title: Pre-travel advice, attitudes and hepatitis A and B vaccination rates among travellers from seven countries†.
abstract: BACKGROUND
  Knowledge about the travel-associated risks of hepatitis A and B, and the extent of pre-travel health-advice being sought may vary between countries.
  
  
  METHODS
  An online survey was undertaken to assess the awareness, advice-seeking behaviour, rates of vaccination against hepatitis A and B and adherence rates in Australia, Finland, Germany, Norway, Sweden, the UK and Canada between August and October 2014. Individuals aged 18-65 years were screened for eligibility based on: travel to hepatitis A and B endemic countries within the past 3 years, awareness of hepatitis A, and/or combined hepatitis A&B vaccines; awareness of their self-reported vaccination status and if vaccinated, vaccination within the last 3 years. Awareness and receipt of the vaccines, sources of advice, reasons for non-vaccination, adherence to recommended doses and the value of immunization reminders were analysed.
  
  
  RESULTS
  Of 27 386 screened travellers, 19 817 (72%) were aware of monovalent hepatitis A or combined A&B vaccines. Of these 13 857 (70%) had sought advice from a healthcare provider (HCP) regarding combined hepatitis A&B or monovalent hepatitis A vaccination, and 9328 (67%) were vaccinated. Of 5225 individuals eligible for the main survey (recently vaccinated = 3576; unvaccinated = 1649), 27% (841/3111) and 37% (174/465) of vaccinated travellers had adhered to the 3-dose combined hepatitis A&B or 2-dose monovalent hepatitis A vaccination schedules, respectively. Of travellers partially vaccinated against combined hepatitis A&B or hepatitis A, 84% and 61%, respectively, believed that they had received the recommended number of doses.
  
  
  CONCLUSIONS
  HCPs remain the main source of pre-travel health advice. The majority of travellers who received monovalent hepatitis A or combined hepatitis A&B vaccines did not complete the recommended course. These findings highlight the need for further training of HCPs and the provision of reminder services to improve traveller awareness and adherence to vaccination schedules.
authors.affiliation: School of Public Health and Community Medicine, Faculty of Medicine, UNSW Australia, Level 3, Samuels Building, Sydney 2052, Australia a.heywood@unsw.edu.au.
authors.forename: Anita E
authors.initials: AE
authors.lastname: Heywood
authors.affiliation: University of Munich, Munich, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Nothdurft
authors.affiliation: Family Medicine, Groupe Sante Voyage, Quebec, Canada Unité Hospitalière de Recherche, d'enseignement et de soins sur le sida, CHUM, University of Montreal, Montreal, Canada.
authors.forename: Dominique
authors.initials: D
authors.lastname: Tessier
authors.affiliation: Healthcare, Ipsos MORI, London, UK.
authors.forename: Melissa
authors.initials: M
authors.lastname: Moodley
authors.affiliation: Centre for Clinical Research, Sormland County Council and Uppsala University, Eskilstuna, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Rombo
authors.affiliation: Medical Affairs, GSK Vaccines, Wavre, Belgium.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Marano
authors.affiliation: Medical Affairs, GSK Vaccines, Wavre, Belgium.
authors.forename: Laurence
authors.initials: L
authors.lastname: De Moerlooze
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006506:Hepatitis A / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000008:administration & dosage*; D006509:Hepatitis B / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D011795:Surveys and Questionnaires; D014195:Travel / Q000706:statistics & numerical data; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D022362:Hepatitis A Vaccines; D017325:Hepatitis B Vaccines
keywords: Travel; adherence; awareness; healthcare providers; hepatitis A; hepatitis B; vaccination