Hepatitis B immunisation in travellers: poor risk perception and inadequate protection

Jane N Zuckerman, Bernard Hoet
Travel Medicine and Infectious Disease 2008, 6 (5): 315-20

OBJECTIVES: A survey of European travellers was conducted during 2006 to determine travellers' immunisation status and risk for exposure to hepatitis B while travelling.

DESIGN: A first telephone (Omnibus) survey established the prevalence of travel in the previous five years as well as demographic profile of travellers amongst the general population. A second online survey targeted travellers to moderate or high hepatitis B endemicity countries, using data from the first survey to ensure a final sample representative of the travelling population in each country. Self-reported vaccination status and participation in activities/situations at high risk of exposure to hepatitis B were recorded.

PARTICIPANTS: A total of 5948 interviewees participated in the first (Omnibus) survey and 4151 travellers completed the online survey.

SETTING: Belgium, Italy, Finland, Germany, Netherlands, Spain, Sweden and UK.

RESULTS: Only 15% of 4151 travellers to endemic countries recalled specifically receiving hepatitis B vaccination. Fifty-one percent of travellers to endemic countries visited a health care professional (HCP) before travelling. Of these, 54% did not receive any hepatitis B vaccination. Fifty percent of all respondents had never discussed risk factors for hepatitis B infection with a health care professional. Altogether, 1 in 4 travellers were at increased risk for exposure to hepatitis B due to hospitalisation, sexual activity or body piercing/tattooing amongst others. Three percent of travellers to high risk destinations were health tourists of which 65% did not recall being vaccinated against hepatitis B.

CONCLUSION: Compared to a previous survey, this follow on survey 7 years later indicates the risk of exposure to hepatitis B has increased, but not hand-in-hand with the protection of travellers against hepatitis B through vaccination: travellers to at risk destinations continue to be unvaccinated against hepatitis B, including those who visit health care practitioners prior to travelling. Advice regarding hepatitis B immunisation for travel is received infrequently and travellers remain unaware of the risks of hepatitis B associated with travel. Many high risk situations are not predictable prior to travel, supporting an all-inclusive approach to hepatitis B vaccination in travellers.

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