RIXENSART, Belgium -- Recent consensus review of existing studies shows that there is a risk of contracting hepatitis A and B infections not only on trips to far-away tropical lands but also to 'near-at-hand' destinations such as Mediterranean countries and Eastern Europe. On the occasion of the Congress of International Society of Travel Medicine, in Lisbon, Professor Hans Dieter Nothdurft, MD, a specialist in travelers' diseases at the Tropical Institute in Munich, stated that many holidaymakers unfortunately completely underestimated this danger.
Hepatitis A viruses (HAV) spread via fecal and oral transmission. Persons infected excrete the pathogens via the stools. Hepatitis A is widespread throughout the Mediterranean area and Eastern Europe. For example, last summer more than 350 holiday-makers from nine European countries were infected by hepatitis A while staying at an 'all-inclusive' hotel in an Egyptian seaside resort. Usually the hepatitis A infection is relatively harmless and not fatal, but the course of the disease may be complicated and lead to protracted periods of hospitalization.
Inflammation of the liver triggered by hepatitis B is very often much more serious. The hepatitis B virus (HBV) is transmitted by direct human contact in the form of infected body fluids such as blood and sperm. It has been recognized that hepatitis B is transmitted through human behaviour such as sexual intercourse or medical intervention. Such activities however, cannot be planned for or avoided during traveling. In his criticism of insufficient awareness among large sections of Europe's population with regard to the risks involved, Nothdurft explained that the tiniest wound could prove a gateway for the incursion of this pathogen. Hepatitis B is highly infectious, he said, and the risk of contraction about 100 times higher than that of the HIV virus. The disease, furthermore, is very often chronic and can lead to cirrhosis of the liver and even cancer. Thousands of people die each year in Europe as an outcome of hepatitis B infection.
There are vaccines available against hepatitis A and B as well as combination of both vaccines together. Nothdurft claims that precisely the incident of an outbreak of hepatitis in an Egyptian four-star hotel shows that one can never be absolutely safe. Many people believe that only backpackers catch travelers' hepatitis. The best protection to avoid infection by hepatitis A or B is prophylactic vaccination, Nothdurft contends.
Consensus Statements on Hepatitis A and Hepatitis B Vaccination for Travel Destinations in Central and Eastern Europe and the Mediterranean Region
With the significant numbers of holidays, visits to friends and relatives and business travel to increasingly popular Central and Eastern Europe and Mediterranean regions, the development and adoption of standardized hepatitis A and hepatitis B vaccination statements is an important public health issue.
A consensus vaccination recommendation was presented by an international panel of senior experts in travel medicine at the Congress of International Society of Travel Medicine in Lisbon.
Both HAV and HBV vaccination is recommended in the following Central and Eastern European destinations: Bulgaria, Bosnia and Herzegovina, Romania, Russia and CIS (Commonwealth of Independent States), Serbia and Montenegro (including Kosovo), Slovakia and Ukraine.
Both HAV and HBV vaccination is recommended in the following Mediterranean traveler destinations: Albania, Egypt, Former Yugoslav Republic of Macedonia (FYROM), Israel, Jordan, Lebanon, Libya, Morocco, Syria, Tunisia and Turkey.
At a satellite symposium organised by GlaxoSmithKline, the experts highlighted:
*there is no "zero-risk" destination for hepatitis A
*hepatitis B is linked to behavioural factors like casual sex, tattooing, piercing, risky sports and healthcare exposure (i.e., dentistry or cosmetic surgery), which cannot always be avoided during travel.
*Duration of stay should not be taken into account in deciding whether to vaccinate due to the long-term protection of the vaccines and the possibility of recurrent traveling.
Source: GlaxoSmithkline, Biologicals SA.