Medical examination results obtained from the UK P&I Club PEME clinic network indicate 10.1% of crew unfitness is related to hepatitis, with 8.5% of the total crew found unfit due to Hepatitis B.

Hepatitis refers to an inflammatory condition of the liver. The condition can progress to fibrosis (scarring), or liver cancer.Other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.

According to theWorld Health Organization (WHO), hepatitis caused 1.34 million deaths in 2015.Moreover, 325 million people worldwide carried hepatitis B or C virus infections. Although vaccines exist for hepatitis A and hepatitis B, the development of a hepatitis C vaccine has presented challenges.Symptoms

• Fatigue
• Flu-like symptoms
• Dark urine or pale stool
• Abdominal pain
• Loss of appetite or unexplained weight loss
• Yellow skin and eyes,which may be signs of jaundice

Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle to notice.Five types of hepatitis

There are five unique hepatitis viruses, identified by the letters A, B,C,D, and

E.While all cause liver disease, they vary in important ways.

1. Hepatitis A virus (HAV)

Present in faeces and most often transmitted through consumption of

contaminated water or food.Certain sex practices can also spread HAV. Infections are in many cases mild,with

most people making a full recovery. However,HAV infections can also be severe and life threatening. Safe and

effective vaccines are available to prevent HAV.

2. Hepatitis B virus (HBV)

Transmitted through exposure to infected blood, semen and other body fluids.HBV can be transmitted from infected mothers to infants at the time of birth or from family member toinfant in early childhood.Transmission

may also occur through transfusions or contaminated injections. Safe and effective vaccines are available to prevent HBV.

3. Hepatitis C virus (HCV)

Mostly transmitted through exposure to infective blood.This may happen through transfusions of HCV-contaminated blood and blood products, contaminated  injections during medical procedures, and through injection drug use.There is no vaccine for HCV.

4. Hepatitis D virus (HDV)

Infections occur only in those who are infected with HBV.The dual infection

of HDV and HBV can result in a more serious disease and a worse outcome.

Hepatitis B vaccines provide protection from HDV infection.

5. Hepatitis E virus (HEV)

Mostly transmitted through consumption of contaminated water or food.HEV is

a common cause of hepatitis outbreaks in developing parts of the world. Safe

and effective vaccines to prevent HEV infection have been developed but are not widely available.

For more information on vaccinations for hepatitis, please visit our website and download our advice sheet: Minimising the risk of hepatitis