title: Ineffectiveness of the current strategy to prevent hepatitis A in travelers.
abstract: BACKGROUND
  Each year, a large number of Canadians travel to regions of the world where hepatitis A remains endemic. Many of these travelers are not immune and the current preventive strategy relies wholly on self-referral to a travel clinic. All of the costs associated with such a visit are assumed by the traveler. We estimated the effectiveness of this strategy.
  
  
  METHODS
  This case-control study included 108 travel-related hepatitis A cases with onset of disease between 1997 and 1999 and 620 controls who traveled during the same period.
  
  
  RESULTS
  Hepatitis A was strongly associated with high-risk travel (Odds Ratio = 7.2, 95% Confidence Interval 1.76-29.4), but only 7% of cases were found in this category. The risk of hepatitis A was 5 times lower in travelers who visited a travel clinic than in those who did not (80% efficacy). However, only 14% of the controls visited a travel clinic. As a result, the effectiveness of the current strategy is estimated to be 11% (80% of 14%).
  
  
  CONCLUSIONS
  Hepatitis A in travelers can be prevented effectively by attendance at a travel clinic. Unfortunately, most travelers do not visit such clinics prior to departure. Even if all high-risk travelers were to visit a travel clinic and receive vaccination, this would have negligible impact on the number of travel-related hepatitis A cases (approximately 7% reduction). The current strategy for the prevention of hepatitis A in travelers is ineffective and should be reexamined.
authors.affiliation: Institut National de Santé Publique du Québec, Québec, Canada.
authors.forename: Gaston
authors.initials: G
authors.lastname: De Serres
authors.forename: Bernard
authors.initials: B
authors.lastname: Duval
authors.forename: Ramak
authors.initials: R
authors.lastname: Shadmani
authors.forename: Nicole
authors.initials: N
authors.lastname: Boulianne
authors.forename: Gina
authors.initials: G
authors.lastname: Pohani
authors.forename: Monika
authors.initials: M
authors.lastname: Naus
authors.forename: Monique Douville
authors.initials: MD
authors.lastname: Fradet
authors.forename: Louis
authors.initials: L
authors.lastname: Rochette
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Ward
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Kain
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006506:Hepatitis A / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011792:Quebec / Q000453:epidemiology; D014195:Travel