Hepatitis A among residents of First Nations reserves in British Columbia, 1991-1996

Background: Hepatitis A spreads by the fecal-oral route. We hypothesize that it is more common in Aboriginal communities because of poverty, crowded housing and inadequate or substandard water and sewage systems. Methods: We tabulated on-reserve cases reported to First Nations and Inuit Health Branch, Health Canada. We obtained information on community water supply, sewage disposal and mean population per housing unit, from site inspections in a 1994 survey. Results: Crude incidence on-reserve was 31 per 100,000 persons per year (95% CI: 25 to 37), twice as high as in the general population of BC (15.1 per 100,000). Higher incidence of hepatitis A was associated with more persons per housing unit and with presence of community water supply problems. Conclusions: An ecologic, multi-factorial approach to disease prevention is needed, including upgrading housing and sanitary infrastructure, specific measures (i.e., hepatitis A vaccination) and general measures (e.g., education, poverty reduction, population planning).