Reactivation of hepatitis B virus infection in a seafarer: an omitted problem of maritime medicine.

Abstract

Infection with hepatitis B virus (HBV), despite the implementation of extensive preventive measures, has remained one of the biggest health problems worldwide. There are still people not covered by the compulsory vaccination programme and carriers of an actively replicating virus among professionally active seafarers. The article is based on a case report of a seafarer with life-threatening reactivation of long-term uncontrolled HBV infection that resulted in decompensated cirrhosis and liver transplant. The case shows clinical aspects of chronic hepatitis B and contributes to discussion about HBV infection with regard to seafarers. The article also analyses the current legal regulations and guidelines in terms of preventing new infections and detecting people already infected with HBV. Considering the specific nature of work on seagoing ships, it is justified to recognise the seafaring as a profession with a high risk of HBV infection. Monitoring the course of the disease can prevent reactivation of inflammatory process and serious consequences of chronic hepatitis B during a cruise. The elementary issue is specific prophylaxis, that is, covering the unvaccinated persons with the vaccination programme. The prevalence of HBV infection and the specifics of the seafarer labour market require development of new international regulations, which will unify Pre-Employment Medical Examination (PEME) protocols and take into consideration compulsory vaccination.