title: Participant-collected, mail-delivered oral fluid specimens can replace traditional serosurveys: a demonstration-of-feasibility survey of hepatitis A virus-specific antibodies in adults.
abstract: BACKGROUND
  Although population-based serosurveys offer an optimal measure of cumulative infection rates, they are seldom performed due to high cost and complex logistics. Use of participant self-collected oral fluid as a diagnostic specimen and mail for specimen delivery has the potential of generating reliable, population-representative data at limited cost.
  
  
  METHODS
  A survey of oral fluid HAV-specific immunoglobulin G (an indicator of past HAV infection) was undertaken in a provincially representative sample of 20-39 year olds as a pilot study. A provincial administrative database served as the sampling frame. Potential participants were invited by mail to collect oral fluid and complete a questionnaire at home and return both by mail. Additional telephone prompting was directed at slow responders. Oral fluid was tested using a validated ELISA.
  
  
  RESULTS
  From among 2,448 potential participants, contact by mail or telephone was made with 1,009 eligible subjects; 59% (585) participated. Materials withstood mailing and the quality of self-collected specimens was excellent. A positive test result was found in 22.1% overall and in 15.7% of self-reported non-vaccinated subjects. Among Canadian-born, non-vaccinated individuals, the positive test rate increased progressively from 1.2% (95% CI: 0-6.3) in 20-24 year olds to 16.4% (95% CI: 9.5-23.3) in 35-39 year olds. Antibody prevalence was higher among Canadian-born non-immunized 20-29 year olds who reported travel to developing countries (33.3%, 95% CI: 11.6-55.1) than in non-travellers (2.5%, 95% CI: 0.7-6.2).
  
  
  CONCLUSIONS
  Mail-based population surveys of infection markers in oral fluid are feasible provided an appropriate sampling frame is used. This survey revealed a high anti-HAV antibody prevalence in young Canadian adults, increasing with age and travel to developing countries.
authors.affiliation: University of British Columbia, Department of Pediatrics, Vaccine Evaluation Centre, Vancouver. jochnio@interchange.ubc.ca
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Ochnio
authors.forename: David W
authors.initials: DW
authors.lastname: Scheifele
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Marion
authors.forename: Mark
authors.initials: M
authors.lastname: Bigham
authors.forename: David M
authors.initials: DM
authors.lastname: Patrick
authors.forename: Margaret
authors.initials: M
authors.lastname: Ho
authors.forename: Michelle
authors.initials: M
authors.lastname: Mozel
mesh_terms: D000328:Adult; D000367:Age Factors; D001955:British Columbia / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006306:Health Surveys; D006506:Hepatitis A / Q000175:diagnosis / Q000453:epidemiology*; D035922:Hepatitis A Antibodies / Q000302:isolation & purification*; D017957:Hepatitis A Virus, Human / Q000276:immunology*; D006801:Humans; D008297:Male; D011177:Postal Service; D015995:Prevalence; D012463:Saliva / Q000276:immunology* / Q000821:virology; D013048:Specimen Handling / Q000379:methods*; D011795:Surveys and Questionnaires; D014195:Travel
chemical_list: D035922:Hepatitis A Antibodies