Hepatitis is the medical term for inflammation (-itis – think appendicitis and tonsillitis) of the liver (doctors call anything to do with the liver ‘hepatic’). There are many different causes and types of hepatitis. They are divided into infectious or non-infectious causes and acute (short-term) or chronic hepatitis.
Your liver works hard 24 hours a day, storing energy for the body, processing and removing medicines and toxins, making bile to help digest food, and producing proteins essential for blood clotting. Anything that disrupts its work can lead to short or long-term illness.
The most common non-infectious cause of hepatitis is excessive alcohol use. Drinking too much over long periods can lead to stiffening and inflammation of the liver. If caught in time, alcoholic hepatitis can usually be reversed – your liver has remarkable powers of regeneration. But drinking very large quantities even over a short period can lead to alcohol poisoning and being severely unwell.
For holidaymakers, the most important distinction is whether they are caused by infection with a virus – this carries the biggest risk to travellers abroad and can often be avoided with vaccination.
In the UK, we have been faced with worrying headlines in the first few months of 2022 about children developing hepatitis. The first cases were detected in early 2022, and by April they had been seen in Denmark, Ireland, the Netherlands, Spain, and Ireland, as well as in the UK. Out of 197 children affected, 11 were ill enough to need a liver transplant.
Most cases of infectious hepatitis are due to one of the five hepatitis viruses, A to E. However, other virus infections can also sometimes cause inflammation of the liver. Most of the children affected were aged 3 to 5 years old, and all were under 10.
Scientists quickly ruled out any connection with COVID-19 vaccination – none of the under 5s – who made up ¾ of all children affected - had received the vaccine. Only a few of the children had recently had COVID-19 infection, so it is thought unlikely that this virus is the cause.
Instead, it seems more likely that the virus to blame is an adenovirus. This family of viruses is a common cause of minor childhood illnesses, including sore throats, acute bronchitis, common cold symptoms, tummy bugs, conjunctivitis, and less often pneumonia. While this is obviously a cause for concern among parents, the overall number of children is very small – about 200 by the end of May – and the rate of infection has now slowed considerably.
The most common cause of hepatitis is infection with a virus. There are five main different viruses that can cause hepatitis – hepatitis A, B, C, D, and E. Hepatitis A and B have been known for many decades – by contrast, the hepatitis D virus was only discovered in 1977, and the hepatitis E virus in 1978. Which one you are most at risk of will depend largely on your travel destination and your lifestyle.
Hepatitis A used to be called ‘infectious hepatitis’ because it is so easy to catch. It’s spread by the ‘fecal-oral route’ – which is as unpleasant as it sounds! The virus is passed out in the poo of people who are infected. If sewage disposal is poor, it can get into water supplies. This means you can catch it from contaminated water.
Unfortunately, this also means food that has been washed in contaminated water! So salads and fruit can pose a risk as well, as can ice in bottled drinks. Even homemade ice cream could be an issue. Shellfish which have been caught in water contaminated with the virus can also lead to infection.
You can also catch hepatitis A from a person who’s infected if they haven’t washed their hands thoroughly after going to the bathroom. This could either be via direct contact or if they are preparing food.
Symptoms usually develop within 2-7 weeks after you’ve been infected. Even before you develop symptoms, you can pass on the virus if you don’t wash your hands thoroughly every time you visit the bathroom.
The first symptoms include flu-like symptoms (tiredness, aches and pains, headaches), feeling or being sick, diarrhoea, and pain in the upper right side of your tummy. From a few days later you may develop jaundice – yellowing of your skin and the whites of your eyes – and sometimes dark urine and pale poos.
There is no specific treatment for hepatitis A, but your doctor may advise on remedies to ease your symptoms while your body fights off the infection. It’s very important to practice really careful hand hygiene and avoid handling food while you’re infectious. Your doctor can advise when it’s safe for you to return to work.
Fortunately, the symptoms of hepatitis A usually settle within a few weeks, although you can feel tired for several months. Hepatitis A doesn’t tend to cause serious or long-term complications. What’s more, there is an effective vaccination against hepatitis A. If you’re travelling to any area outside Western Europe, Australasia, or the USA, speak to your practice nurse about whether you need vaccination.
Hepatitis B is not as easy to catch as hepatitis A. For instance, it can’t be passed on by sharing cups or crockery, or through contaminated water. The most common ways to catch hepatitis B are through unprotected sex with an infected person or from exposure to infected blood. This includes non-sterile needs for dental procedures or tattoos, as well as sharing needles for injecting drugs.
However, while most people recover completely from hepatitis A, a proportion go on to develop long-term complications. This can lead to you feeling generally unwell (tiredness, feeling sick, tummy pains, jaundice, lack of appetite). In severe cases, it can lead to severe liver damage – cirrhosis of the liver – and liver cancer.
The short-term symptoms of hepatitis B are similar to those of hepatitis A. About half of people who catch hepatitis B don’t develop jaundice and just have mild flu-like symptoms. About 1 in 10 people go on to have a long-term hepatitis B infection.
The best protections are avoiding high-risk situations and vaccination. If you aren’t immunised and are exposed to the virus, an injection of antibodies (called immunoglobulin) as well as starting an immediate course of vaccination, is recommended.
Hepatitis C is caught in similar ways to hepatitis B. While it is less likely that you will catch hepatitis C from unprotected sex, it is extremely common among people who inject drugs. Up to have of injecting drug users become infected.
Like hepatitis B, there is an ‘acute phase’ of hepatitis C which develops about 7-8 weeks after infection, with similar symptoms to hepatitis A and B. About half of people infected with hepatitis C go on to develop long-term complications, including feeling generally unwell, cirrhosis, and more rarely liver cancer.
There is no vaccination to protect against hepatitis C, so avoiding high-risk behaviour is the best way to protect yourself.
Hepatitis D and E
Hepatitis D is spread in similar ways to hepatitis B and C. However, it only affects people who have already been infected with hepatitis B.
Hepatitis E, like hepatitis A, is caught through contaminated food and drink. It causes similar symptoms to hepatitis A and most people recover completely. However, there is no vaccination against hepatitis E.
How you can protect yourself
There are several ways you can protect yourself against hepatitis when you’re travelling. The key ones include:
- Find out whether you’re going to a high-risk area by visiting the NHS Scotland fitfortravel website where you can find a full list of all the vaccinations and other health precautions recommended for different countries.
- Alternatively, speak to your practice nurse, to see if your practice offers NHS travel vaccinations. They can give you a full rundown of vaccinations etc.
- If your practice doesn’t provide NHS travel vaccinations, you can access them privately from many community pharmacists.
- Make an appointment for your travel vaccinations well in advance – ideally at least 2 months before you plan to travel. You may need more than one vaccine.
- While you’re away, take precautions to avoid putting yourself at high risk of infection – this includes unprotected sex.
- If you are exposed to someone else’s blood while away, seek immediate medical help.
- Where hepatitis A and food and drink are concerned:
- Use the mantra ‘Boil it, cook it, peel it or forget it!’ - cooked foods carry a much lower risk than salads, and remember that tap water (as well as ice, ice cream, and shellfish) can be contaminated.
- Wash your hands regularly and thoroughly.
- Use bottled or treated water to brush your teeth.
- Be careful about buying food from street vendors – check plates are clean and food is piping hot.
- Remember that buffet food that has been left out, where flies can land on it, also poses a risk.