title: Characteristics of Travelers to Asia Requiring Multidose Vaccine Schedules: Japanese Encephalitis and Rabies Prevention.
abstract: BACKGROUND
  Japanese encephalitis (JE) and rabies are serious vaccine preventable diseases which are an important consideration for travelers to Asia.
  
  
  METHODS
  Five Boston-area travel clinics collected demographic data, trip information, and interventions for travelers to Asia seen at pre-travel consultations from March 1, 2008, through July 31, 2010. We evaluated travelers for proportion vaccinated for JE and rabies, those traveling for >1 month, and whether travelers had adequate time to complete the JE series (clinic visit ≥28 days before departure) and rabies pre-exposure prophylaxis (clinic visit ≥21 days before departure).
  
  
  RESULTS
  Among 15,440 travelers from five Boston Area Travel Medicine Network travel clinics, Asia was the most common destination region, visited by 5,582 (36%) of travelers. Among these travelers, 4,810 (86%) planned to travel to only one Asian subregion. Median trip duration was 17 days, with more than 20% traveling for >1 month. The most common destinations were South (41%), Southeast (26%), and East (23%) Asia. Of those traveling to South, Southeast, or East Asia, over one-third with trips >1 month had insufficient time to complete a series for either JE or rabies vaccine. Overall, only 10% of travelers were vaccinated (past and pre-travel visit) for either JE or rabies, with lowest percentages among travelers visiting friends and relatives. Most travelers received advice on vector precautions (96%) and rabies prevention, which included avoiding animal contact, washing wounds, and obtaining appropriate post-exposure prophylaxis (88%).
  
  
  CONCLUSIONS
  Given the insufficient time for completion and relatively low vaccination rates, greater awareness of earlier pre-travel consultations, at least 4-6 weeks before travel, and accurate risk assessment for travelers are important. Effective counseling about vector avoidance, rabies, and animal bite prevention and management remains critical.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Xaviour J
authors.initials: XJ
authors.lastname: Walker
authors.affiliation: Section of Pediatric Infectious Diseases, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Barnett
authors.affiliation: Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Wilson
authors.affiliation: Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Macleod
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Jentes
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Faculty of Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Adolf W
authors.initials: AW
authors.lastname: Karchmer
authors.affiliation: Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.|Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
authors.affiliation: Faculty of Medicine, Harvard Medical School, Boston, MA, USA.|Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA.
authors.forename: Lin H
authors.initials: LH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001208:Asia; D001900:Boston; D004672:Encephalitis, Japanese / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D022321:Japanese Encephalitis Vaccines / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis / Q000706:statistics & numerical data; D011818:Rabies / Q000517:prevention & control*; D011819:Rabies Vaccines / Q000008:administration & dosage*; D018570:Risk Assessment; D014195:Travel; D057236:Travel Medicine; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D022321:Japanese Encephalitis Vaccines; D011819:Rabies Vaccines