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On the 28th of July, organisations worldwide come together to raise awareness and promote action to reduce the burden of viral hepatitis. There are several types of viral hepatitis: A, B, C, D, and E, all of which cause inflammation of the liver and can lead to liver damage. Worldwide more than 350 million people live with hepatitis and global action is underway to eliminate viral hepatitis as a public health threat by 2030. While many people make a full recovery following an acute infection, the hepatitis virus can also result in chronic infection, progressive liver damage, liver cancer, and even death. Occupations that are exposed to bodily fluids, faecal matter, sewage, and potential needle stick injuries, are at an increased risk of infection and should take preventative measures, including vaccination.

The impact of viral hepatitis in New Zealand

In New Zealand, around 150,000 individuals are living with hepatitis. Of these New Zealanders, 100,000 have hepatitis B, and around 50,000 have hepatitis C.

However, since hepatitis can present as flu-like symptoms or remain asymptomatic for many years it is impossible to determine the true burden of the disease. For this reason, it is known as the silent epidemic, with many people not being diagnosed until a chronic infection has caused damage to their liver. Currently, hepatitis C is the leading cause of liver transplantation in New Zealand.

Being a highly contagious virus which can survive outside the human body for up to 7 days it is essential that high-risk individuals are vaccinated against hepatitis A and B. The screening procedure should be followed after potential exposure to hepatitis, such as with needle stick injuries and contact with high-risk blood samples.

Recommended hepatitis vaccinations for your occupation

Since the introduction of the hepatitis B vaccination to the national immunisation schedule in 1987, infection rates have dropped drastically in New Zealand. Today infection is rare among those under 25 due to high rates of vaccination, however, immunity can wane over time. For individuals working in high-risk occupations, it is possible to do a blood test to confirm whether you need to receive a vaccination against hepatitis B.

Vaccination against hepatitis A is also recommended in high-risk occupations, as while complications are rare, there is a risk of liver failure and death.

Occupation	Hepatitis A	Hepatitis B
Healthcare professionals	✔ (if working with children)	✔
Healthcare assistants & carers	✔ (if exposed to faeces)	✔
Police, emergency services, & correctional facilities staff		✔
Armed forces personnel	✔ (if deployed in high-risk countries)	✔
Individuals who work with children	✔	✔
Laboratory staff	✔ (if exposed to faeces)	✔
Sewage workers & plumbers		✔
Funeral workers & embalmers		✔
Tattooists & body-piercers		✔
Individuals who work with animals	✔

Symptoms of hepatitis

In some cases, hepatitis will cause no symptoms or mild flu symptoms such as tiredness, aches and a fever.

Often in an acute infection, or when symptoms being to appear after an asymptomatic hepatitis C infection, you will experience:

nausea
tiredness
dark urine
pale bowel motions
joint and muscle pain
jaundice

Understanding hepatitis infection

Hepatitis A (HAV)

Generally, hepatitis A will result in an acute, self-limiting infection which resolves within 2 months of symptoms developing. On rare occasions, an infection can lead to complications such as liver failure and death.

There is no specific treatment for the virus and in most cases, your immune system will clear the infection. Vaccination, PPE, appropriate hand hygiene, and food preparation will reduce your risk.

Since hepatitis A is spread by contact with faeces and contaminated food, vaccination is recommended that individuals travelling to developing countries or working in high-risk industries.

Hepatitis B (HBV)

This variant of hepatitis is spread by contact with blood, and other bodily fluids and can be passed from pregnant mothers to their babies. Infection with hepatitis B can cause an acute infection, with symptoms appearing 6 weeks – 6 months after exposure. In cases of acute infection, individuals may fully recover, or go on to carry the virus in their blood.

In others, hepatitis B infection can go unnoticed for years, but they continue to carry the virus in their liver, progressively causing liver damage and potentially severe complications such as liver failure and liver cancer.

Both individuals who have hepatitis B present in their blood and their liver are considered to have a chronic hepatitis B infection, their blood remains infectious even when symptoms are not present.

Even if you have received a vaccination against hepatitis B, please access testing services if you believe you have been exposed. Treatment of hepatitis B infection is possible, but there is currently no cure for chronic infection.

Hepatitis C (HCV)

Hepatitis C is spread predominantly through exposure to the blood of an infected individual, contact with non-sterile needles and syringes, such as needle stick injuries, or receiving a tattoo or body piercing from unsterile equipment.

In an acute infection, 1 in 3 people will recover within 6 months. It is believed that a large proportion of infected individuals are undiagnosed due to being unaware of prior exposure and the ability of hepatitis C to remain asymptomatic for years, even decades. Due to many people having no symptoms it is often called a silent epidemic, with people commonly noticing symptoms 20 – 30 years after infection. By this point, the chronic infection may have caused liver damage and cirrhosis. Currently, hepatitis C is the leading cause of liver transplantation in New Zealand.

There is no vaccine to prevent hepatitis C, however, there is treatment available which can potentially cure people with a chronic infection. Early diagnosis and treatment is key to limiting or preventing liver damage. If you are at risk of exposure or believe you may have been exposed, please speak to your doctor to discuss testing options. There are many locations in the community where testing can be provided free of charge to individuals eligible for funded healthcare.

Hepatitis D (HDV)

The least common but the most severe form of viral hepatitis, hepatitis D, is only found in individuals with hepatitis B as it can not replicate on its own. This co-infection can cause more serious complications, but most will recover from hepatitis D and never develop a chronic hepatitis D infection. However, people living with chronic hepatitis B are likely to experience a ‘super infection’ and develop chronic hepatitis D.

There is no vaccination against hepatitis D, but individuals without hepatitis B infection can receive the HBV vaccination to prevent infection. As hepatitis D is spread by blood contact, and to a lesser extent sexual contact and mother to baby, safe handling of bodily fluids, safe sex, and the use of sterile injection, tattoo and piercing equipment will reduce the risk of hepatitis B and hepatitis D exposure.

Hepatitis E (HEV)

While hepatitis E is not usually seen in New Zealand, there are around 20 million infections worldwide each year. Most of these infections occur in countries such as India, Asia, Africa and Central America. Hepatitis E is mostly spread through contaminated drinking water, but it can also be transmitted by contaminated food, blood contact, and from a pregnant mother to her unborn baby. To reduce the risk of infection maintain hygiene practices such as handwashing with clean water while travelling, and avoid consuming potentially contaminated water, ice, uncooked shellfish and produce.

Most infections will resolve within 6 weeks of developing symptoms, but in rare cases, it can cause liver failure and death. Pregnant women are at a higher risk of complications and death from hepatitis E.

MedPro is proud to be New Zealand’s leading provider of workplace vaccinations, contact us today to discuss your occupational vaccination requirements.

Resources:

https://www.who.int/campaigns/world-hepatitis-day/2022

https://www.worldhepatitisalliance.org/what-is-viral-hepatitis/

https://www.hepatitisfoundation.org.nz/hepatitis/hepatitis-a

https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/hepatitis

https://www.immune.org.nz/node/43

https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/hepatitis-b

https://www.hepatitisfoundation.org.nz/hepatitis/hepatitis-b

https://www.immune.org.nz/diseases/hepatitis-b

https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/hepatitis-c

https://www.hepatitisfoundation.org.nz/liver-disease/hepatitis/hepatitis-c

https://www.hepatitisfoundation.org.nz/liver-disease/hepatitis/hepatitis-d