Viral hepatitis in travellers

Abstract

Viral hepatitis poses a significant threat to global public health, with a myriad of causative agents, including hepatotropic viruses A through E. This chapter provides a comprehensive overview of the epidemiology, transmission, clinical course, diagnosis, and treatment of hepatitis A through E, focusing on travellers. Hepatitis A, primarily transmitted through the faecal-oral route, exhibits varying endemicity levels across regions. Improved sanitation and vaccination programs have led to a decline in developed countries but continue to pose risks to travellers. The clinical course ranges from subclinical to acute hepatitis, with a well-defined diagnostic approach involving HAV-specific antibodies. Vaccination remains a key preventive measure. Hepatitis B and D, caused by DNA viruses, share transmission routes, including blood-blood contact and sexual interactions. Prevalence varies globally, influencing the risk for travellers. Chronic infections may lead to cirrhosis and hepatocellular carcinoma, emphasizing the importance of vaccination, especially in regions with moderate to high prevalence. Hepatitis C, an RNA virus primarily transmitted through blood contact, exhibits diverse genotypes. Travel-related risks involve activities such as intravenous drug use and medical procedures. Screening and confirmation of HCV antibodies guide diagnosis, and recent advances in direct-acting antivirals revolutionize treatment. Hepatitis E, caused by Hepeviridae, exhibits varied genotypes with different epidemiological patterns. While genotypes 1 and 2 cause epidemics in regions with poor sanitation, genotypes 3 and 4 pose risks in developed countries, often linked to consumption of contaminated meat. Diagnosis involves serology, and acute infections are typically self-limiting, while chronic cases in immunocompromised individuals may require antiviral therapy. In conclusion, understanding the diverse characteristics of hepatitis A through E is crucial for travellers' health. Vaccination, hygiene practices, and awareness of transmission routes are pivotal for prevention and early intervention, ensuring the well-being of individuals in diverse global settings.