Environmental hepatitis A detection and awareness on a Native American reservation.

Hepatitis A incidence among Native Americans is the highest of any subpopulation in the United States. The lack of wastewater management, an underdeveloped economic base, a traveling tourist population, and decentralized health resources make Native American reservations prone to periodic outbreaks of hepatitis. In 1993-1995 over 10% of the population of the Hoopa Valley Reservation, California, were treated for exposure to hepatitis. Using Global Information System (GIS) technology data and previous testing results, selected sample sites were designated to evaluate the environmental risk of infection on the reservation. Having determined that hepatitis A virus was present, culturally appropriate health education was implemented in the local schools. Combining environmental detection and community awareness provides a sound approach to controlling infectious disease.