Hepatitis A, typhoid and malaria among travelers--surveillance data from Québec (Canada).

Analysis of epidemiological data on health problems related to international travel helps put into perspective preventive interventions for travelers. To document the epidemiological context of travel health interventions in Québec, we reviewed surveillance data for three infectious diseases. The analysis included data collected in the notifiable diseases surveillance system for hepatitis A, typhoid, and malaria cases reported from 2000 to 2002. Additional data were obtained from the provincial hepatitis risk factor database as well as from regional public health departments. More than 40% of cases of hepatitis A for which risk factor information is available are associated with international travel; 20% of these cases were contracted in Mexico and 22% in the West Indies. The risk of acquiring hepatitis A seems to be higher among travelers under 35 years of age; also, given the number of Quebecers traveling to all regions of the world, this risk is proportionally higher in Africa. Data gathered for typhoid indicate that the risk to travelers from Québec is proportionately higher for Quebecers traveling to the Indian subcontinent and whose purpose is to visit family and friends, and for those who stay abroad for 4 weeks or longer. The risk of malaria is greater in Africa (where contracted cases are mostly caused by Plasmodium falciparum). Over half of malaria cases involve individuals traveling abroad for business (including volunteerism), and almost 75% contracted the disease during a stay of a month or more. Nearly half of the cases had not taken chemoprophylaxis. Available data have limitations for infectious disease surveillance among Québec travelers: imprecise number of cases (underdiagnosis and underreporting), imprecise denominators (number of travelers), and lack of data on the characteristics of trips taken. However, despite its limitations, this profile of infectious diseases among travelers from Québec provides interesting data for preventive intervention.

Travel clinics in Québec (Canada).

To continuously improve its assistance to Québec travel health providers, the Québec Advisory Committee on Travel Health conducted an exploratory and descriptive survey of dedicated travel clinics in Québec (Canada). During autumn 2003, a cross-sectional descriptive survey was carried out among the 97 travel health clinics listed in Québec. Data were collected using a self-administered questionnaire sent by mail. The response rate was 94%. More than three quarters of travel clinics in Québec are located in community health centers; the others are in private clinics and in hospitals. Although 80% of the clinics are located outside the most densely inhabited regions of Québec, they carry out less than 30% of the total number of pretravel consultations. Almost 60% of the clinics have fewer than 500 consultations a year. Overall, more than 114,000 travel health consultations are performed annually in Québec travel health clinics. Preventive services to travelers, including the most commonly used vaccines for travelers, are available in all regions of Québec, except in the northernmost region. Smaller clinics offer fewer services to travelers in terms of antimalarial prescriptions, less common vaccines, and post-travel consultations. The main sources of information for travel health practitioners are guidelines provided by public health authorities. Data obtained provide an up-to-date portrait of the services available in travel clinics in Québec that should assist public health authorities adapt their interventions to the needs and realities of these clinics.

Varicella vaccination for grades 4 and 5 students: from theory to practice.

BACKGROUND: In 2002-2003, as part of a pilot project, varicella vaccination was offered to susceptible students in grades 4 and 5 in schools whose health services are provided by a local community services centre in Montréal. This immunization campaign was merged with the hepatitis B immunization programme. OBJECTIVES: To calculate the proportion of grade 4 and 5 students susceptible to varicella; to calculate the proportion of susceptible students who agree to be vaccinated; to compare the proportion of susceptibles who agree to be vaccinated when varicella vaccination is offered with the first or the second dose of hepatitis B; and to assess whether a catch-up varicella immunization programme would affect the vaccine coverage of a concurrent hepatitis B vaccination programme. METHODS: The proportions of susceptible students and of parents of susceptibles who consented to vaccination were calculated. The proportions of parents of susceptibles who consented to vaccination were compared for both immunization strategies: varicella vaccination given with the first or second dose of hepatitis B vaccine. Logistic regression was performed to identify possible associations between consent to varicella vaccination and the various variables collected. Rates of vaccine coverage against hepatitis B after two doses were compared for the years 2000-2001 and 2002-2003. RESULTS: Of 3,856 registered students, 3,486 (90.4%) returned consent forms. Among the 3,272 students for whom information was available, 441 (13.5%) were susceptible, including 394 (89.3%) who consented to vaccination. The rates of vaccine coverage in the schools after two doses of hepatitis B vaccine were exactly the same for the 2000-2001 and 2002-2003 school years. CONCLUSION: Varicella vaccination of susceptible grade 4 and 5 students associated with a coincident hepatitis B vaccination campaign can be performed without negative impact on the hepatitis B vaccination programme.

Hospitalisations for gastroenteritis: the role of rotavirus.

To determine the proportion of hospitalisations for gastroenteritis caused by rotavirus, we tested for rotavirus stool samples of all children under the age of five hospitalised for gastroenteritis between 1 December 1999 and 30 May 2000 in seven community and specialised hospitals in Quebec. Of 944 children hospitalised, 565 (59.9%) were screened for rotavirus and 405 (71.7%) tested positive. From December to April, the proportion of positive results rose from 51.6 to 78.1%. Compared with children whose test results were negative, children who tested positive presented vomiting more frequently upon admission (88.9 versus 60.4%) and needed IV fluids in greater proportion (94.1 versus 78.0%), but spent less time in hospital (2.8 versus 3.3 days). Aside from dehydration, no complications were noted. In Quebec, a large majority of winter and spring hospitalisations for gastroenteritis in children is attributable to rotavirus.