WASHINGTON — Most American travelers to regions endemic for hepatitis B do not receive pretravel health advice and are underimmunized, according to an anonymous survey of 618 adult travelers to such areas.
In the survey of people who traveled to countries with moderate to high rates of hepatitis B from 2000 onward, 31% of respondents visited a health practitioner to get pretravel health advice, 13% saw a travel medicine specialist, and 18% saw other health care providers, Dr. Bradley A. Connor reported during a poster session at the annual meeting of the American Society of Tropical Medicine and Hygiene.
The strongest predictor of not seeking medical advice was travel duration of less than 20 days. Income of less than $100,000 per year also was a strong predictor of not seeking advice from a travel medicine specialist, wrote Dr. Connor, medical director of the New York Center for Travel and Tropical Medicine.
The survey respondents were international travelers identified from commercially available mailing lists; they received the survey by mail.
Respondents were significantly more likely to report having a domestic or travel-related risk factor for hepatitis B if they were age 40 years or younger, unmarried and male, or had traveled for more than 20 days. The 150 travelers who were aged 18–40 years reported significantly higher rates of domestic risk factors for hepatitis B than did the 468 older travelers (43% vs. 17%).
Compared with patients older than 40 years, younger patients also were more likely to participate in activities that were of high risk (12% vs. 7%) or potential risk (48% vs. 27%) for hepatitis B during their most recent trip.
High-risk activities were defined as an accident or illness that required invasive medical attention, a skin-perforating cosmetic procedure, or sexual intercourse with a native who was unknown to the respondent prior to travel.
Activities of potential risk for hepatitis B included sharing personal grooming items, participation in certain sporting or adventure activities, cosmetic activities with risk of skin perforation, or an accident or illness that did not require invasive care.
Hepatitis B vaccination rates on departure declined with increasing age from 33% among travelers aged 18–40 years to 19% among those aged 41–59 years and 9% among travelers aged 60 years or older.
Of the travelers who had not previously completed hepatitis B vaccination, the percentage who actually received the vaccine during their pretravel visit was 40% for those who saw a travel medicine specialist and 19% for those who visited other practitioners.
Dr. Connor reported that he is on the speaker's bureau and receives grant support from GlaxoSmithKline, which funded the study, and is on the speaker's bureau for Sanofi Pasteur; both companies manufacture hepatitis B vaccines.