[Screening policy for travellers from Rotterdam for hepatitis A antibodies prior to eventual immunization: favourable cost-benefit ratio]

Abstract

Objective: To evaluate costs and benefits of the screening and immunisation policy for hepatitis A virus (HAV) infection among travellers from Rotterdam.

Design: Descriptive and cost-benefit analysis.

Method: From the data of the Municipal Health Service Rotterdam (GGD), the Netherlands, the details were collected on individuals travelling frequently to HAV endemic countries, who were born before 1950, or had lived for more than 10 years in an HAV endemic country or had ever suffered jaundice. Persons to whom these criteria applied were screened for HAV antibodies at the GGD before immunisation for HAV in the period January 1st 1996-June 30th 1998. Screening and vaccination policies were compared with a cost analysis.

Results: Antibodies against HAV were found in 79% of 1466 screened people. The lowest prevalence of antibodies was found among Dutch nationals (67%). A significantly higher prevalence was found amongst individuals from Turkey/Morocco (96%) and from the Cape-Verde Islands (97%). In the cost analysis the break even point, the prevalence level of HAV antibodies in the population at which screening cost as much as blind prophylaxis, lay for passive immunisation between 69% and 93%. For active immunisation this point lay around 17%.

Conclusion: The selection criteria for prevaccination screening are effective in identifying individuals with a high probability of being immune against HAV infections. The current screening policy for antibodies against HAV is cost effective.