title: Hepatitis B immunisation in travellers: poor risk perception and inadequate protection.
abstract: OBJECTIVE
  A survey of European travellers was conducted during 2006 to determine travellers' immunisation status and risk for exposure to hepatitis B while travelling.
  
  
  METHODS
  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.
  
  
  METHODS
  A total of 5948 interviewees participated in the first (Omnibus) survey and 4151 travellers completed the online survey.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: WHO Collaborating Centre for Travel Medicine, The Academic Centre for Travel Medicine and Vaccines, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK. j.zuckerman@medsch.ucl.ac.uk
authors.forename: Jane N
authors.initials: JN
authors.lastname: Zuckerman
authors.forename: Bernard
authors.initials: B
authors.lastname: Hoet