Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Vaccine. 2010 Nov 29;28(51):8105-11. doi: 10.1016/j.vaccine.2010.09.107. Epub 2010 Oct 16.
Canadian guidelines recommend hepatitis A virus (HAV) vaccination for high-risk persons, such as travelers to HAV-endemic areas. The US CDC advocates universal immunization.
To explore whether a universal strategy for HAV immunization rather than the Canadian targeted approach for travelers is justified by measuring compliance of postsecondary students with Canadian guidelines.
A cross-sectional study using an electronic survey method elicited HAV risk factors, immunization history, disease status, and factors affecting immunization status from postsecondary students. Seropositivity was determined by measuring HAV antibodies in saliva from a convenience sample of survey participants within each study group. Statistical analysis used Fisher's exact test and logistic regression.
We received 2279 completed surveys (10.6% response) and 235 saliva samples (58.7% response). A total of 1380 (60.6%) participants had traveled to HAV-endemic regions and 1851 (81.2%) were planning to do so within the next 5 years. Less than half who traveled to HAV-endemic areas reported a history of HAV vaccination (48.0%). HAV seropositivity rates were higher amongst those who traveled to (63.6%) or were planning to travel to (55.0%) HAV-endemic areas than those who had never traveled or had no plans to travel to such areas (17.4%). Only 8.9% of unvaccinated students were seropositive (5.3% of Canadian-born students). Amongst unvaccinated, seropositive students, there was a nonsignificant trend for higher seropositivity in those who had previously traveled to HAV-endemic areas (14.7%) than those who had not traveled abroad (4.4%), suggesting an exposure to HAV during travel. Nearly all (96.5%) unvaccinated students, who were willing to be vaccinated based on current knowledge or if their doctor recommended it, indicated a willingness to receive vaccine if it were provided free of charge.
Current Canadian guidelines for HAV vaccination are not being followed within the postsecondary student population. Given high rates of travel to HAV-endemic areas in this population, a universal approach to HAV vaccination may be warranted.
加拿大指南建议对甲型肝炎病毒 (HAV) 高危人群（如前往 HAV 流行地区的旅行者）进行疫苗接种。美国疾病控制与预防中心提倡普遍免疫。
通过衡量大学生对加拿大指南的遵从性，探讨 HAV 免疫接种的普遍策略是否比加拿大针对旅行者的有针对性方法更合理。
使用横断面研究，通过电子调查方法从大学生中获取 HAV 风险因素、免疫史、疾病状况以及影响免疫状况的因素。从每个研究组的调查参与者中随机抽取唾液样本，通过检测 HAV 抗体来确定血清阳性。统计分析采用 Fisher 确切检验和逻辑回归。
我们收到了 2279 份完整的调查（10.6%的回复率）和 235 份唾液样本（58.7%的回复率）。共有 1380 名（60.6%）参与者曾前往 HAV 流行地区，1851 名（81.2%）计划在未来 5 年内前往。在前往 HAV 流行地区的人群中，仅有不到一半（48.0%）报告有 HAV 疫苗接种史。曾前往（63.6%）或计划前往（55.0%）HAV 流行地区的 HAV 血清阳性率高于从未前往或无计划前往此类地区的人群（17.4%）。未接种疫苗的学生中，仅有 8.9%（8.9%）的血清阳性（8.9%的加拿大出生学生）。在未接种疫苗的血清阳性学生中，曾前往 HAV 流行地区的学生（14.7%）比从未出国旅行的学生（4.4%）血清阳性率有升高趋势，但无统计学意义，提示在旅行中接触到了 HAV。几乎所有（96.5%）未接种疫苗的学生，如果基于当前知识或如果医生建议，愿意接种疫苗，并表示如果免费提供疫苗，他们愿意接种。
目前加拿大的 HAV 疫苗接种指南在大学生群体中并未得到遵守。鉴于该人群中前往 HAV 流行地区的高旅行率，普遍接种 HAV 疫苗可能是合理的。
