Risks of Hepatitis B in Travelers as Compared to Immunization Status


  • Jane N. Zuckerman,

    Corresponding author
    1. Jane N. Zuckerman: Head of the Academic Unit of Travel Medicine and Vaccines, Royal Free and University College Medical School, University College, London, United Kingdom
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  • Robert Steffen

    1. Robert Steffen: Head, Division of Communicable Diseases, Institute of Social and Preventive Medicine (ISPM), University of Zurich, Somatrastrasse 30 CH-8006 Zurich, Switzerland.
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Reprint requests; Dr. Jane N. Zuckerman, The Academic Unit of Travel Medicine and Vaccines, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK


Background: Our objective was to determine the risks of infection with hepatitis B among European travelers and to compare this with the immunization status in various risk groups.

Methods: A cross-sectional telephone questionnaire survey of randomly selected subjects, in nine European study populations was used. A total of 9,008 individuals were involved, with approximately 1,000 interviews conducted in each country in the native languages. Situations with a high risk of hepatitis B infection, such as invasive medical procedures, attending to a bleeding person, and skin perforating cosmetic practices, particularly when performed in countries with medium/high transmission risk, and vaccination status of travelers, were the main outcome measures.

Results: Depending upon the destination, 6.6–11.2% of travelers were classified as at high risk of hepatitis B, with 24.4% vaccinated; between 60.8–75.8% of travelers at potential risk, with 19.2% vaccinated; and 33.4% of travelers where no hepatitis B risk was identified. Significantly more travelers who only visited medium/high endemicity regions exposed themselves to a high risk of contracting hepatitis B, (40, 10.5%) compared to travelers who only visited low endemicity regions (225, 6.6%; p < .01).

Conclusions: A significant proportion of travelers surveyed unwittingly exposed themselves to the risk of hepatitis B infection while at medium/high risk destinations. The majority of at-risk travelers had not been vaccinated, regardless of their destination. Improved advice and clear recommendations to avoid transmission are needed.