New combined hepatitis A and B vaccineBMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7140.1317 (Published 25 April 1998) Cite this as: BMJ 1998;316:1317
Risks of viral hepatitis related to travel
- Jane N Zuckerman, Head
- Academic Unit of Travel Medicine and Vaccines, Royal Free Hospital School of Medicine, London NW3 2PF
- Bracknell, Berkshire RG12 7WW
- Smithkline Beecham Pharmaceuticals, Welwyn Garden City, Hertfordshire AL7 1EY
EDITOR—The prevention of infectious diseases in travellers is an important public health measure which receives insufficient emphasis. Although Dedicoat and Ellis mention the importance of preventing the transmission of bloodborne viruses for which no vaccines are currently available,1 there are effective vaccines against viral hepatitis.
Around 1.4 million cases of hepatitis A are reported annually, with 350 million carriers of hepatitis B worldwide. Steffen reported the incidence of infection with hepatitis A in unprotected travellers as 3-6 per 1000 travellers per month of travel in a tourist resort, rising to 20 per 1000 per month for those in other settings.2 The incidence of hepatitis B was reported as 8-240 per 100 000 per month for ex-patriates, which fell by 2-10 times in short term travellers.2
The sexual transmission of hepatitis B is well recognised. Recent evidence suggests that advice about safe sex is often ignored by British tourists. One study showed that only 46% of young travellers having sex with a new partner used a condom.3 Other risk factors include exposure to unsterilised medical or dental instruments; use of unscreened blood during medical intervention such as after an accident (the commonest cause of death in travellers); and use of unsterilised equipment used in acupuncture, tattooing, and body piercing (all popular with visitors to developing countries).
British residents made 40 million visits abroad in 1995, an increasing proportion travelling to Africa, Asia, …