Hepatitis has been making headlines lately. Outbreaks have been primarily affecting gay, bisexual and other men who have sex with men (MSM). In Victoria free vaccinations are available till June 30, 2019.
In other jurisdictions, low cost vaccinations may also be available through your general practitioner or sexual health service.
Some outbreaks in Australia have been linked to eating contaminated frozen berries and, in September 2017, to a number of sex-on-premises venues in Sydney. Overseas outbreaks in Europe and the Americas have also mostly been affecting men who have sex with men, highlighting the need for travelling gay men to be vigilant.
So, what’s going on? We spoke to Associate Professor Benjamin Cowie, infectious diseases specialist at Royal Melbourne Hospital, about why hepatitis keeps happening, and how you can keep yourself safe in the kitchen and the bedroom.
1. What is hepatitis?
“‘Hepatitis’ just means an inflammation of the liver. But when we talk about a ‘hepatitis outbreak’, what we normally mean is infectious hepatitis caused by a virus,” explains Cowie.
Symptoms of hepatitis can vary, but they include nausea, fatigue, abdominal pain, diarrhoea and jaundice (yellowing of the skin and eyes). Becoming infected with viral hepatitis can also have non-specific symptoms, or no symptoms at all.
2. What are the different types of hepatitis?
“We most commonly deal with a group of viruses called hepatitis A through E. They’re all completely different viruses. In Australia, hepatitis B and C are most common, but outbreaks of viral hepatitis are usually caused by hepatitis A.”
“Importantly, both hepatitis A and hepatitis B can be prevented with vaccinations.”
3. So, hepatitis A, B, C, D and E aren’t actually part of the same ‘family’?
“No. They’re not otherwise related apart from the fact that they’re all viruses and they all attack the liver. Hepatitis A actually has more in common with the common cold virus than it does with hepatitis B.”
4. How do you get hepatitis? What was going on in those saunas in Sydney?
Transmission is different for each hepatitis virus.
“Hepatitis A, which is responsible for both recent outbreaks in Australia, is acquired through the mouth, predominantly from contaminated food or faecal-oral transmission,” says Cowie.
Faecal-oral transmission doesn’t necessarily mean direct contact with faeces. The virus can survive for several hours outside the body and it can be easily transferred on food or hands (or anything else you put in your mouth).
Hepatitis B is carried in body fluids like blood and semen. It can be transmitted during sex or by using unsterile injecting equipment. “Globally, most people living with chronic (long-term) hepatitis B acquired it in childhood, often from mother-to-child transmission during birth.”
Importantly, both hepatitis A and hepatitis B can be prevented with vaccinations. See below for more details!
Hepatitis C is transmitted via infected blood. This is usually through unsterile injecting equipment, but it can also uncommonly be passed on during sex. “This has been particularly noted among men who have sex with men who are living with HIV,” adds Cowie.
“Hepatitis C can now be readily cured with short courses of oral medication in over 90 per cent of people.”
5. Why are men who have sex with men (MSM) more at risk of contracting hepatitis?
Simply put, we’re more at risk because of the sort of sex we have.
Rimming, anal sex and ass-play can all help to spread hepatitis A. “Oral-anal contact is potentially a significant risk factor for hepatitis A transmission,” adds Cowie. “Having condomless sex with multiple partners also increases the risk of acquiring a variety of STIs, including hepatitis A.”
6. What if I acquire hepatitis ? Is it treatable?
Yes and no – again, it depends what sort.
Hepatitis A can’t be treated, so you just have to wait it out. “If you get infected, your body will clear the virus by itself, and you’ll have long-standing immunity against it,” says Cowie. “However, a person with acute hepatitis A can be unwell for weeks or months.” Hepatitis A symptoms will usually appear 2-6 weeks after infection, and it will usually resolve within two months, though some cases can last up to six months.
Hepatitis B resolves by itself in around 95 per cent of adults who acquire it, compared with only 10 per cent of infants. Symptoms will usually appear around 90 days after exposure, and your immune system will usually clear the infection within a few weeks, though some infections can last up to six months. For the approximately 5 per cent of adults who do develop chronic hepatitis B, regular monitoring is important and, if required, specific antiviral treatment can control it and reduce the risk of liver complications.
Hepatitis C can now be readily cured with short courses of oral medication in over 90 per cent of people. “Since March 2016, the hepatitis C treatment has been on the PBS in Australia – it’s now curable with 12 weeks of tablets, with very few side effects,” says Cowie. Anyone who thinks they may have hepatitis C, or has been at risk, should see their doctor for a test – and if they have hep C, get cured!
Again, it’s important to know that you can still spread hepatitis A, B and C without having any symptoms.
“Know your status, get vaccinated if you’re not immune, and get into care if you have hepatitis B or hepatitis C – hepatitis B is treatable, and hepatitis C is curable.”
7. How do hepatitis vaccinations work?
Getting vaccinated for hepatitis A and B is common practice in Australia. Many children get vaccinated as part of routine childhood immunisation, particularly with regard to hepatitis B. Each vaccination is given on a specific schedule over a series of months to help your immune system build a proper response to the virus.
“Hepatitis A and B vaccines are really safe and effective. In general, we try to give vaccinations at the appropriate schedule,” Cowie says. “Getting an injection later than recommended in the schedule is OK – but getting it too early is not.”
The hepatitis A vaccine is given on a schedule of two injections. The second dose is given at least six months after the first. Sometimes there can be mild pain at the site of the injection, but there aren’t any other common side effects. “Hepatitis A vaccination gives you immunity for at least ten years, if not life,” Cowie says.
The hepatitis B vaccine is given on a schedule of three injections. The second dose is given at least one month after the first, and the third dose is given at least six months after the first. Side effects aren’t common, but there can be some pain at the injection site and a slight fever after the injections. “The hepatitis B vaccine is for life – once you have immunity, you’ll never need a booster,” says Cowie.
A combined hepatitis A and hepatitis B vaccine is also commonly used in Australia, depending on which state you’re in and whether you already have immunity to either hepatitis A or hepatitis B. This is given on the same schedule as the hepatitis B vaccine (second dose after one month, third dose after six months).
Costs for the vaccines vary from state to state, and will also depend on where you’re getting vaccinated and which vaccine is being used. Hepatitis B vaccinations are free in most parts of Australia under the National Immunisation Program. But as a rough guide (based on Queensland):
- Hepatitis A: approx. $66 per dose x 2 doses = approx. $132
- Hepatitis B: approx. $21 per dose x 3 doses = approx. $63
- Combination Vaccination A/B: approx. $69 per dose x 3 doses = approx. $207.
There will usually be a consultation fee on top of this as well. Your doctor will be able to tell you the most appropriate vaccine(s) for you, and how much it’s likely to cost.
8. So, what are the best ways to protect ourselves against hepatitis?
If you’re not vaccinated (or not sure), using a condom during sex will help protect against hepatitis B and C – but hepatitis A is trickier. Cowie’s recommendation is threefold: know your status, get vaccinated if you’re not immune, and get into care if you have hepatitis B or hepatitis C – hepatitis B is treatable, and hepatitis C is curable.
“People in Australia should really know their status for hepatitis A, B and C, particularly those at risk of having been infected,” he says. “If you’re susceptible to hepatitis A or B, you should consider getting vaccinated. Ask your doctor. A blood test will tell you your status – whether you’re immune, infected or if you’ve had it before and cleared it.”
And always wash your hands.