In the U.S., the risk of contracting viral hepatitis has fallen sharply in recent years. The risk is higher for Americans who travel abroad -- especially to regions where hepatitis is prevalent and sanitation is poor.
“Travelers who go to non-urban areas of developing countries are most likely to get infected,” says Scott D. Holmberg, MD, chief of the epidemiology and surveillance branch of the division of viral hepatitis at the Centers for Disease Control and Prevention (CDC) in Atlanta. But it’s possible to contract hepatitis even during a stay in a luxury hotel.
Several types of hepatitis have been identified. The main types are hepatitis A, B, and C.
Hepatitis A spreads by fecal-oral contact. This can occur by consuming food or beverages contaminated with even tiny amounts of virus-laden feces, or through close personal contact with someone who has hepatitis A. Most people with hepatitis A recover fully within a matter of weeks or months.
Hepatitis B and C spread through contact with infected blood (and, in the case of B, other body fluids). This can occur via sexual contact with someone who has hepatitis B or C, by sharing personal items (nail trimmers, razors, drug paraphernalia, etc.) of an infected person, or from dirty hypodermic needles or transfusions of blood that wasn’t screened for hepatitis. Hepatitis B and C can lead to cirrhosis of the liver, liver cancer, and death.
What can you do to minimize your risk of contracting hepatitis while traveling abroad? Here are eight strategies.
1. Get vaccinated.
Safe, effective vaccines are available for hepatitis A and B, though not yet for hepatitis C. Some experts say vaccination makes sense for just about anyone who leaves the country. “Anyone who travels abroad frequently should probably be vaccinated,” says Melissa Palmer, MD, clinical professor of medicine at New York University School of Medicine.
The hepatitis A vaccine is typically given in two doses six months apart. The hepatitis B vaccine is typically given to adults in three doses spread over six months, and to children in three or four doses spread over six to 18 months.
Adults are also eligible to get a combined vaccine given in three doses over six months.
If you don’t have time for all of the injections before embarking on a trip, get the first injection. That way, you’ll have at least partial immunity. Another possibility is to ask the doctor about getting all of the injections on an accelerated schedule.
2. Know your destination.
Your risk of contracting hepatitis is small if you’re traveling to Canada, Japan, Western Europe, or another area where the disease isn’t prevalent and where sanitation is good.
But travel to a developing country where hepatitis is prevalent calls for extra vigilance.
Viral hepatitis is especially common in Sub-Saharan Africa, Eastern Europe, the Middle East, the Amazon basin, and Asia.
The World Health Organization and the CDC have maps that show countries with high rates of hepatitis.
- The hepatitis A map is at https://gamapserver.who.int/mapLibrary/Files/Maps/Global_HepA_ITHRiskMap.png
- The hepatitis B map is at https://gamapserver.who.int/mapLibrary/Files/Maps/Global_HepB_ITHRiskMap.png
- The hepatitis C map is at https://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/hepatitis-c.aspx
3. Keep your hands clean.
Frequent hand washing helps keep fecal matter from spreading from your hands to your mouth, where it can cause infection. Wash your hands with warm, soapy water -- or use a hand sanitizer -- after using the bathroom or changing a diaper and before eating. If you must use a dirty bathroom, consider using a napkin or paper towel to turn off the tap and to open the door.
4. Watch what you eat.
Uncooked food, including fruits, vegetables, salads, and raw meat or shellfish, can transmit hepatitis. Where sanitation is iffy, stick with cooked foods -- eaten while they are still hot. Eat fresh fruits and vegetables only if you peel them yourself.
“It’s like we used to say in the Peace Corps,” Holmberg says. “Boil it, cook it, peel it, or forget it.” Finally, don’t buy food from street vendors.
5. Avoid contaminated water.
In regions with poor sanitation, tap water can transmit hepatitis. To cut your risk, use bottled water for drinking as well as for washing fruits and vegetables. Steer clear of ice cubes unless you’re sure they were made from pure water.
“You don’t want to buy bottled water and then pour it into a glass containing ice cubes made from contaminated water,” Palmer says. Experts recommend buying bottled water only from a source you trust -- street vendors have been known to refill water bottles with tap water and sell them to unsuspecting tourists.
6. Take precautions regarding sex.
Because all three of the main types of hepatitis can be spread by sexual contact, it’s a good idea to learn something about a potential sex partner -- especially if he/she is from a region where hepatitis is endemic.
There’s no easy way to tell whether a particular person has hepatitis. Many people look healthy even in the disease’s latter stages. But your risk may be higher with a partner who has tattoos, has used illegal drugs, or has a history of sexual promiscuity.
7. Beware of ‘sharps.’
Dirty (reused) hypodermic needles can spread hepatitis, as can acupuncture needles and instruments used to make tattoos or piercings.
If there’s any doubt that a needle is sanitary - such as in an area where adequate sterilization techniques are unavailable -- avoid it.
What about medical care? If you’re in a developing country, “don’t get a blood transfusion or any type of IV unless absolutely necessary,” Palmer says. Invasive medical or dental treatment makes sense only if the benefits clearly outweigh the risks -- for example, if you need emergency treatment for life-threatening injuries sustained in an accident.
8. Steer clear of blood.
It’s prudent to assume that blood from another person is infectious. “Any blood exposure can transmit hepatitis B and C,” says John W. Ward, MD, director of the CDC’s division of viral hepatitis.
If you need to render first aid to someone who is bleeding, do your best to avoid contact with his/her blood. If blood does get on you, wash it off at once.
“It’s OK to be a Good Samaritan, but make sure open cuts and sores are covered,” Palmer says.