Hepatitis A Seroprevalence And Risk Factors Among Day-Care Educators

Background: Day-care centres play a role in the epidemiology of hepatitis A virus (HAV). Up-to-date documentation on its seroprevalence and potential risk factors among day-care educators, who may be at risk for significant HAV morbidity, is nevertheless lacking. The availability of a hepatitis A vaccine provides an additional opportunity for prevention in this population. To determine the seroprevalence of previous HAV infection among day-care educators and to identify potential risk factors, we undertook a survey.Methods: Of 167 randomly selected centres, 81 centres participated. Directors and educators completed questionnaires on risk factors. Sera were collected during on-site visits from October through December 2001.Results: Seroprevalence of previous HAV infection in 492 participating educators was 35.6%. Significant risk factors in multivariate analysis included birth in a high-versus moderate/low-income country (odds ratio [OR] 20.8; 95% confidence interval [CI] 9.4-46.0); self-reported HAV vaccination (OR 6.1, CI 2.9-13.0); travel to endemic areas (OR 2.4, CI 1.3-4.2); and age (5-yr OR 1.5, CI 1.3-1.7). When Canadian-born educators were analyzed separately, an association was found between seropositivity and the number of years worked in day-care centres (5-yr OR 1.3, CI 1.0-1.8).Interpretation: This represents the first study in Canada designed to examine risk factors for previous HAV infection among adult day-care educators. As a group, their risk factors for seropositivity are similar to those in the general population. However, educators born in Canada (a low-endemicity area for hepatitis A) appear to be at additional risk by working in day-care centres. The benefits of HAV screening and routine vaccination of day-care educators need to be examined.