title: Preferences and decision needs of Boston-area travelers to countries with risk of Yellow fever virus transmission: implications for health care providers.
abstract: BACKGROUND
  Yellow fever (YF), a potentially fatal mosquito-borne infection, is preventable with a live-attenuated vaccine, rarely associated with severe adverse events. We surveyed travelers to assess their reasons for pre-travel medical consultation, information they considered important regarding YF disease and vaccination, whether they recalled receiving this information, and whether they were involved in vaccine decision-making.
  
  
  METHODS
  Travelers aged 18 years and older were surveyed at three Boston-area travel clinics. Only those making YF vaccination decisions were included for analyses.
  
  
  RESULTS
  Of 831 travelers surveyed, 589 (70%) indicated making a YF vaccination decision. Travel medicine providers recommended YF vaccination to 537 (91%) of 589 travelers; 92% of these 537 received vaccine. Among 101 travelers aged 60 years and older, 9% declined the vaccine; among those younger than 60 years, 4% declined the vaccine (p = 0.06). Of 589 travelers, most agreed they needed to understand destination-specific YF risks (82%) and vaccine risks (88%), and were involved in YF vaccine decisions (87%). Less than half recalled discussing their concerns about YF vaccine with the provider (42%) or what risks and benefits mattered most to them (32%).
  
  
  CONCLUSIONS
  Most participants sought YF disease and vaccine risk information and wanted to be involved in decision-making; however, fewer than half recalled discussing their opinions or concerns about YF vaccine. Providers need effective risk communication skills and the ability to elicit and respond to travelers' concerns to help them make informed, shared decisions.
authors.affiliation: Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Lown
authors.forename: Lin H
authors.initials: LH
authors.lastname: Chen
authors.forename: Pauline V
authors.initials: PV
authors.lastname: Han
authors.forename: Emily S
authors.initials: ES
authors.lastname: Jentes
authors.forename: Mary E
authors.initials: ME
authors.lastname: Wilson
authors.forename: Christine M
authors.initials: CM
authors.lastname: Benoit
authors.forename: Karen A
authors.initials: KA
authors.lastname: Avery
authors.forename: Winnie
authors.initials: W
authors.lastname: Ooi
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Barnett
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001900:Boston / Q000453:epidemiology; D003256:Community Participation / Q000706:statistics & numerical data; D003657:Decision Making; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018570:Risk Assessment; D014195:Travel; D057236:Travel Medicine; D014611:Vaccination; D015004:Yellow Fever / Q000517:prevention & control*; D022341:Yellow Fever Vaccine / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D022341:Yellow Fever Vaccine
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