Screening travelers for hepatitis A antibodies: an observational cost-comparison study of vaccine use.
OBJECTIVE
To measure the seroprevalence of antibodies to hepatitis A virus (anti-HAV) in a health plan population of travelers and to determine whether prevaccination screening for anti-HAV can reduce unnecessary vaccination and thus promote the most effective, economic use of hepatitis A vaccine.


METHODS
Observational, cost-comparison study.


METHODS
Central injection clinic of a health maintenance organization medical center.


METHODS
Five hundred twenty-seven adults who denied having previous hepatitis A or vaccination. MAIN OUTCOME MEASURES Subgroups with the greatest prevalence of anti-HAV seen between June 1995 and April 1996 for immunizations before traveling to nonindustrialized countries. Relative costs of their screening and immunization.


RESULTS
The presence of anti-HAV precluded the need for vaccination in 148 subjects (28.1%). The highest prevalence of anti-HAV (82.7%) was found in subjects born in nonindustrialized countries (62/75), in subjects who had previously traveled to areas of endemic hepatitis A (32.1% [135/420]), and in subjects born before 1945 (29.2% [92/315]). Costs of screening and vaccinating travelers were cheapest if prevaccination antibody sera testing was limited to subjects born in nonindustrialized countries and those born before 1945.


CONCLUSIONS
Prevaccination screening of travelers for hepatitis A can be done selectively on the basis of age and country of origin. This strategy could lead to a more economic use of the vaccine and clinic resources.
Lee
K K
KK
Department of Medicine, Kaiser Permanente Medical Center, 2025 Morse Ave, Sacramento, CA 95825-2115, USA. kenneth.k.lee@ncal.kaiperm.org
Beyer-Blodget
J
J
D000293:Adolescent; D000328:Adult; D006506:Hepatitis A / Q000517:prevention & control*; D017957:Hepatitis A Virus, Human / Q000276:immunology*; D006508:Hepatitis Antibodies / Q000032:analysis*; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D014195:Travel; D014765:Viral Vaccines / Q000627:therapeutic use*
D006508:Hepatitis Antibodies; D014765:Viral Vaccines