Hepatitis A in Hispanic Children Who Live Along the United States–Mexico Border: The Role of International Travel and Food-Borne Exposures

Abstract

Objectives. Hispanic children who live along the United States–Mexico border historically have had among the highest hepatitis A rates in the United States, but risk factors have not been well characterized. The objective of this study was to examine risk factors associated with acute hepatitis A virus (HAV) infection in Hispanic children who live along the United States–Mexico border in San Diego County, California. Methods. In this case-control study, hepatitis A cases among Hispanic children who were younger than 18 years reported from June 1998 through August 2000 were matched by age group and exposure period to Hispanic children who were susceptible to HAV infection. Participants and their families were interviewed about demographic information and potential sources of HAV infection, including attending child care, food and waterborne exposures, cross-border and other international travel, and travel-related activities. Results. Participants included 132 children with hepatitis A and 354 control subjects. The median age of study participants was 7 years (range: 1–17). Sixty-seven percent of case-patients traveled outside the United States during the incubation period, compared with 25% of the children without hepatitis A (odds ratio [OR]: 6.3; 95% confidence interval [CI]: 4.0–9.7); all children, except 1, had traveled to Mexico. In multivariate analysis, hepatitis A was associated with having eaten food from a taco stand or street food vendor (adjusted OR: 17.0; 95% CI: 4.1–71.1) and having eaten salad/lettuce (adjusted OR: 5.2; 95% CI: 1.3–20.1) during travel. Conclusions. Hepatitis A among Hispanic children who live in an urban area of the United States–Mexico border is associated with cross-border travel to Mexico and food-borne exposures during travel. Travelers to areas where hepatitis A is endemic should receive hepatitis A vaccine before travel.