Hepatitis B risks and immunization coverage among American travelers

Hepatitis B is endemic in much of Asia, Africa, and parts of South America, regions that are increasingly popular destinations for American travelers. The frequency of hepatitis B risks during travel has been examined for Europeans but not Americans. Further, limited data are available to describe the domestic hepatitis B risk factors of American travelers, the proportion vaccinated, and whether immunization activities target travelers at highest risk. We conducted a survey of international travelers to address these issues.

A survey was mailed to 884 American international travelers, of whom 618 (70%) responded. The survey covered demographic and travel characteristics, sources of pre-travel health advice, immunization status, and items needed to assess hepatitis B vaccination candidacy. Travel-specific items concerned the most recent trip to a hepatitis B endemic region. Hepatitis B risk during the most recent trip was classified as high, potential, or none based on potential exposure to blood or bodily fluids.

Only 31% of respondents visited any health practitioner to obtain pre-travel health advice; 13% visited a travel medicine specialist. Totally 45% of respondents reported (3)1 domestic or travel-related hepatitis B risk, and 8% were at high risk during travel. Risk factors were more common among younger travelers and those with longer travel durations. Travel medicine specialists were more likely than nonspecialists to provide hepatitis B vaccine (40% vs 21%, p= 0.01). Travelers with risk factors were no more likely to be vaccinated in specialist or nonspecialist settings. Upon departure, only 19% of all travelers and 30% of travelers with risk factors had received three or more hepatitis B vaccine doses.

Most US travelers to hepatitis B endemic regions do not secure pre-travel health advice, and most have not received three doses of hepatitis B vaccine. A substantial share are candidates for hepatitis B vaccination based on their domestic activities, and/or face hepatitis B risks during travel.