass the virus to others. Other suffers of chronic hepatitis B may also experience liver inflammation with flu-like symptoms and jaundice, in more serious cases the infection can lead to cirrhosis of the liver or cancer.
Expats travelling to countries where hepatitis B is common should be immunised against infection. They should also avoid putting themselves at risk through unprotected sex or contact sports and should try to avoid tattooing, piercing or medical and dental treatment where there is a risk that the equipment may not be sterile. Any activity where there is a risk of contact with an infected person’s blood or other bodily fluids, such as injecting drugs, is also very high risk.
Hepatitis C is the virus which has done most to give hepatitis its socially unacceptable tag. It is a blood-borne virus and in advanced countries it is mostly contracted by drug users who share needles. It is however possible to contract hepatitis C from infected blood products, from contact with an infected person’s blood and in a number of other ways.
Symptoms of hepatitis C infection are similar to the flu-like symptoms experienced by sufferers of hepatitis A and B, however unlike other forms of hepatitis there is a far higher risk that the infection will remain in the blood stream and around 4 out of 5 cases people will develop a chronic infection. While some people with a chronic infection may experience no symptoms, some will experience persistent symptoms due to liver inflammation and around 1 in 5 will develop cirrhosis of the liver and some may go on to develop cancer.
Expats are no more at risk of contracting hepatitis C than the general populace, however as there is no immunisation and it is possible to be re-infected, high risk activity should be avoided wherever expats are in the world.
Its connotation with illegal drug use has led many expats to believe that they are at limited risk of contracting a hepatitis virus. This is unfortunate as both hepatitis A and B are common in many countries visited by expats and an infection can be easily contracted through eating and drinking and in normal social contact. Fortunately, by taking sensible precautions and making sure they are properly immunised, expats can easily avoid infection with any of the hepatitis viruses wherever they are based in the world.