title: Hepatitis B: A cross-sectional survey of knowledge, attitudes and practices amongst backpackers in Thailand.
abstract: BACKGROUND
  In 2013, 200 million tourists visited countries that are endemic for hepatitis B virus (HBV). Backpackers are potentially at greater risk of hepatitis B than other travellers yet exposure to HBV remains under researched in this population.
  
  
  METHODS
  A cross-sectional survey of backpackers visiting two islands in Thailand was performed during early 2015. Participation in activities with high HBV exposure risk was recorded, alongside rates of vaccination and an evaluation of knowledge and attitudes towards the risk of HBV.
  
  
  RESULTS
  1680 questionnaires were completed and analysed; the median participant age was 24 (range: 18-68) and 47.9% were male. 20.8% took part in activities with a high risk of HBV exposure. Over two-thirds of the sample were not protected against HBV. 24% were able to correctly identify HBV transmission methods. 44.1% underestimated the risk of HBV in Thailand.
  
  
  CONCLUSIONS
  The proportion of backpackers participating in high-risk activities was double the level found in previous studies that have examined the HBV exposure risk amongst travellers to endemic countries. Voluntary risk activities were the largest source of potential exposure to HBV and rates of vaccination are low. Backpackers should be considered for routine vaccination and education on risk behaviours should be included in the pre-travel consultation.
authors.affiliation: University of Birmingham, Edgbaston, Birmingham, West Midlands, B15 2TT, England. Electronic address: ghf126@bham.ac.uk.
authors.forename: Georgina
authors.initials: G
authors.lastname: Frew
authors.affiliation: University of Birmingham, Edgbaston, Birmingham, West Midlands, B15 2TT, England.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McGeorge
authors.affiliation: University of Birmingham, Edgbaston, Birmingham, West Midlands, B15 2TT, England.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Grant
authors.affiliation: University of Birmingham, Edgbaston, Birmingham, West Midlands, B15 2TT, England.
authors.forename: Gilles
authors.initials: G
authors.lastname: de Wildt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006509:Hepatitis B / Q000453:epidemiology / Q000635:transmission / Q000821:virology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012309:Risk-Taking; D011795:Surveys and Questionnaires; D013785:Thailand / Q000453:epidemiology; D014195:Travel; D014611:Vaccination; D055815:Young Adult
chemical_list: D017325:Hepatitis B Vaccines
keywords: Cross-sectional studies; Risk-taking; Travel; Vaccination