HEPATITIS-A INFECTION IN AIRCREWS - RISK OF INFECTION AND COST-BENEFIT-ANALYSIS OF HEPATITIS-A VACCINATION

Background: Since a hepatitis A vaccine (HAV) with long-lasting effica cy has become available, its indication in airline crews needs to be d etermined. Hypothesis: Destinations in developing countries are a risk factor for hepatitis A infection in airline crews, and Vaccination is cost-beneficial. Methods: Retrospective analysis was performed for al l Swissair medical files for the period 1987-91. Denominator and cost data were obtained by the personnel department, and a cross-sectional seroepidemiological survey was performed in 734 Sabena staff. Results: Among 3,322 Swissair crewmembers who spent an average of 45 nights in developing countries, 22 hepatitis A infections occurred. For the non -immune crewmembers, the overall annual incidence rate was 1.53 per 10 00, whereas the incidence rate while staying in a high risk country wa s 12.2 per 1000. Cockpit crews with destinations limited to Europe had a rate of zero. Male flight attendants had a threefold higher rate as compared to female flight attendants or pilots. In Sabena, anti-HAV s eroprevalence was 33.3%. Increased rates were observed in male as comp ared to female flying crews and in employees stationed abroad, whereas flying personnel had no higher rate than ground personnel. Simplified comparison of cost of infection and cost of vaccination indicates tha t vaccination may be cost-saving to the airline company for both male flight-attendants and pilots. Conclusions: Hepatitis A vaccination may be recommended to staff stationed in high risk countries and to flyin g crews with such destinations.