Population-based survey of travel patterns among Canadians visiting hepatitis A-endemic countries.

Each year, approximately 42 million trips are made outside Canada, and this number is constantly rising.1,2 The increasing number of trips is largely attributable to visits of tropical and subtropical areas, where hygiene and health care standards may be different than those existing in North America. While hepatitis A (HA) is the most common vaccine‐preventable disease among travelers,3,4 it can also be considered an interesting marker of the hygienic infrastructure of the destination countries and for the general risk of enteric diseases. An analysis of the patterns of travel in HA‐endemic countries may therefore be useful to assess the general health risks of travelers. Most published studies in the medical literature have focused on the travel patterns of individuals visiting travel clinics. Because only a very small percentage of travelers seek appropriate pretravel health services,5 these studies are subject to selection bias in that they mostly reflect the travel patterns of risk‐conscious individuals. Planning prevention programs requires reliable data on travel patterns of all individuals, in particular those unlikely to visit travel clinics. The objective of this population‐based study was to describe the travel patterns of Canadians who went to HA‐endemic countries between 1990 and 1999. A phone survey was conducted between October 27 and December 6, 1999, among adults selected through random‐digit dialing and residing in either Quebec (7 million people) or Ontario (12 million people), the two largest provinces of Canada, documenting travels to HA‐endemic countries between 1990 and 1999. Details on study design have been previously published.5,6 For the current analyses, comparisons of proportions were made using results from the chi‐square test or Fisher’s exact test. The Mantel–Haenszel chi‐square test for trend was used for polytomic ordinal variables, whereas the two‐sided Cochrane–Armitage exact test for trend was used with dichotomic variables. Among the …