Hepatitis A occurs throughout the world. The risk of infection in developed countries such as Slovenia is actually very low. There is, however, a medium-high or even very high risk of infection in the countries of Africa, Central and South America, the whole of Asia with the exception of Japan and Singapore, and some countries of Eastern and Southeast Europe. 10 to 20 cases of hepatitis A are recorded in Slovenia per year. But in our immediate surroundings and in the countries of the former Yugoslavia, where Slovenians travel most often, there are as many as several hundred or even several thousand cases of hepatitis A per year, sometimes even in the form of epidemics. One of the largest hepatitis A epidemics occurred at the turn of 2007 in Serbia, predominantly in Niš and its surroundings. Serbia recorded a total of almost 5000 cases of the disease in 2007 and 2008. 

In less developed parts of the world, most of the population is infected during their childhood or early adulthood. In Slovenia, persons younger than 50 have mostly not come into contact with the virus in their entire lives, making them all the more at risk of infection when travelling to the abovementioned regions of the world, where there is a high risk of infection. In the countries of Western and Central Europe, more than half of all patients are infected while travelling abroad. The risk of infection depends upon the destination and duration of the trip, as well as the living conditions, food and drink safety standards and, of course, the sanitary conditions at the destination. Although the risk of infection can be reduced by practicing good hand hygiene, it is not possible to ensure that the persons who prepare and serve your food during your trip practice proper hygiene and handle the food correctly.

Even tourists who only visit holiday resorts in endemic countries for short periods of time and stay and eat at high-class hotels can develop a serious case of the disease. A good example of this is the hepatitis A epidemic which occurred among the guests of one of the all-inclusive high-class hotels in Hurghada, Egypt, in 2004, when at least 350 persons from 9 European countries became ill; most of them, 271, were from Germany. The cause of the infection was most likely the freshly squeezed orange juice served at breakfast.  Regardless of the fact that Egypt is a country with a high risk of hepatitis A infection, most of the German tourists had not been vaccinated against the disease. After returning from Hurghada, an Austrian tourist also caused a local hepatitis A epidemic among the guests of the restaurant at which she worked. Because symptoms of hepatitis only begin to show in infected persons a few weeks after infection, while the virus begins to be shed before the disease develops, the hepatitis A virus was transmitted from the tourist onto 13 guests of the restaurant at which she worked.

Research shows, however, that the risk of infection has been decreasing in the past years for passengers travelling from developed countries to less developed parts of the world. Nonetheless, hepatitis A remains the most common travel-related disease, and it can be protected against by vaccination.  Vaccination is actually the only effective way of preventing infection. Hepatitis A vaccine is a so-called dead vaccine and is thus entirely safe. It is also very effective, as it makes virtually all vaccinated persons immune as soon as a month after the first dose of the vaccine.  The second dose, which is administered 6 months to a year after the first dose, ensures long-term protection. Current research shows that after the two doses are administered, vaccinated persons develop lifelong immunity, and booster doses are therefore no longer required under current doctrine.

The greatest risk of infection for Slovenian travellers is, of course, travelling to the countries of Africa, Asia and Central and South America, regardless of the duration of the trip and the living conditions. Despite the fact that most people think that taking a short holiday in holiday resorts in Turkey, Egypt, Tunis, Morocco and other popular destinations does not constitute a risk for infection with hepatitis A or other infectious diseases, actual data and research show that this is far from the truth. Considering the fact that Slovenians mostly travel to nearby destinations, it must be noted that there is a risk of hepatitis A infection even when travelling to or visiting friends or relatives in Bosnia and Herzegovina, Serbia, Montenegro, Macedonia or Kosovo.  International travel medicine experts are of the opinion that it is advisable to get vaccinated against hepatitis A before travelling to any of the aforementioned countries of the former Yugoslavia, as well as Albania, Bulgaria, Romania, Moldavia, Ukraine, Belarus or Russia (more at http://drustvo-bpnb.si/index.php/english-articles/202-vaccination-agains-hepatitis-a and http://drustvo-bpnb.si/index.php/english-articles/204-vaccination-against-hepatitis-a-and-hepatitis-b). 

The virus is found in all body fluids, and the most important in terms of transmission of infection are the blood, saliva and semen of infected persons. The infection is most commonly transmitted through contact with infected blood, through sexual intercourse and from mother to child during pregnancy or birth. It is also possible to become infected through tattooing, ear piercing and acupuncture. There is a high risk of infection among intravenous drug users who share their accessories, and inhalant users.

The HBV can survive for several months in a serum at 4oC, up to six months in a surveillance culture at temperatures between 30 and 32oC and several years at -20oC. Boiling water destroys the virus in 10 minutes, dry heat at 160oC in 2 hours, 1% sodium hypochlorite in 30 minutes and 40% formaldehyde in 12 hours.

According to some estimates, there are more than 350 million people in the world who are chronically infected with hepatitis B, and the blood of as much as a third of the global population shows signs of past or fresh infection with hepatitis B. There are approximately four million new acute cases each year, and approximately a million people die of chronic effects of cancer and liver cirrhosis.

Almost one in a hundred Slovenians carry the hepatitis B virus but do not experience any problems. Experts estimate that there are approximately twenty thousand chronic carriers of the virus in Slovenia, many of which are chronic liver patients. The symptoms and consequences of liver inflammation depend on the properties of the virus, the organism’s defensive capabilities and certain external factors. The risk of liver cancer for a person who is chronically infected with the hepatitis B virus is ten times greater than the risk of lung cancer for a smoker.

In 90 percent of adults, acute infection leaves no consequences, but in 10 percent of infected adults, 25 percent of infected children and 80 percent of infected newborns, the disease becomes chronic, and the viral infection lasts for a minimum of 6 months and is reflected by abnormal results of liver function tests, and changes in liver tissue. In a few years, chronic patients can get liver cirrhosis or liver cancer. Liver failure due to chronic hepatitis B infection occurs in more than half a million people per year and constitutes the reason for 5 to 10 percent of all liver transplants.

Risk for HBV transmission through unprotected sexual intercourse

Sexual intercourse with a person with:

• acute HBV: the risk of transmission is 20-40%;

• if the sexual partner is a chronic carrier and it is a long-term relationship, the risk of transmission is in excess of 70%;

• 30-40% of all infections as yet lack an etiological explanation.

Vaccination against hepatitis B is mandatory for people with an increased risk of infection, and since 1998 all children in Slovenia are vaccinated against hepatitis B before starting school. More at http://drustvo-bpnb.si/index.php/english-articles/203-vaccination-against-hepatitis-b.

Vaccination against hepatitis B is recommended to anyone travelling to countries where the disease is widespread, as well as to those with an increased risk of infection due to their habits. Vaccination with vaccine against hepatitis A and hepatitis B (bivalent recombinant vaccine) protects against both types of hepatitis. More at http://drustvo-bpnb.si/index.php/english-articles/204-vaccination-against-hepatitis-a-and-hepatitis-b. 

Ticks are dangerous because they can transmit pathogens of meningoencephalitis, Lyme disease and human granulocytic anaplasmosis (former name: ehrlichiosis), and they can cause localised skin inflammation.

Not all ticks are infected. The rate of ticks infected with the tick-borne meningoencephalitis virus, which causes meningitis and encephalitis, varies in Slovenia. The disease is the most widespread in Gorenjska, central Slovenia, Koroška and in the region of Celje.

• Tick-borne meningitis can have lasting consequences, such as headaches or decreased concentration and work capacity, as well as paresis or paralysis. The disease is fatal for one or two percent of those who contract it. The most effective method of protection from tick-borne meningoencephalitis is vaccination (more at http://drustvo-bpnb.si/index.php/english-articles/205-vaccination-against-tick-borne-meningoencephalitis-tbe and http://drustvo-bpnb.si/index.php/gradivo).

• Ticks across Slovenia are infected with Lyme disease agents. There is no vaccine, which makes it all the more important to take precautions against tick bites. It is important to wear suitable clothing and footwear and use insect repellents when outdoors, in nature. If you notice a tick, it should be removed as soon as possible. A red skin rash which appears around the bite wound made by the tick within seven to fourteen days and begins to spread, but fades at the centre, is the first sign of Lyme disease. The skin rash can also appear elsewhere on the skin; there can be one or multiple blemishes, and they are not necessarily ring-shaped. If Lyme disease is diagnosed during this stage, the disease can be effectively treated with appropriate antibiotics. Another early sign of Lyme disease, in addition to skin blemishes, is swelling in areas such as the earlobes or nipples.

On  the link below you can watch the short movie about ticks.

http://www.youtube.com/watch_popup?v=wq1nHjIc1B4&vq=large

Recommended vaccination schedule:
1st dose.
2nd dose between the 6th and the 12th month after the first dose.
No booster doses required.

Recommended standard vaccination schedule:
1st dose.
2nd dose after one month.
3rd dose 6 months after the first dose.

Recommended rapid vaccination schedule:
1st dose.
2nd dose seven days after the first dose.
3rd dose 21 days after the first dose.
4th dose 12 months after the first dose.

No booster doses required.

VACCINE FOR CHILDREN ABOVE THE AGE OF 15 AND ADULTS (Energix B 20 µg and HBVAXPRO 10 µg vaccine).

Recommended vaccination schedule:
1st dose.
2nd dose after one month.
3rd dose 6 months after the first dose.

No booster doses required. The vaccination schedule is different for children born to HBsAg-positive mothers, for dialysis patients and for persons with injuries which present a risk of infection with the hepatitis B virus.

VACCINE FOR CHILDREN ABOVE THE AGE OF 16 AND ADULTS (FSME Immun 0.5 vaccine).

Recommended standard vaccination schedule:
1st dose.
2nd dose 1 to 3 months after the first dose.
3rd dose 5 to 12 months after the second dose.

Recommended rapid vaccination schedule:
1st dose.
2nd dose 14 days after the first dose.
3rd dose 5 to 12 months after the second dose.

Booster doses: upon completion of the primary vaccination course, the first booster dose is administered after 3 years, all further booster doses until the age of 60 are administered in 5-year intervals and all doses after the age of 60 are again administered in 3-year intervals.

VACCINE FOR CHILDREN ABOVE 12 YEARS OF AGE AND ADULTS (Encepur vaccine).

Recommended standard vaccination schedule:
1st dose.
2nd dose 1 to 3 months after the first dose.
3rd dose 9 to 12 months after the second dose.

Recommended rapid vaccination schedule:
1st dose.
2nd dose 7 days after the first dose.
3rd dose 21 days after the first dose.

Booster doses: upon completion of the primary vaccination course, the first booster dose is administered after 3 years, all further booster doses until the age of 49 are administered in 5-year intervals and all booster doses after the age of 49 are again administered in 3-year intervals.

In the rapid vaccination schedule, the first booster dose is administered after one year, all further booster doses until the age of 49 in 5-year intervals and all booster doses after the age of 49 again in 3-year intervals.

TBE VACCINATION LOCATIONS
 

(Here)