THE RISK OF VIRAL HEPATITIS-A, HEPATITIS-B, HEPATITIS-C, AND HEPATITIS-E AMONG NORTH-AMERICAN MISSIONARIES

The seroprevalence and incidence of hepatitis A, B, C, and E virus inf ection were determined among North American missionaries (n = 328) ser ving in various geographic locations between 1967 and 1984. The mean a ge of subjects at entry into the study was 39.7 years (range 5-73 year s); 65% were female; 89% had lived outside the United States before th e study began. Seventy-eight percent of subjects served in sub-Saharan Africa during the study. At initial evaluation, 50.9% of the subjects had antibodies to hepatitis A virus (total anti-HAV), 8.5% to hepatit is B virus core antigen (total anti-HBc), 0.6% to hepatitis C virus (t otal anti-HCV by second-generation immunoblot assay), and 0% to hepati tis E virus (IgG anti-HEV). After an average period of service of 7.3 years (2,396 person-years total), 5.8% of the missionaries seroconvert ed to anti-HAV, 5.5% to anti-HBc, 0.6% to anti-HCV, and 0% to anti-HEV . This study indicates a relatively low risk of hepatitis C and E viru s infection among missionaries while confirming the previously reporte d high risk of hepatitis A and B virus infection. Hepatitis A and B va ccination is recommended for long-term travelers to developing countri es.