Hepatitis A

Hepatitis A is a viral liver disease which is also referred to as infectious jaundice, as infection with the hepatitis A virus can lead to liver inflammation with symptoms of abdominal pain, nausea, fever and the appearance of yellow pigmentation of the skin and conjunctivas.  The symptoms occur within 15-50 days of infection. Interestingly, the symptoms and severity of the disease depend upon the age of the infected person. In most adults infected with the virus, the disease causes jaundice, and it is fatal for approximately 2% of persons over the age of 50. In some cases, the disease only lasts for a few weeks, but for a minority, issues related to liver inflammation can persist for up to a year. In contrast to adults, however, the disease mostly manifests itself in a milder form in children, even without jaundice. But while they may not experience problems, they shed the virus in their excrement, thus causing the spread of infection among people in their vicinity; infected persons shed the hepatitis A virus in their excrement up to 10 days before the onset of symptoms, when they themselves are not yet experiencing any medical problems, and for some days after the onset of jaundice. If infected persons do not practice good hygiene, the virus is given a constant source of food, and if sanitary conditions are inadequate, it can even find its way into drinking water. The hepatitis A virus is contracted through direct contact with an infected person and by ingesting contaminated food or water. Raw or inadequately thermally processed mussels, in which viruses are accumulated from the contaminated sewage which flows into the sea, also present a risk of infection.

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Hepatitis A occurs throughout the world. The risk of infection in developed countries such as Slovenia is actually very low. There is, however, a medium-high or even very high risk of infection in the countries of Africa, Central and South America, the whole of Asia with the exception of Japan and Singapore, and some countries of Eastern and Southeast Europe. 10 to 20 cases of hepatitis A are recorded in Slovenia per year. But in our immediate surroundings and in the countries of the former Yugoslavia, where Slovenians travel most often, there are as many as several hundred or even several thousand cases of hepatitis A per year, sometimes even in the form of epidemics. One of the largest hepatitis A epidemics occurred at the turn of 2007 in Serbia, predominantly in Niš and its surroundings. Serbia recorded a total of almost 5000 cases of the disease in 2007 and 2008. 

In less developed parts of the world, most of the population is infected during their childhood or early adulthood. In Slovenia, persons younger than 50 have mostly not come into contact with the virus in their entire lives, making them all the more at risk of infection when travelling to the abovementioned regions of the world, where there is a high risk of infection. In the countries of Western and Central Europe, more than half of all patients are infected while travelling abroad. The risk of infection depends upon the destination and duration of the trip, as well as the living conditions, food and drink safety standards and, of course, the sanitary conditions at the destination. Although the risk of infection can be reduced by practicing good hand hygiene, it is not possible to ensure that the persons who prepare and serve your food during your trip practice proper hygiene and handle the food correctly.

Even tourists who only visit holiday resorts in endemic countries for short periods of time and stay and eat at high-class hotels can develop a serious case of the disease. A good example of this is the hepatitis A epidemic which occurred among the guests of one of the all-inclusive high-class hotels in Hurghada, Egypt, in 2004, when at least 350 persons from 9 European countries became ill; most of them, 271, were from Germany. The cause of the infection was most likely the freshly squeezed orange juice served at breakfast.  Regardless of the fact that Egypt is a country with a high risk of hepatitis A infection, most of the German tourists had not been vaccinated against the disease. After returning from Hurghada, an Austrian tourist also caused a local hepatitis A epidemic among the guests of the restaurant at which she worked. Because symptoms of hepatitis only begin to show in infected persons a few weeks after infection, while the virus begins to be shed before the disease develops, the hepatitis A virus was transmitted from the tourist onto 13 guests of the restaurant at which she worked.

Research shows, however, that the risk of infection has been decreasing in the past years for passengers travelling from developed countries to less developed parts of the world. Nonetheless, hepatitis A remains the most common travel-related disease, and it can be protected against by vaccination.  Vaccination is actually the only effective way of preventing infection. Hepatitis A vaccine is a so-called dead vaccine and is thus entirely safe. It is also very effective, as it makes virtually all vaccinated persons immune as soon as a month after the first dose of the vaccine.  The second dose, which is administered 6 months to a year after the first dose, ensures long-term protection. Current research shows that after the two doses are administered, vaccinated persons develop lifelong immunity, and booster doses are therefore no longer required under current doctrine.

The greatest risk of infection for Slovenian travellers is, of course, travelling to the countries of Africa, Asia and Central and South America, regardless of the duration of the trip and the living conditions. Despite the fact that most people think that taking a short holiday in holiday resorts in Turkey, Egypt, Tunis, Morocco and other popular destinations does not constitute a risk for infection with hepatitis A or other infectious diseases, actual data and research show that this is far from the truth. Considering the fact that Slovenians mostly travel to nearby destinations, it must be noted that there is a risk of hepatitis A infection even when travelling to or visiting friends or relatives in Bosnia and Herzegovina, Serbia, Montenegro, Macedonia or Kosovo.  International travel medicine experts are of the opinion that it is advisable to get vaccinated against hepatitis A before travelling to any of the aforementioned countries of the former Yugoslavia, as well as Albania, Bulgaria, Romania, Moldavia, Ukraine, Belarus or Russia (more at http://www.drustvo-bpnb.si/index.php/english-articles/202-vaccination-agains-hepatitis-a and http://www.drustvo-bpnb.si/index.php/english-articles/204-vaccination-against-hepatitis-a-and-hepatitis-b). 

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