Hepatitis A risk in travelers.
BACKGROUND
Traveling to highly endemic areas for hepatitis A is increasing while the immunization level in travelers has been shown to be low in the countries studied.


METHODS
In this population-based study, we have estimated the incidence rate of travel-related hepatitis A during 1997 to 2005 by use of the Swedish notification system of communicable diseases and an ongoing national database on travel patterns. We have also acquired airport-based immunization data from 2007.


RESULTS
During the study period, 636 cases of travel-related hepatitis A were notified. Traveling to East Africa was associated with the highest incidence rate (14.1 cases/100,000 person months), followed by the Middle East (5.8/100,000 person months), and India with neighboring countries (5.6/100,000 person months). Visiting Friends and Relatives (VFR) travelers represented 83, 91, and 70% of the cases to these three regions. By age-group, the highest incidence was found in children 0 to 14 years (3.1/100,000 travelers) where 88% of the cases were VFR travelers. Incidence rate in unprotected travelers to East Asia, North Africa, and the Middle East was 2, 12, and 18 cases/100,000 person months, respectively. In 2007, 79% of the travelers were immunized against hepatitis A.


CONCLUSIONS
We conclude that travelers, and especially children, who are VFR in endemic areas constitute a high-risk group for acquiring hepatitis A infection, while the risk for unprotected tourists to East Asia is low.
Askling
Helena H
HH
Department of Medicine/Unit for Infectious Diseases, Solna, Karolinska Institute, Karolinska University Hospital, S-17176 Stockholm, Sweden. helena.hervius-askling@karolinska.se
Rombo
Lars
L
Andersson
Yvonne
Y
Martin
Stephen
S
Ekdahl
Karl
K
D000293:Adolescent; D000328:Adult; D000351:Africa, Eastern / Q000453:epidemiology; D000352:Africa, Northern / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D019353:Endemic Diseases / Q000517:prevention & control / Q000706:statistics & numerical data; D005202:Asia, Eastern / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006506:Hepatitis A / Q000453:epidemiology* / Q000517:prevention & control; D022362:Hepatitis A Vaccines / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D014195:Travel; D055815:Young Adult
D022362:Hepatitis A Vaccines