Spanish Travelers to High-Risk Areas in the Tropics: Airport Survey of Travel Health Knowledge, Attitudes, and Practices in Vaccination and Malaria Prevention


  • Preliminary data of this article were presented in the 9th Conference of the International Society of Travel Medicine, Lisbon, 2005.

Rogelio Lopez-Velez, MD, PhD, Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar Km 9,1, Madrid 28034, Spain. E-mail:


Objective To evaluate travel health knowledge, attitudes, and practices on vaccination and malaria prevention among Spanish travelers to the tropics.

Methods A cross-sectional survey was carried out in the departure lounge of the two main Spanish international airports in the summer of 2004. A questionnaire was administered to 1,206 Spanish citizens traveling to high-risk areas of tropical South America, 635 travelers (52.6%); Southeast Asia, 251 (20.8%); Sub-Saharan Africa, 181 (15.0%), and the Indian subcontinent, 139 (11.6%). Risk areas were defined according to published sources. Travelers were asked about their attitudes to travel vaccines and malaria prophylaxis and whether they had received either or both on this or previous trips. Adequate malaria prophylaxis was considered as the correct drugs for the destination as indicated by the World Health Organization.

Results Fifty-eight percent of travelers were male and the mean age was 38 years. Thirty-six percent were traveling to tropical areas for the first time. The main reason for travel was tourism (82%) or business (12%). The mean time preparing the trip was 39 days; 73% looked for information a mean of 19 days in advance and 54% were advised in travelers’ clinics. Fifty-five percent received no travel vaccines. A total of 48.1% of tourists and 30.1% of business travelers were vaccinated (p < 0.00006). The most frequent vaccines administered were as follows: typhoid fever, 32%; yellow fever, 29%; tetanus–diphtheria, 24%; and hepatitis A, 14%. Malaria prophylaxis was taken by 422 travelers including mefloquine (44%), atovaquone–proguanil (17%), chloroquine (16%), chloroquine–proguanil (15%), doxycycline (3%), and unknown (5%).

Conclusions More than half of travelers to risk areas received no vaccinations before the trip. More than a third of travelers to Sub-Saharan Africa received no malaria prophylaxis.