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Hepatitis A Risk in Travelers |
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| Authors: | Helena H. Askling MD Lars Rombo MD PhD Yvonne Andersson MPH Stephen Martin MD and Karl Ekdahl MD PhD |
| Affiliation: | Department of Medicine/Unit for Infectious Diseases, Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden;;Centre for Clinical Research, Sormland County Council, Eskilstuna, Sweden;;Department of Epidemiology, Swedish Institute for Infectious Diseases Control (SMI), Stockholm, Sweden;;WHO Global Influenza Programme, Geneva, Switzerland;;Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden;;European Center for Disease Prevention and Control (ECDC), Stockholm, Sweden |
| Abstract: | 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. |
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