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Screening travelers for hepatitis A antibodies: an observational cost-comparison study of vaccine use
1Department of Medicine, Kaiser Permanente Medical Center, 2025 Morse Ave, Sacramento, CA 95825-2115, USA. kenneth.k.lee@ncal.kaiperm.org
Objectives:
To measure the seroprevalence of antibodies to hepatitis A virus (anti-HAV) in a health plan population of travelers and to determine whether prevaccination screening for anti-HAV can reduce unnecessary vaccination and thus promote the most effective, economic use of hepatitis A vaccine.
Design:
Observational, cost-comparison study.
Setting:
Central injection clinic of a health maintenance organization medical center.
Subjects:
Five hundred twenty-seven adults who denied having previous hepatitis A or vaccination. MAIN OUTCOME MEASURES Subgroups with the greatest prevalence of anti-HAV seen between June 1995 and April 1996 for immunizations before traveling to nonindustrialized countries. Relative costs of their screening and immunization.
Results:
The presence of anti-HAV precluded the need for vaccination in 148 subjects (28.1%). The highest prevalence of anti-HAV (82.7%) was found in subjects born in nonindustrialized countries (62/75), in subjects who had previously traveled to areas of endemic hepatitis A (32.1% [135/420]), and in subjects born before 1945 (29.2% [92/315]). Costs of screening and vaccinating travelers were cheapest if prevaccination antibody sera testing was limited to subjects born in nonindustrialized countries and those born before 1945.
Conclusions:
Prevaccination screening of travelers for hepatitis A can be done selectively on the basis of age and country of origin. This strategy could lead to a more economic use of the vaccine and clinic resources.