Viral hepatitis in foreign residents and travelers in Nepal

Fifty-two consecutive patients presenting with viral hepatitis at a clinic for foreigners in Nepal were studied over a 21-month period from 1986 to 1988 to determine the etiology of viral hepatitis. Among travellers, all cases of hepatitis (n=22) were hepatitis A. Of the 22 travellers who developed hepatitis A, one died and three required aero-medical evacuation from mountain areas. Among foreign residents, there were 25 cases of hepatitis A and five cases of non-A, non-B hepatitis. The non-A, non-B hepatitis cases occurred during the monsoon season, a time when increased numbers of cases of enterically-transmitted non-A, non-B hepatitis were seen among Nepali residents of the Kathmandu Valley. No cases of hepatitis B were seen. Among patients with hepatitis, seven had received immune globulin in the preceding six months. Of these immune globulin prophylaxis failures, two were cases of hepatitis A occurring between 17 and 21 weeks after administration of 5 ml of immune globulin; four were cases of presumed entrically transmitted non-A, non-B hepatitis. We conclude that hepatitis A and occasionally enterically transmitted non-A non-B hepatitis occur among foreigners in Nepal. Better immune globulin prophylaxis of hepatitis A may be achieved with a 5 ml dose given every four months.