title: The role of ethnicity and travel on Hepatitis A vaccination coverage and disease incidence in Arizona at the United States-Mexico Border.
abstract: BACKGROUND
  Hepatitis A (HAV) incidence has decreased in the United States, yet regional disparities persist. The role of international travel has become increasingly important in HAV transmission. We compared the relative burden of HAV in border and non-border regions in Arizona and examined the role of travel in sustaining HAV transmission.
  
  
  METHODS
  HAV vaccination coverage was calculated by age and region, using Arizona State Immunization Information System data. Incidence, demographics, and risk factors of cases reported through Arizona's infectious disease surveillance system between 2006 and 2011 were analyzed.
  
  
  RESULTS
  Hepatitis A incidence was higher in the border region of Arizona. Compared with the rest of Arizona, one-dose coverage in children<15 years was lower in the border region until 2008. Second dose coverage was lower in the border region, particularly among Spanish speakers. International travel among cases was generally high; however, in the border region cases were more likely to visit Mexico or South/Central America (94% vs. 80%, P value = 0.01) and be Hispanic (68% vs. 42%, P value = 0.0003).
  
  
  CONCLUSIONS
  Rates of HAV continue to be higher in the Arizona border region; the risk appears particularly high among Hispanics with recent travel in the Americas. Border surveillance should be emphasized, along with vaccination of all travelers, to continue to decrease and control HAV.
authors.affiliation: University of Arizona; College of Public Health; Tucson, AZ USA.
authors.forename: Kacey C
authors.initials: KC
authors.lastname: Ernst
authors.affiliation: Arizona Department of Health Services; Phoenix, AZ USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Erhart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001130:Arizona / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000639:trends; D005006:Ethnicity / Q000208:ethnology*; D005260:Female; D006506:Hepatitis A / Q000208:ethnology* / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008800:Mexico / Q000208:ethnology; D008875:Middle Aged; D012307:Risk Factors; D014195:Travel / Q000639:trends; D014481:United States / Q000208:ethnology; D014611:Vaccination / Q000639:trends; D055815:Young Adult
chemical_list: D022362:Hepatitis A Vaccines
keywords: Hepatitis A; United States–Mexico border; travel; vaccination