Dr Sarah Jarvis, MBE
Author: Dr Sarah Jarvis, MBE, General Practitioner (GP)

Dr Sarah Jarvis is the Clinical Director of the Patient Platform, an active medical writer, broadcaster, and the resident doctor for BBC Radio 2.

Originally posted: 17th Jun 2022

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.

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Infectious hepatitis

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

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 immune system and body fight off the infection. It’s very important to practice 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. 

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, joint pain, tummy pains, jaundice, lack of appetite). In severe cases, it can lead to severe damage to the liver – cirrhosis of the liver, liver disease, reduced liver function, liver failure, scarring of the liver – and liver cancer.

Woodland path

Hepatitis B

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.

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 ways to prevent hepatitis 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

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.

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 the 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.

Mountain Range

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 NHS Scotland's Fit For Travel, 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.
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You must have a permanent UK address, have lived in the UK for the last 6 months and be registered with a medical practitioner in the UK. All trips must start and end in the UK and you must purchase the insurance before you depart for your first trip.

A pre-existing is any medical condition for which medical advice, diagnosis, care, or treatment was recommended or received before applying for a travel insurance policy. For some conditions, we'll need to know if they have ever been present, whilst for others if they occurred within a certain period.

A pre-existing condition is a diagnosed medical condition that existed before taking out a policy. We'll ask a series of questions about the medical history for you and any travellers on your quote. If you answer yes to any of these, you will need to tell us about the traveller's conditions. This could be a condition that a traveller has now or has had in the past. If you are not sure what conditions you need to declare, we have online support available to help you 24/7!

It is simple and quick to do! After you've told us about your trip details and answered some medical history questions you can add your pre-existing conditions, one by one, for each traveller. You'll only need to enter your details once, it's all online and there's no need to call, or provide details of your conditions in writing.

Single Trip insurance is for one-off, individual trips and will cover your specified travel dates. This is usually up to 45 days; however, some insurance providers can cover up to 94 days. If you’re not a frequent traveller, single trip cover is a great option and will likely be cheaper than an annual multi-trip cover.

If you are going on 2 or more trips a year, then an Annual Trip policy may save you money!

Suppose you’ve had hepatitis or are currently suffering from hepatitis and want to travel. In that case, you should always speak to your doctor or a healthcare professional before booking anything. Looking into specialised medical travel insurance means you can travel with peace of mind that you're covered should anything happen regarding your condition whilst you’re away.


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