Hepatitis B

What is hepatitis B?

Hepatitis B is caused by a virus that infects the liver. It is one of the most common vaccine-preventable diseases affecting travellers and can cause either acute or chronic infection.

About 90 to 95 percent of adults with acute hepatitis B infection will clear the virus on their own within six months, and develop lifelong protection against it.

Some people are unable to clear the virus, and develop chronic hepatitis B. Untreated chronic hepatitis B can later develop into serious health problems. Children under four years old are at particular risk of chronic hepatitis B, because only up to 10% will clear the virus.

What is my risk?   

Your risk depends of several factors: destination, length of stay, what you do when you are travelling and whether you have direct contact with blood or other body fluids. In certain destinations, your risk may be higher, as some areas have higher numbers of people with chronic hepatitis B in the general population.  

The risk increases with certain activities, such as unprotected sex, sharing needles, tattooing and acupuncture.

Aid and health care workers and anyone who receives medical or dental care with unsterilized or contaminated equipment in a country where hepatitis B occurs are also at greater risk.

How is it transmitted?

Hepatitis B is highly infectious, and is spread from one person to another through exposure to infected blood and body fluids (including semen and vaginal fluid). It can be spread through:

• blood transfusions or organ transplantation in countries where blood or blood products have not been properly screened for hepatitis B and other viruses transmitted through blood
• unprotected sex with an infected person
• sharing needles or equipment for injecting drugs
• unsterilized medical/dental equipment and shared/contaminated materials or equipment used for tattooing, body piercing or acupuncture
• sharing toothbrushes or razors
• childbirth (an infected mother to her infant)
• household contact between family members

What are the symptoms?

• Symptoms can take two to six months to appear.
• Many people who are infected with hepatitis B have either no symptoms or only mild symptoms.
• Symptoms of acute hepatitis B can include fatigue, loss of appetite, joint pain, abdominal pain, nausea, vomiting, fever, and dark urine. A small number of people will develop jaundice (yellowing of the skin and eyes).
• Some people develop chronic hepatitis B and most remain contagious for the rest of their lives. Chronic infection may lead to cirrhosis (scarring of the liver) and/or liver cancer. Most people with chronic hepatitis B are unaware of their infection.

What is the treatment?

• There is no specific treatment for acute hepatitis B. Most adults completely recover from the infection by getting lots of rest, proper nutrition and fluids.
• Antiviral drugs can be used to treat some chronic cases of hepatitis B infection.

Where is hepatitis B a concern?

Hepatitis B occurs worldwide.

Regions with higher numbers of people with chronic hepatitis B in the general population include parts of Southern and Eastern Europe, South and Central America, Africa, Asia and the Middle East.

A map of countries and areas of risk for hepatitis B is available on the World Health Organization (WHO) website.

Recommendations

Consult a health care provider or visit a travel health clinic preferably six weeks before you travel.

1. Get vaccinated if you are at risk but are not immunized (either through previous vaccination or previous hepatitis B infection). Those at risk include:

• Travellers who visit or stay in areas of risk for an extended period of time.
• Travellers who engage in risk activities such as unprotected sex, tattooing and acupuncture, or sharing needles and other equipment for drug use.
• Travellers who work in a health care setting.

2. Protect yourself:

• Avoid dental, medical or cosmetic procedures that penetrate the skin (for example, transfusions, acupuncture, piercing and tattooing) unless you are certain that the needles, materials and equipment are sterile.
• Always practise safer sex (use condoms/dental dams).
• Do not share personal items such as toothbrushes and razors.
• Never share needles or syringes.  

It is not always possible to protect yourself against accidents and the possibility that you may need urgent health care (medical or dental) while travelling. In developing countries, urgent medical care may increase your risk of becoming infected with hepatitis B and other infections transmitted by blood. If you receive medical care while in another country, it is important to follow up with your health care provider when you return to Canada, and to inform them of the care you received abroad.