title: Risks of hepatitis B in travelers as compared to immunization status.
abstract: BACKGROUND
  Our objective was to determine the risks of infection with hepatitis B among European travelers and to compare this with the immunization status in various risk groups.
  
  
  METHODS
  A cross-sectional telephone questionnaire survey of randomly selected subjects, in nine European study populations was used. A total of 9, 008 individuals were involved, with approximately 1,000 interviews conducted in each country in the native languages. Situations with a high risk of hepatitis B infection, such as invasive medical procedures, attending to a bleeding person, and skin perforating cosmetic practices, particularly when performed in countries with medium/high transmission risk, and vaccination status of travelers, were the main outcome measures.
  
  
  RESULTS
  Depending upon the destination, 6.6-11.2% of travelers were classified as at high risk of hepatitis B, with 24.4% vaccinated; between 60.8-75.8% of travelers at potential risk, with 19.2% vaccinated; and 33.4% of travelers where no hepatitis B risk was identified. Significantly more travelers who only visited medium/high endemicity regions exposed themselves to a high risk of contracting hepatitis B, (40, 10.5%) compared to travelers who only visited low endemicity regions (225, 6.6%; p <.01).
  
  
  CONCLUSIONS
  A significant proportion of travelers surveyed unwittingly exposed themselves to the risk of hepatitis B infection while at medium/high risk destinations. The majority of at-risk travelers had not been vaccinated, regardless of their destination. Improved advice and clear recommendations to avoid transmission are needed.
authors.affiliation: Academic Unit of Travel Medicine and Vaccines, Royal Free and University College Medical School, University College, London, United Kingdom.
authors.forename: J N
authors.initials: JN
authors.lastname: Zuckerman
authors.forename: R
authors.initials: R
authors.lastname: Steffen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology* / Q000276:immunology* / Q000517:prevention & control; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014195:Travel