Knowledge, attitudes, and practices of US travelers to Asia regarding seasonal influenza and H5N1 avian influenza prevention measures.
BACKGROUND
International travel is a potential risk factor for the spread of influenza. In the United States, approximately 5%-20% of the population develops an influenza-like illness annually. The purpose of this study was to describe the knowledge, attitude, and practices of US travelers to Asia regarding seasonal influenza and H5N1 avian influenza (AI) prevention measures.


METHODS
We surveyed travelers to Asia waiting at the departure lounges of 38 selected flights at four international airports in New York, Chicago, Los Angeles, and San Francisco. Of the 1,301 travelers who completed the pre-travel survey, 337 also completed a post-travel survey. Univariate and multivariate logistic regression were used to calculate prevalence odds ratios (with 95% CI) to compare foreign-born (FB) to US-born travelers for various levels of knowledge and behaviors.


RESULTS
Although the majority of participants were aware of influenza prevention measures, only 41% reported receiving the influenza vaccine during the previous season. Forty-three percent of participants reported seeking at least one type of pre-travel health advice, which was significantly higher among US-born, Caucasians, traveling for purposes other than visiting friends and relatives, travelers who received the influenza vaccine during the previous season, and those traveling with a companion. Our study also showed that Asians, FB travelers, and those working in occupations other than health care/animal care were less likely to recognize H5N1 AI transmission risk factors.


CONCLUSIONS
The basic public health messages for preventing influenza appear to be well understood, but the uptake of influenza vaccine was low. Clinicians should ensure that all patients receive influenza vaccine prior to travel. Tailored communication messages should be developed to motivate Asians, FB travelers, those visiting friends and relatives, and those traveling alone to seek pre-travel health advice as well as to orient them with H5N1 AI risk factors.
Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. Eyanni@cdc.gov
Emad A
EA
Yanni
Nina
N
Marano
Pauline
P
Han
Paul J
PJ
Edelson
Sena
S
Blumensaadt
Margaret
M
Becker
Susan
S
Dwyer
Kim
K
Crocker
Terrence
T
Daley
Xiaohong
X
Davis
Nancy
N
Gallagher
Victor
V
Balaban
Margaret
M
McCarron
Anthony
A
Mounts
Harvey
H
Lipman
Clive
C
Brown
Phyllis
P
Kozarsky
D000293:Adolescent; D000328:Adult; D000368:Aged; D001208:Asia; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000627:therapeutic use; D007251:Influenza, Human / Q000209:etiology / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D014195:Travel; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
D007252:Influenza Vaccines