Hepatitis B
HBV is a DNA virus in the Hepadnaviridae family, transmitted via exposure to infective blood or body fluids. Acute infection ranges from subclinical to fulminant hepatitis and liver failure, and chronic infection can lead to cirrhosis and hepatocellular carcinoma.
Multiple studies have assessed the risk of acquiring hepatitis B during travel. Only 37% of the 1090 Danish travelers who visited hepatitis B endemic countries recognized the transmission route for hepatitis B; 7% had potential exposure to blood and body fluid (such as acupuncture, cosmetic surgery, tattoos, medical and dental procedures, transfusions and medical treatment). A survey of patients attending two genitourinary medicine clinics in Glasgow found high rates of new sexual contacts during overseas travel: 24% of those traveling for personal reasons and 41% of those traveling for business. Among this biased sample of heterosexual males, 92% of those on business or working abroad had sexual contact with a local resident compared with 22.6% on holiday or VFR.
The WHO recommends consideration of hepatitis B vaccination "for all nonimmune individuals travelling to countries or areas with moderate to high risk of infection". Business travelers should consider immunization, particularly those who go to Asia, Africa and parts of South America, and especially if they travel repeatedly or for long durations. Currently available hepatitis B vaccines (including Engerix® [GlaxoSmithKline, London, UK] and Recombivax® [Merck, NJ, USA]) demonstrate high safety and immunogenicity, and 60% of the persons vaccinated with plasma-derived hepatitis B vaccine have seroprotective antibody levels (anti-HBs ≥10 mIU/ml) for more than 22 years. The major challenge with hepatitis B vaccination in business travelers is the three-dose schedule over 6 months (day 0 and 1 and 6 months). An accelerated schedule in combination with hepatitis A, administered on days 0, 7, 21 and at 12 months (described below), has eased the timing constraints.