Acute Hepatitis in Israeli Travelers

Authors

  • Tamar Lachish MD,

    1. The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
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  • Moshik Tandlich DMD,

    1. Periodontology Department, Hadassah Medical Center, Jerusalem, Israel
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  • Eli Schwartz MD, DTMH

    Corresponding author
    1. The Center for Geographic Medicine and Tropical Diseases, the Chaim Sheba Medical Center, Tel Hashomer & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    • The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
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Corresponding Author: Professor Eli Schwartz, MD, DTMH, Center of Geographic and Tropical Medicine, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mail: elischwa@post.tau.ac.il

Abstract

Background

Acute hepatitis is a well-described cause of morbidity and sporadic mortality in travelers. Data regarding the epidemiology of hepatitis in travelers are lacking. The aim of this study is to describe the epidemiology of acute viral hepatitis among travelers returning from tropical countries, with particular attention to enterically transmitted hepatitis.

Methods

This study is a prospective observational study of ill-returned travelers who presented at two travel medicine clinics in Israel between the years 1997 and 2012. Data of patients with acute hepatitis were summarized. Only travelers were included, immigrants and foreign workers were excluded.

Results

Among 4,970 Israeli travelers who were seen during this period, 49 (1%) were diagnosed with acute hepatitis. Among them, hepatitis E virus (HEV) was the etiology in 19 (39%) cases and hepatitis A virus (HAV) was the etiology in 13 (27%) cases, demonstrating that 65% of all cases were due to enterically transmitted hepatitis. Acquiring acute hepatitis B (two cases) or acute hepatitis C (one case) was uncommon (6.1%). In 27% of the cases, no diagnosis was determined. Fifty-five percent of cases were imported from the Indian subcontinent, with a predominance of HEV infection (84%). A significant male predominance was seen in all groups regardless of etiology. Pre-travel consultation was documented in only 7% of those with vaccine preventable hepatitis (hepatitis A & B) compared to 89% in those with hepatitis E.

Conclusions

Enterically transmitted hepatitis is the main causes of viral hepatitis among travelers. HEV is an emerging disease and has become the most common hepatitis among Israeli travelers. Although an efficacious vaccine has been developed, no licensed HEV vaccine is yet available. Although hepatitis A vaccine is highly efficacious, safe, and easily available, there is a stable number of HAV cases.

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