Hepatitis B is a serious liver disease that is spread by direct contact with body fluids or blood. Although it is often transmitted through sexual contact, it is more than a sexuallytransmitted disease. Anyone undergoing dental treatments, manicures or pedicures, or tattooing, having an accident where the skin is broken (e.g. falling off a bicycle and grazing the knee), sharing grooming items or administering First Aid could come into contact with hepatitis B.

Hepatitis C is spread by direct contact with the blood of an infected person. The most common means of transmission of this form of hepatitis is through injecting drugs. The drug use may have been many years ago and may have happened only one time. Most people who contracted hepatitis C in this way do not recall any illness at the time, nor do they recall sharing needles with anyone who had hepatitis C.

Exposure to hepatitis C may also have occurred through blood transfusion, although the risk of developing a hepatitis C infection in this way is now extremely low in Canada due to the precautions that are taken during screening blood donors.

Since hepatitis A and B are often caught while travelling outside of the country, vacationers are advised to make sure they are vaccinated against these conditions prior to leaving.

More About Hepatitis A & B
Hepatitis A is not always symptomatic, although people who have contracted it usually experience flu-like symptoms. Some may be bedridden for four to ten weeks and symptoms may last up to a year. Those who have no symptoms can be contagious, often spreading the condition to friends, family and coworkers.

Hepatitis A is not a disease confined to poor areas. The World Health Organization (WHO) advises that most cases of hepatitis A occur among travellers who have stayed in resorts and high-quality hotels. Interestingly, half the people who develop the condition have no idea where they contracted it.

The hepatitis A virus (also known as HAV) is transmitted by eating or drinking something that is contaminated. Raw or undercooked food, food handled by people who have not washed their hands, or water contaminated by animal or human waste are often sources of the virus. The problem is, you cannot tell that a food is contaminated as the virus does not cause it to develop an “off” odour.

Hepatitis B (also known as HBV) is the most prevalent hepatitis strain in the world and considered to be the most serious. People with acute HBV or who are carriers can spread the virus through blood and other body fluids or by sexual contact. Many people who have been infected with the hepatitis B virus recover completely and develop lifelong immunity to the virus. Unfortunately, about 90 percent of babies born to mothers who are hepatitis B carriers have a high chance of developing chronic hepatitis B later on in life. This may lead to diseases such as cirrhosis and cancer of the liver.

What Are The Symptoms?
Hepatitis A and B usually produce the following symptoms, any of which may be present alone or in combination with other symptoms:

• Fever
• Loss of appetite
• Nausea
• Abdominal pain
• Jaundice (yellowed skin and whites of the eyes)
• Fatigue

The incubation period for hepatitis A is three to six weeks after infection. For hepatitis B, it is from four to 25 weeks. Health authorities estimate that up to 30 percent of people with hepatitis A or B have no symptoms at all, meaning they are likely to unknowingly infect others.

Who Is at Risk?
Anyone who travels outside of the country is at risk of contracting hepatitis A or hepatitis B. If you are travelling to parts of the world where hepatitis A and hepatitis B are always present (see chart), you should be vaccinated against them. If you aren't, you run a serious risk of contracting the viruses.

Canadians who were born in countries where the hepatitis A virus is common may have developed a natural protection against the condition. If they return for a visit to their country of birth and take their Canadian-born children, the children may become infected if they have not been vaccinated. This category of traveller may also bring the virus home when they return to Canada.

Reducing Your Risk
It is important to remember that many of the people who have contracted hepatitis viruses have done so while staying at five star hotels and resorts. Staying in “better” accommodations does not protect you against hepatitis. Being aware of how the viruses are transmitted and taking the correct precautions does.

The most effective way to protect yourself and your family members is to make sure that you (and they, if also travelling) are vaccinated against hepatitis A and B. Twinrix® (combined hepatitis A and hepatitis B vaccine) will provide you with long-term protection against these conditions.

The Public Health Agency of Canada schedules a number of travel clinics countrywide, where you can be immunized and learn more about the risks in specific areas of the world. This agency provides a list of clinics and their telephone numbers, as well as updated travel advisories through their website, http://www.travelhealth.gc.ca.

Health Canada suggests that Canadians travelling internationally contact their doctor or a travel clinic six to eight weeks before travelling (regardless of where they are going), to have their risk of contracting a variety of diseases assessed. Based on your current health, your travel itinerary and your previous immunization history, a doctor can determine what immunizations and/or preventive medication you may need, as well as advise you on how you can best avoid disease risks.

Since hepatitis A is spread through contaminated food and water, the Public Health Agency of Canada strongly recommends that travellers to countries where hepatitis A is known to occur exercise general food and water precautions to minimize their risk of exposure. The key principles to remember are: boil it, cook it, peel it or leave it.

• Eat only food that is well-cooked and is still hot when served.
• Drink only purified water that has been boiled or disinfected with chlorine or iodine, or treated with Aquatabs® water purification tablets (make sure you use as directed); or commercially bottled water in sealed containers. Carbonated drinks without ice, including beer, are usually safe.
• Avoid ice, unless it has been made with purified water.
• Avoid unpasteurized milk, cheese and ice cream.
• Avoid uncooked foods, especially shellfish, and salads. Fruit and vegetables that can be peeled are usually safe.
• Avoid food from street vendors.
• Wash hands before eating or drinking.

The following activities can put you at risk of coming in contact with body fluids, which increases your risk of contracting hepatitis B:

• Having medical or dental treatment.
• Administering First Aid to a person who is bleeding.
• Activities that involve or risk skin perforation such as tattooing, piercing, haircuts or manicures.
• Unplanned sexual activity (practise safe sex).

Hepatitis A & B Regions and Risk
Very high risk: Africa, parts of South America, the Middle East and South-east Asia
High risk: Brazil's Amazon basin, China and Latin America
Moderate risk: Southern and Eastern Europe, some regions of the Middle East
Low risk: Australia, USA, Western Europe
Very low risk: Northern Europe and Japan

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