title: Hepatitis A infection in aircrews: risk of infection and cost-benefit analysis of hepatitis A vaccination.
abstract: BACKGROUND
  Since a hepatitis A vaccine (HAV) with long-lasting efficacy has become available, its indication in airline crews needs to be determined.
  
  
  OBJECTIVE
  Destinations in developing countries are a risk factor for hepatitis A infection in airline crews, and vaccination is cost-beneficial.
  
  
  METHODS
  Retrospective analysis was performed for all Swissair medical files for the period 1987-91. Denominator and cost data were obtained by the personnel department, and a cross-sectional seroepidemiological survey was performed in 734 Sabena staff.
  
  
  RESULTS
  Among 3,322 Swissair crewmembers who spent an average of 45 nights in developing countries, 22 hepatitis A infections occurred. For the non-immune crewmembers, the overall annual incidence rate was 1.53 per 1000, whereas the incidence rate while staying in a high risk country was 12.2 per 1000. Cockpit crews with destinations limited to Europe had a rate of zero. Male flight attendants had a threefold higher rate as compared to female flight attendants or pilots. In Sabena, anti-HAV seroprevalence was 33.3%. Increased rates were observed in male as compared to female flying crews and in employees stationed abroad, whereas flying personnel had no higher rate than ground personnel. Simplified comparison of cost of infection and cost of vaccination indicates that vaccination may be cost-saving to the airline company for both male flight-attendants and pilots.
  
  
  CONCLUSIONS
  Hepatitis A vaccination may be recommended to staff stationed in high risk countries and to flying crews with such destinations.
authors.affiliation: Division of Communicable Diseases, Institute of Social and Preventive Medicine of the University, Zurich, Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Gutersohn
authors.forename: R
authors.initials: R
authors.lastname: Steffen
authors.forename: P
authors.initials: P
authors.lastname: Van Damme
authors.forename: F
authors.initials: F
authors.lastname: Holdener
authors.forename: P
authors.initials: P
authors.lastname: Beutels
mesh_terms: D000328:Adult; D001359:Aviation / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D005260:Female; D006506:Hepatitis A / Q000191:economics* / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology; D014611:Vaccination / Q000009:adverse effects / Q000191:economics*; D014761:Viral Hepatitis Vaccines / Q000191:economics
chemical_list: D014761:Viral Hepatitis Vaccines