Travel health knowledge, attitudes and practices among Australasian travelers

Exploring the utilization and perceptions of pre-travel health consultations in primary care settings in Saudi Arabia: a cross-sectional study

BACKGROUND

International travel exposes individuals to diverse health risks, necessitating proactive pre-travel health preparations. Saudi Arabia has witnessed increased outbound travel. This study addresses a critical gap in knowledge by investigating the utilization and perceptions of pre-travel health consultations among adults in the Eastern Province of Saudi Arabia.

METHODS

This cross-sectional study surveyed patients at the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University during January 2024 to explore perceptions of pre-travel health consultations among the Saudi Arabian population. Adults aged 18 years or older in the waiting area were invited to complete a self-administered questionnaire.

RESULTS

Of the 772 participants, 624 (80.8%) engaged in international travel within the last year. However, 593 (76.8%) had never sought pre-travel health consultations. Age, gender, and education level significantly influenced the pursuit of pre-travel health advice, with older individuals, females, and those with higher educational attainment more likely to seek consultations. Participants perceived vaccination recommendations (597, 77.4%) and disease prevention information (678, 87.8%) as crucial parts of pre-travel health consultations. However, barriers to seeking advice included perceived low risk (445, 74.8%), lack of awareness (215, 36.3%), time constraints (128, 21.6%), and cost concerns (92, 15.5%).

CONCLUSION

The low prevalence of pre-travel health consultations among travelers highlights the need for targeted educational campaigns and the integration of travel health services into primary healthcare. Addressing the identified barriers and leveraging preferred information sources are crucial steps towards enhancing the uptake of pre-travel health consultations, ultimately improving the health and safety of international travelers from the region.

Knowledge and Attitudes Regarding the Vaccination of Brazilian Immigrants in Portugal: Risks When Returning to Their Country of Origin?

Vaccination is one of the main advancements in public health in the prophylaxis of infectious diseases. We intend to describe the general knowledge about vaccines/vaccination among Brazilian immigrants in Portugal, characterize their attitudes toward vaccination, and describe their knowledge of the yellow fever (YF) vaccine. A cross-sectional study was conducted using a self-completion questionnaire (face-to-face or remote). A total of 542 people participated in the study; the mean age was 36.81 years; 40.1% were male; 44.8% had their 12th year of schooling; and 27.0% had resided for ≥10 years in Portugal. Regarding general knowledge about vaccination, 53.8% answered at least 6/8 questions correctly. A total of 37.1% tended to have a favorable attitude toward vaccination. Concerning traveling, 76.7% attributed the risk of disease at the destination as the main reason for accepting vaccines. A total of 89.3% knew that there was a risk of YF in Brazil. A total of 40% answered correctly only one question about the YF vaccine; 21.6% did not answer any questions correctly. Thus, most of the Brazilian immigrants in this study have high general knowledge about vaccines/vaccination, few have a favorable attitude, and their knowledge about the YF vaccine is scarce. This could limit vaccination adherence when visiting Brazil, making health education actions necessary to increase knowledge and prevent YF risks.

Investigating Awareness Regarding Travel-Related Infectious Disease Prevention in a Metropolitan Area

The rise in international travel has led to an increase in travel-related infectious diseases. It is predicted that by 2030, the number of international travelers will reach 1.8 billion, with over 250 million people affected globally. This issue also has an economic impact, as the eradication of travel-related infectious diseases leads to a loss of USD 12 billion in tourism. To understand the association between demographic variables and knowledge, attitude, and behaviors related to travel-related infectious diseases, a cross-sectional survey-based study was conducted among 1191 individuals in the metropolitan city of Naples, Italy. Multiple linear regression was performed over three models. The results revealed that knowledge about travel-related infectious diseases was positively associated with age, female gender, non-smoking habits, being single, and higher education attainment. The attitude towards travel-related infectious diseases was positively associated with being female, non-smoking habits, being single, higher education attainment, and a higher level of knowledge. A statistically significant association was observed between behaviors and non-smoking habits and between higher levels of knowledge and attitudes. To address this issue, public health programs could be implemented to improve behaviors in the general population. Overall, this study provides valuable information about the determinants of knowledge, attitude, and behaviors related to travel-related infectious diseases in the general population.

Provision of Travel Health Advice Through Local Tourist Handlers: Perspectives of Safari Tour Operators in Uganda

BACKGROUND

The public health burden of travel related diseases (TRDs) remains significant despite the fact that most can be avoided, particularly with the assistance of local tourist handlers such as Safari Tour Operators' (STOs). The STO's are the immediate close contact with tourist groups, and yet their perspectives regarding provision of travel health advice are unknown in Uganda. This study was conducted to determine the level of knowledge, attitude, and practices of STOs regarding TRDs in Uganda.

METHODS

A cross sectional study was carried out among selected STOs in Kampala and Wakiso Districts using self-administered questionnaires.

RESULTS

The overall level of knowledge about travel health information was inadequate. Although 77.5% of the STOs were aware of some TRDs, the availability of travel health information or database in their organisations was not observed. Knowledge of the current TRDs in Uganda among the STOs was very low, with a few individuals mentioning yellow fever (9.7%), malaria (9.2%), cholera (9.2%), and HIV/AIDs (8.9%). Knowledge related to the sources of the travel health information was also low, with STOs (19.1%) and travel health clinics (14.9%) being mentioned as the main sources. The STOs had mostly positive attitude towards provision of travel health advice related to travellers, and all agreed that STOs should play a big role in the provision of travel health advice. First Aid and simple treatment options were mentioned as practices that STOs conducted to keep the travellers safe.

CONCLUSIONS

While the STOs are motivated to do the right thing and provide their clients with sound travel health advice, they have a limited awareness of the actual TRDs in Uganda. The STOs must be educated on pertinent travel health advice, and intra-travel disease and injury management. The responsible government and non-governmental entities in Uganda need to develop educational materials emphasising the relevance of travel health advice.

Pretravel preparation and factors associated with willingness to seek pretravel consultation among Taiwanese travelers

BACKGROUND

Although globalization promotes economic development, cross-border infectious disease transmission is still a serious threat to health. Taiwan is geographically close to Southeast and South Asia, but the needs and expectations of Taiwanese travelers with regard to travel medicine are still largely unknown. This study aimed to clarify the pretravel preparations, needs, willingness to seek pretravel consultation, and factors associated with willingness, in order to provide valuable information for improvement of healthcare service.

METHODS

Data were collected with anonymous structured questionnaires distributed to 477 visitors who tried to get travel health information from New Southbound Health Center between June and November 2019. A multivariate stepwise logistic regression analysis was applied to identify factors associated with the visitors' willingness to seek pretravel consultation.

RESULTS

A total of 304 questionnaires (64%) were collected. Eighty-three percent of the respondents were willing to seek pretravel consultation. A higher level of education (odds ratio 3.6 [95% CI 1.58-8.22]), having a plan to obtain travel medical insurance (2.5 [1.18-5.28]), concern with gastrointestinal diseases (2.0 [1.04-3.94]), concern with mosquito-borne diseases (2.0 [2.07-3.95]), and concern with noncommunicable diseases (2.2 [1.02-4.96]) were independent factors associated with willingness to seek pretravel consultation.: CONCLUSIONS: We found that most of the travelers were willing to seek pretravel consultation. Our study highlighted the need to enhance awareness about travel-related illness among these travelers. Strategies should be tailored according to these findings to help prevent epidemics and improve healthcare service in the future.

Travel patterns and advice-seeking behaviour of pregnant women in the Australian context: A multicentre cross-sectional analysis

BACKGROUND

Travel poses risks to pregnant women, but little data exist describing the travel habits of women during pregnancy or pre-travel recommendations given.

AIMS

To examine travel patterns of pregnant women including frequency of pre-travel consultation, and advice recalled.

MATERIALS AND METHODS

Cross-sectional analysis of post-partum women admitted to five Victorian maternity hospitals between 21 May 2019 and 22 April 2020 in Australia.

RESULTS

Forty-four percent (182/410) of women travelled during pregnancy, 32.9% (135/410) interstate and 19.5% (80/410) internationally. Fifty-five percent travelled for leisure (118/215) and 27% to visit friends/relatives (58/215). Overall, 68.1% (124/182) sought pre-travel advice, primarily from an obstetrician (60.5%, 75/124) or general practitioner (29.8%, 37/124). Only one woman attended a travel clinic. The most common reason for not seeking pre-travel advice was the belief that travel posed no risk (63.4%, 45/71). Pre-travel advice was sought least by those visiting friends/relatives (61.4%, 35/57). Women recalled recommendations regarding travel restrictions by gestational age and venous thromboembolism precautions, but not infectious disease prevention for those to whom it was relevant. Of international travellers, 48.8% (39/80) sought advice from the internet, one-third (13/39) as an alternative to seeing a healthcare provider.

CONCLUSIONS

Travel is common during pregnancy and women seek pre-travel advice from the healthcare provider they see most often during pregnancy. All pregnant women should be provided with consistent, evidence-based pre-travel advice regardless of whom they consult. Further work is needed to educate and provide resources to maternity care providers to optimise pre-travel counselling.

Using social media listening and data mining to understand travellers' perspectives on travel disease risks and vaccine-related attitudes and behaviours

BACKGROUND

Travellers can access online information to research and plan their expeditions/excursions, and seek travel-related health information. We explored German travellers' attitude and behaviour toward vaccination, and their travel-related health information seeking activities.

METHODS

We used two approaches: web 'scraping' of comments on German travel-related sites and an online survey. 'Scraping' of travel-related sites was undertaken using keywords/synonyms to identify vaccine- and disease-related posts. The raw unstructured text extracted from online comments was converted to a structured dataset using Natural Language Processing Techniques. Traveller personas were defined using K-means based on the online survey results, with cluster (i.e. persona) descriptions made from the most discriminant features in a distinguished set of observations. The web-scraped profiles were mapped to the personas identified. Travel and vaccine-related behaviours were described for each persona.

RESULTS

We identified ~2.6 million comments; ~880 k were unique and mentioned ~280 k unique trips by ~65 k unique profiles. Most comments were on destinations in Europe (37%), Africa (21%), Southeast Asia (12%) and the Middle East (11%). Eight personas were identified: 'middle-class family woman', 'young woman travelling with partner', 'female globe-trotter', 'upper-class active man', 'single male traveller', 'retired traveller', 'young backpacker', and 'visiting friends and relatives'. Purpose of travel was leisure in 82-94% of profiles, except the 'visiting friends and relatives' persona. Malaria and rabies were the most commented diseases with 12.7 k and 6.6 k comments, respectively. The 'middle-class family woman' and the 'upper-class active man' personas were the most active in online conversations regarding endemic disease and vaccine-related topics, representing 40% and 19% of comments, respectively. Vaccination rates were 54%-71% across the traveller personas in the online survey. Reasons for vaccination reluctance included perception of low risk to disease exposure (21%), price (14%), fear of side effects (12%) and number of vaccines (11%).

CONCLUSIONS

The information collated on German traveller personas and behaviours toward vaccinations should help guide counselling by healthcare professionals.

Residents' Support for Tourism Amidst the COVID-19 Era: An Application of Social Amplification of Risk Framework and Knowledge, Attitudes, and Practices Theory

Given that the concept of risk perception stems primarily from consumer behaviour, tourism research has tended to address the issue from tourists' perspective, resulting in a lack of consideration of destination residents' risk perception and its impact on their attitudes and subsequent behaviour. Based on the social amplification of risk framework (SARF) and the knowledge, attitudes, and practices (KAP) theory, this study constructed a theoretical model to deepen the understanding of destination residents' support for tourism. Results indicate that residents' social media use, knowledge of COVID-19 and attitudes to tourism and tourists are all positively related to their support for tourism. Furthermore, residents' risk perception is negatively associated with their attitudes to tourism, attitudes to tourists and support for tourism. However, the relationship between residents' social media use and risk perception was not confirmed. Theoretical and managerial implications were discussed.

Sidek Ahmad Z, Zarkasi K, Ramli N, Che Jamaludin F. Pretravelling health-seeking behavior, knowledge of vaccines, and attitudes toward travel health among malaysian travelers

Background:

Travelers are at higher risk of developing health-related problems, especially travel-related diseases, and this remains a major public health burden.

Aims:

To assess pretravel health behavior-seeking factors, knowledge of vaccine, and travel health attitudes. A cross-sectional design among Malaysian travelers.

Methods:

An online survey was conducted from December 2017 till March 2018 among 226 participants. Demographic data, pretraveling health behaviors, knowledge of vaccine-preventable diseases, and travel health were asked. Independent t-test and ANOVA were performed using SPSS version 20.

Results:

Among travelers, 51.3% and 63.7% used health-related information on their destination before departure and collected information on possible travel hazards at their destination. Participant age (P = 0.02), monthly income (P = 0.01), predeparture health information (P = 0.03), information on possible hazards (P = 0.04), and travel health advice from medical professionals (P = 0.03) have been reported as a major predictor of knowledge of vaccine-preventable disease. Travelers’ gender (P = 0.01), household income (P = 0.01), and travel health advice from professionals (P = 0.002) were significantly associated with travel health attitude.

Conclusions:

Sociodemographic and pretravel health-seeking behavior influence knowledge of vaccine-preventable disease and attitudes towards travel health which requires a public health need for community outreach programs targeting this group.

Assessment of knowledge, attitudes, and practices regarding travel health among (King Abdulaziz) international airport travelers in Jeddah, Kingdom of Saudi Arabia 2019

Background:

Travelers to different countries have endemic/pandemic diseases can increase the risk of exposure to various infectious agents and can facilitate their spread across borders.

Objectives:

To determine the levels of travel health knowledge, attitudes and practices among travelers at international airports of KSA.

Methods:

An observational cross-sectional study was conducted starting from 30 September, 2019 at the departure halls of King Abdulaziz International airport (KAIA). Representative sample adult travelers who were waiting to board were recruited.

Results and Discussion:

Good level of knowledge regarding travel health was observed among 28.2%. The majority of the participants (84.7%) got information about their destination prior to the trip. The main reported source of information was family/friends (53.8%). Negative health seeking behavior was observed among 70.8% of the participants. Purpose of the trip and duration of destination were significantly associated with health seeking behavior. Knowledge, attitude towards health information seeking behavior and practice-related to travel health among international travelers at King Abdulaziz International airport are insufficient.

Expansion and Specification of Knowledge, Skills, Attitudes and Practices Survey Model for Community-Based Tourism Development

This paper investigates the use of the Knowledge Attitude Practices (KAP) survey and suggests its extension to Knowledge Attitude Skills Practices (KSAP). It brings value to tourism theories at the level of the tourist and hosts, and argues that communities must be capacitated with the knowledge, attitudes, skills, and practices that transcend tourism. This is a conceptual paper, compiled using secondary data that already exists in the public domain. The paper suggests carrying out surveys that incorporate KSAP regarding CBT at level 1, tourism at level 2, and livelihoods at level 3, for a holistic understanding of these aspects among community members, tourists, and other stakeholders. The KSAP model posited in this paper is a tool that may be used by considering the prevailing local conditions and contexts, and the appropriate unit of analysis from tourism stakeholders.

Profile and complexity of travel medicine consultations in Chile: unicentric cross-sectional study

OBJECTIVE

To analyse the spectrum, vaccination needs and pretravel advice complexity of travellers presenting at a travel medicine clinic in Santiago, Chile.

DESIGN

Cross-sectional study.

SETTING

Pretravel consultations in a private healthcare centre in Chile, an 'emerging market' country in South America.

PARTICIPANTS

Travellers (n=1341) seeking pretravel advice at the Travel Medicine Program of Clínica Alemana, Santiago, from April 2016 to March 2018.

PRIMARY AND SECONDARY OUTCOME MEASURES

Demographical and travel characteristics, indications for travel vaccines and malaria prophylaxis, and complexity of travel consultations.

RESULTS

Of 1341 travellers, 51% were female; the median age was 33 years. Most frequent travel reasons were tourism (67%) and business (20%). Median travel duration and time to departure were 21 days and 28 days, respectively. Most destinations were located in America (41%), followed by Asia (36%) and Africa (26%); 96% visited less developed countries, mostly in tropical regions, with risk of arboviral infections (94%) and malaria (69%). The indicated vaccine indications comprised hepatitis A (84%), yellow fever (58%), typhoid fever (51%), rabies (29%), polio (8%), Japanese encephalitis (6%) and meningococcal meningitis (5%). More than 60% of consultations were classified as complex.

CONCLUSION

The studied population mostly visited less developed tropical regions, resulting in a high requirement of yellow fever and other travel-related vaccinations. Most consultations were complex and required a comprehensive knowledge and training in travel medicine.

The Impact of Receiving Pretravel Health Advice on the Prevention of Hajj-Related Illnesses Among Australian Pilgrims: Cohort Study

Background

Pretravel health advice can play a crucial role in improving both travelers’ awareness about disease risk and compliance with preventive measures. General practitioners (GPs) and the internet have been reported internationally to be the main sources of health advice for travelers to non–mass gathering (MG) destinations. However, few studies have attempted to investigate the sources of health advice among travelers to MGs including the Hajj pilgrimage, and none of these studies further investigated the impact of pretravel advice on pilgrims’ health behaviors.

Objective

The objective of this study was to investigate the impact of the source of pretravel health advice (from GPs and specialized Hajj travel agents) on Hajj pilgrims’ awareness of and compliance with health recommendations, and the incidence of Hajj-associated illnesses.

Methods

A prospective cohort study (before and during Hajj) was conducted among Australian pilgrims aged ≥18 years in 2015.

Results

A total of 421 pilgrims participated prior to Hajj, and 391 (93%) provided follow-up data during Hajj. All participants obtained pretravel health advice from one or more sources, with Hajj travel agents (46%) and general practitioners (GPs; 40%) the most commonly reported sources. In total, 288 (74%) participants reported Hajj-related symptoms, of which 86% (248/288) were respiratory symptoms. Participants who obtained pretravel health advice from travel agents were more likely to be aware of the official Saudi recommendations (adjusted odds ratio [aOR] 2.1, 95% CI 1.2-3.8; P=.01), receive recommended vaccines before travel (aOR 2.4, 95% CI 1.4-3.9; P=.01), use hand sanitizers including soap (aOR 2.5, 95% CI 1.1-6.1; P=.03), and wash their hands after touching an ill person during Hajj (aOR 2.9, 95% CI 1.1-7.1; P=.01), compared to those who sought advice from GPs. However, neither advice from travel agents nor GPs was associated with a lower incidence of Hajj-related illnesses.

Conclusions

Advice from travel agents appeared to be accessed by more travelers than that from GPs, and was associated with an increased likelihood of positive travel health behaviors.

Malaria Disease and Chemoprophylaxis Usage among Israeli Travelers to Endemic Countries

Prevention of malaria in travelers to endemic countries is one of the complex challenges of travel medicine. Israel has a widespread culture of travel to developing countries, but information regarding malaria prevention is limited so far. Our study, conducted in Sheba Medical Center, Israel, during the years 2008-2018 examined malaria chemoprophylaxis usage and malaria cases in a large group of Israeli travelers returning from endemic countries with any medical complaint. Data were collected regarding travel destinations, conditions, duration of stay, and pretravel consultation. Altogether, 4,708 travelers were included in our study. Travel destinations included Asia (51%), Latin America (31%), and sub-Saharan Africa (SSA) (17%). Median travel duration was 26 days. Only 11.9% reported taking malaria chemoprophylaxis. Of the travelers to SSA, 41.3% took prophylaxis as opposed to only 6% outside of Africa. During the study years, 136 cases of malaria were diagnosed; among them, 82 (60%) were infected with Plasmodium falciparum, of whom all but two were from SSA and none adhered to prophylaxis. Malaria chemoprophylaxis usage was found to be negligible in travel to many countries still considered endemic. Higher prophylaxis usage was found among travelers to SSA, but numbers are still lower than recommended. The low number of malaria cases seen in destinations outside SSA, as documented in our cohort, is likely to represent travel to low risk areas and not high prophylaxis usage. We urge re-evaluation of current CDC and Israeli guidelines which still recommend using chemoprophylaxis in many low-risk countries, as focus on high-risk countries may increase adherence.

Assessing the Travel Health Knowledge of Australian Pharmacists

Worldwide, the numbers of travellers are increasing, with pharmacists having the potential to play a significant role in the provision of pre-travel health services to a large number of these travellers. However, studies examining whether pharmacists have the travel health knowledge to provide these services are limited. This study thus aimed to explore the travel health knowledge of Australian pharmacists. Surveys assessing pharmacists’ knowledge of travel health were distributed through the Pharmaceutical Society of Australia and community pharmacies for self-completion. Overall, the travel health knowledge of participants was found to be good. However, although the majority of participants were aware of the common causes of morbidity and mortality in travel health, some slightly overestimated the prevalence of malaria and were less knowledgeable about the global distribution of some diseases. Most participants also demonstrated an ability to give appropriate advice on the management of traveller’s diarhoea, the selection of appropriate items for inclusion in travel first aid kits, vaccinations, and malarial chemoprophylaxis for travellers visiting endemic areas. This study highlights that Australian pharmacists have the knowledge to deliver travel health advice, with the potential to improve both access and outcomes for travellers.

Adherence to recommendations at a Canadian tertiary care Family Travel Clinic - A single centre analysis

BACKGROUND

Infectious and non-infectious risks associated with international travel can be reduced with adherence to pre-travel advice from practitioners trained in travel medicine.

METHODS

A prospective cohort study was conducted in a tertiary care children's hospital to assess adherence to malaria chemoprophylaxis, safe water and food consumption, mosquito bite protection, motor vehicle safety and travel vaccines using structured questionnaires. High risk groups assessed included child travelers and those visiting friends and relatives (VFRs).

RESULTS

In total, 290 participants (133 children and 157 adults) were enrolled and completed at least one study questionnaire. In general, with the exception of vaccines, adherence to recommendations was sub-optimal. Among children and adults, adherence to malaria prophylaxis recommendations was lower in VFRs than in non-VFRs. The proportion of children VFRs (cVFRs) and adult VFRs (aVFRs) who adhered to the following recommendations were malaria chemoprophylaxis (47%, 33%), safe water (71%, 74%) and food recommendations (18%, 6%), insect bite avoidance (21%, 12%), and motor vehicle safety (13%, 11%) respectively. Adherence to recommended vaccines uptake was greater than 90% in all groups.

CONCLUSION

With the exception of vaccine uptake, sub-optimal adherence levels to travel recommendations was identified in all groups, and in particular VFRs, highlighting the need for proactive discussions around barriers to adherence.

Imported Malaria at a Referral Hospital in Tokyo from 2005 to 2016: Clinical Experience and Challenges in a Non-Endemic Setting

In this study, we reviewed imported malaria cases observed at the National Center for Global Health and Medicine, Tokyo, between 2005 and 2016, to comprehend their demographic and clinical characteristics. Data on 169 cases were used to analyze demographic information; data on 146 cases were used for the analysis of clinical information. The median patients’ age was 34 years, and 79.3% of them were male. The proportion of non-Japanese patients increased and surpassed that of Japanese patients after 2015. In 82.2% of the cases, the region of acquisition was Africa, and Plasmodium falciparum was the dominant species (74.0%) followed by Plasmodium vivax (15.4%). We observed 19 (18.4%, 19/103) severe falciparum malaria cases. Mefloquine was the most commonly used drug for treatment until the early 2010s; atovaquone/proguanil was the most commonly used after its licensure in 2013. Although none of the patients died, four recrudescence episodes after artemether/lumefantrine (A/L) treatment and one relapse episode were observed. Overall, malaria was diagnosed on median day 4 of illness, and, thereon, treatment was initiated without delay. Diagnosis on day 5 or later was significantly associated with severe disease in Japanese cases (odds ratio = 4.1; 95% CI = 1.2–14.3). We observed a dominance of falciparum malaria, an increase in the number of non-Japanese cases, late treatment failure after A/L treatment, a low relapse rate, and an association between delayed malaria diagnosis and higher disease severity. Pretravel care and early diagnosis are necessary to reduce malaria-related mortality and morbidity in settings such as ours.

Knowledge, attitude and compliance towards travel vaccines among Nigerian travellers at an international airport

BACKGROUND

The risk of contracting a travel-related disease does not only depend on the destination of travel and length of the trip, but also on the traveller's own health status. Travel vaccines avert the increase of communicable disease. Awareness of traveller's behaviours and their attitudes concerning infectious diseases can inform policy aimed at protecting the individual travellers, their contacts and the communities into which they travel.

AIM

This study on travel vaccine was aimed to determine the level of knowledge, attitude and compliance to travel vaccines.

SETTING

This study was conducted among Nigerian travellers at Murtala Mohammed International Airport, Ikeja, Nigeria.

METHODS

It was a cross-sectional descriptive study using systematic sampling technique, with the aid of interviewer-administered questionnaire to select 198 respondents for the study. The statistical software EPI-Info 7 was used for data analysis.

RESULTS

The mean age of respondents was 35.34 + 9.91 years and majority (58.1%) of the respondents were men. Majority (54.0%) were married and (43.4%) had tertiary education. About 35.9% were travelling to other African countries, 9.6% to Middle Eastern countries, 16.2% to Europe, 13.6% to North America and 7.6% to Australia. Their main purpose of travel was for employment or working (22.2%), business activities (20.7%), touring (16.2%) and visiting families and relatives (15.7%). About a half (41.4%) had good knowledge of travel vaccines, majority (83.8%) had positive attitude and majority (66.2%) had been vaccinated for yellow fever before travel.

CONCLUSION

Significant associations exist between tribe, religion, education and knowledge of travel vaccines.

Exploring Australian Hajj Tour Operators' Knowledge and Practices Regarding Pilgrims' Health Risks: A Qualitative Study

Background

Travel agents are known to be one of the main sources of health information for pilgrims, and their advice is associated with positive health behaviors.

Objective

This study aimed to investigate travel agents’ health knowledge, what health advice they provide to the pilgrims, and their sources of health information.

Methods

In-depth interviews were conducted among specialist Hajj travel agents in Sydney, Australia. Thematic analysis was undertaken.

Results

Of the 13 accredited Hajj travel agents, 9 (69%) were interviewed. A high level of awareness regarding gastrointestinal infections, standard hygiene methods, and the risk of injury was noted among the participants and was included in advice provided to pilgrims. However, very limited knowledge and provision of advice about the risk of respiratory infections was identified. Knowledge of the compulsory meningococcal vaccine was high, and all participated travel agents reported influenza vaccine (a recommended vaccine) as a second “compulsory” vaccine for Hajj visas. Conversely, participants reported very limited knowledge about other recommended vaccines for Hajj. The Ministry of Hajj website and personal Hajj experience were the main sources of information.

Conclusions

This study identifies a potential path for novel health promotion strategies to improve health knowledge among Hajj travel agents and subsequently among Hajj pilgrims.

Health risk management behaviors and related factors among Japanese university students participating in short-term study abroad programs

BACKGROUND

Overseas travelers should prepare for health problems at their destinations prior to travel. No prospective studies have evaluated factors related to health risk management behaviors among overseas travelers, specifically young travelers.

METHODS

We prospectively collected data from pre- and post-travel questionnaire surveys, targeting students of a university in Japan who participated in short-term study abroad programs (n = 532, 6 to 38 travel days and 11 countries). We examined health information collection, receipt of travel vaccinations for the programs and medical kit preparation as health risk management behavior outcomes and their related factors among the participants (82.7% follow-up rate).

RESULTS

In total, 17.5%, 8.0% (28.6% in Southeast Asia) and 68.9% of participants, respectively, collected travel health information via the Japanese or foreign official websites, received travel vaccinations and carried commonly used medicines. Female, travel experience to study destination, parental medical occupation and presence of illness in treatment were positively associated with the health risk management behaviors after adjusting for the covariates including study destination. For example, the adjusted odds ratio (OR) (95% confidence interval [CI]) of receiving travel vaccinations was 4.16 (1.70-10.2) for parental medical occupation relative to non-medical occupation. The adjusted OR (95% CI) of collecting travel health information was 2.54 (1.04-6.21) for travel experience to study destination relative to no overseas travel experience.

CONCLUSIONS

Personal characteristics including overseas travel experience and parental occupation provide a useful insight into approaches to promoting health risk management among university students traveling abroad.

Perceptions of tick-borne encephalitis risk: a survey of travellers and travel clinics from Canada, Germany, Sweden and the UK

BACKGROUND

While the worldwide endemicity of tick-borne encephalitis (TBE) has been increasing, a lack of awareness of the risks of this life-threatening disease may be leading to an underutilization of preventive measures among travellers to TBE-endemic regions. This study's objectives were to assess travellers' awareness of TBE and advice-seeking attitudes, and to evaluate practices of travel clinics regarding pre-travel advice.

METHODS

We used an online questionnaire to identify individuals aged 18-65 years residing in the UK, Germany, Canada and Sweden, who had travelled to TBE-endemic countries between 2013 and 2016. This sample was defined as the visit-risk sample. Of these, the first 375 respondents who reported that they had engaged in pre-defined at-risk activities (e.g. hiking in forests) were asked to complete an additional online survey and were included in the activity-risk sub-sample. We also used an online/phone questionnaire to interview travel clinic personnel.

RESULTS

The TBE visit-risk sample included 4375 individuals; 69% had heard of the disease and 32% had heard of a TBE vaccine. Before travelling, travellers most commonly sought information online (26%); fewer travellers consulted family doctors (8%) or travel clinics (5%). In the activity-risk sample, 79% of the travellers were aware of at least one correct TBE prevention measure; however, only 15% reported being vaccinated within the past 3 years, with 11% of vaccinated travellers doing so following a clinic's recommendation. One hundred and eighty travel clinic representatives responded and reported that TBE vaccination was recommended to an average of 61% of travellers to endemic regions. Vaccination-reminder services such as follow-up appointments, e-mail and text reminders were offered by 50% of the clinics.

CONCLUSIONS

There is a need to increase awareness of the risk and prevention of TBE among travellers to endemic countries, and travel clinics could play an important role in this process. 5975671594001tay062media15975671594001.

Australian Pharmacists' Perceptions and Practices in Travel Health

Worldwide, pharmacists are playing an increasing role in travel health, although legislation and funding can dictate the nature of this role, which varies from country to country. The aim of this study was to explore the current and potential future practices in travel health for pharmacists in Australia, as well as the perceived barriers, including training needs, for the provision of services. A survey was developed and participation was sought from a representative sample of Australian pharmacists, with descriptive statistics calculated to summarise the frequency of responses. A total of 255 participants, predominantly female (69%), below 50 years (75%) and registered less than 30 years completed the survey. Although over two-thirds (68%) provided travel-related advice in their current practice, the frequency of advice provision was low (less than 2 travellers per week) and limited to responding to travellers questions. Although Australian pharmacists are currently unable to administer travel vaccines and prescription only medications without prescription, they still consider travel health to be an appropriate role and that their clients would seek travel health advice from pharmacies if offered. Currently, key roles for Australian pharmacists are advising travellers who do not seek advice from other practitioners, reinforcing the advice of other health practitioners and referring travellers needing vaccinations and antimalarials. In order to expand these services, the barriers of workload, time, staffing and the need for training in travel health need to be addressed. In summary, the travel health services provided by pharmacies in Australia still have a way to go before they match the services offered by pharmacies in some other countries, however Australian pharmacist are keen to further develop their role in this area.

Adherence to anti-vectorial prevention measures among travellers with chikungunya and malaria returning to Australia: comparative epidemiology

Objective

Compare the adoption and adherence to health protection behaviours prior to and during travel among international Australian travellers who return to Australia with notified chikungunya or malaria infection. This information could inform targeted health promotion and intervention strategies to limit the establishment of these diseases within Australia.

Results

Seeking travel advice prior to departure was moderate (46%, N = 21/46) yet compliance with a range of recommended anti-vectorial prevention measures was low among both chikungunya and malaria infected groups (16%, N = 7/45). Reasons for not seeking advice between groups was similar and included ‘previous overseas travel with no problems’ (45%, N = 9/20) and ‘no perceived risk of disease’ (20%, N = 4/20). Most chikungunya cases (65%, N = 13/20) travelled to Indonesia and a further 25% (N = 5/20) visited India, however most malaria cases (62%, N = 16/26) travelled to continental Africa with only 12% (N = 3/26) travelling to India. The majority (50%, N = 10/20) of chikungunya cases reported ‘holiday’ as their primary purpose of travel, compared to malaria cases who most frequently reported travel to visit friends and family (VFR; 42%, N = 11/26). These results provide import data that may be used to support distinct public health promotion and intervention strategies of two important vector-borne infectious diseases of concern for Australia.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3695-9) contains supplementary material, which is available to authorized users.

Pre-travel health seeking practices of Umrah pilgrims departing from Assiut International Airport, Egypt

OBJECTIVES

to assess the health seeking practices and their determinants among Umrah pilgrims departing from Assiut international Airport.

METHODS

We interviewed 300 pilgrims departing from Assiut International Airport while they were in the departure lounge, using a semi-structured questionnaire.

RESULTS

Only 60%, 46.3% and 46.3% of Umrah pilgrims believed in importance of pre-travel vaccination, seeking health information, and health examination, respectively. The most frequently practiced pre-travel health related behaviour was getting vaccinated (56.3%), as compared to much lower frequencies of seeking health information (24%) or having a clinical health examination (26.7%). Private clinics, internet and the tourism companies were the main sources of health information of the pilgrims. Positive attitude of pilgrims about health seeking practices, the perception of health risk of travelling to Hajj/Umrah and having a chronic disease were the predictors of pre-travel health practices.

CONCLUSION

Raising awareness among Hajj/Umrah pilgrims about the importance of seeking professional pre-travel health advice and communicating the risk of exposure to travel-related diseases to pilgrims could be important strategies to improve the uptake of preventive measures. Training of general practitioners in the public health sector about the travel health information would promote the travel health services.

Tour leaders with detailed knowledge of travel-related diseases play a key role in disease prevention

In Taiwan, group tours are a popular mode of international travel; hence, group tour leaders must ensure traveler safety and health. This study identified factors influencing tour leaders' willingness to recommend pretravel medical consultation and vaccination.A cross-sectional questionnaire survey was administered to tour leaders from January 2011 to December 2012. Multivariate logistic regression analyses were performed to estimate the odds ratios of having a positive attitude and willingness based on different knowledge scores of the tour leaders after adjustments for age, sex, education level, and seniority.Tour leaders with a more detailed knowledge of both travel-related infectious and noninfectious diseases demonstrated a higher willingness to receive vaccination. They believed that consultation at travel clinics before travel can improve travelers' health (P < .05).This study supports the importance and effectiveness on educating tour leaders' knowledge about travel-related diseases to improve health care for travelers.

Improving access and provision of pre-travel healthcare for travellers visiting friends and relatives: a review of the evidence

BACKGROUND

Travellers visiting friends and relatives (VFR travellers) in their country of origin are at increased risk of a range of preventable infections. Risks are broadly related to circumstances of travel, risk misconceptions and access to health services. Despite nearly two decades of literature highlighting these increased risks little impact has been made on their risk disparity.

METHODS

This review draws on evidence from travel medicine literature, supplemented by evidence from the broader field of immigrant health, and is structured to include strategies that aim to reduce barriers at the patient, provider and health system level.

RESULTS

For the travel medicine provider, tailored risk communication that is cognisant of the unique health beliefs and barriers to travel health for VFR travellers is needed, including enhanced communication through the use of interpreters and supplementary written communication. Primary care providers are uniquely placed to identify future travel plans among immigrant patients, however, greater awareness of VFR traveller risks and training in travel medicine are required. Community health promotion interventions that are culturally appropriate, translated into multiple languages and takes into account the cumulative risk of multiple return visits are key to normalizing travel healthcare seeking behaviours and improving awareness of VFR travel risks. Currently, there are few examples of novel strategies to engage migrant communities in travel health with no formal evaluations of their effectiveness. Best practice includes the use of community-consulted approaches in collaboration with government, primary care and travel medicine.

CONCLUSIONS

Multifactorial barriers related to health beliefs and access to health services require a range of strategies and interventions in both reaching and providing advice to VFR travellers. To improve the evidence base, future research should focus on the evaluation of novel strategies that address these barriers and improve access and provision of pre-travel healthcare to VFR travellers.

Redefining priorities towards graded travel-related infectious disease research

Our knowledge of the health problems and infections encountered by international travellers has evolved considerably in the past decades. The growth of global networks such as the GeoSentinel Surveillance network, TropNet Europe, EuroTravNet and networks based in North America have provided valuable information on the frequency of a wide array of travel-related diseases and accidents, including details on the destination of travel and trends over time. The information gained from these network studies has provided important data for the practice of travel medicine and in some instances for the development of practice guidelines. However, network data due to a lack of denominators usually cannot serve as a basis for a GRADE approach to guideline development. Although epidemiological network studies will continue to serve an important role in travel medicine we encourage an additional strong focus towards translational scientific research questions and towards the broader use of novel techniques to obtain more accurate epidemiological analyses to address the many unanswered questions in our field.

Risk activities and pre-travel health seeking practices of notified cases of imported infectious diseases in Australia

BACKGROUND

Travellers are at risk of acquiring infectious diseases during travel, with risks differing by destination, travel and traveller characteristics. A pre-travel health consultation may minimize this risk. However, uptake of pre-travel health advice remains low. We investigated pre-travel health preparations and disease-specific risk behaviours among notified cases of selected travel-associated infectious diseases imported into Australia.

METHODS

Prospective enhanced surveillance of notified cases of typhoid, paratyphoid, measles, hepatitis A, hepatitis E, malaria and chikungunya was conducted in two Australian states between February 2013 and January 2014. Details of pre-travel health preparation and disease-specific risk behaviours were collected.

RESULTS

Among 180 cases associated with international travel, 28% were <18 years, 65% were VFR travellers and 22% were frequent travellers, having travelled ≥5 times in the past 5 years. 25% had sought pre-travel advice from a healthcare provider, and 16% reported a pre-travel vaccine. Seeking pre-travel health advice did not differ by immigrant status ( P  = 0.22) or by reason for travel ( P  = 0.13) but was more commonly sought by first time travellers ( P  = 0.03). Travellers visiting friends and relatives were more likely to report at-risk activities of brushing teeth with tap water ( P  < 0.001) and eating uncooked food ( P  = 0.03) during travel compared to other travellers.

CONCLUSIONS

Pre-travel health advice seeking practices and vaccine uptake was suboptimal among cases of notified disease. The results of this study highlight the need for a better understanding of barriers to pre-travel health seeking, particularly among high risk travellers, to reduce the importation of infectious diseases into Australia.

Primates on display: Potential disease consequences beyond bushmeat

Human interactions with nonhuman primates vary tremendously, from daily cultural engagements and food commodities, to pet ownership and tourist encounters. These interactions provide opportunities for the exchange of pathogenic organisms (both zoonoses and anthroponoses). As exposures are not limited to areas where bushmeat usage continues to be a major problem, we must work to understand better our motivations for engaging in activities like owning primates as pets and having direct physical contact with wild primates within the context of nature-based tourism. These topics, and the theoretical potential for pathogen transmission, are reviewed in the present manuscript. This is followed by a case study utilizing 3845 survey responses collected from four international locations known for primate-based tourism, with results indicating that while a majority of people understand that they can give/get diseases to/from wild primates, a surprising percentage would still touch or feed these animals if given the opportunity. Many people still choose to touch and/or own primates, as their drive to bond with animals outweighs some basic health behaviors. Desires to tame, control, or otherwise establish emotional connections with other species, combined with the central role of touch for exploring our environment, necessitate the development of better communication and educational campaigns to minimize risks of emerging infectious diseases.

Health Seeking Behaviours and Knowledge of Infectious Disease Risks in Western Australian Travellers to Southeast Asian Destinations: An Airport Survey

As the number of Australians engaging in short-term international travel increases, so does the opportunity for importing overseas-acquired infectious diseases. This study aimed to determine knowledge of infectious disease risks and pre-travel health advice (PTHA) seeking behaviour among Western Australians travelling to Bali, Indonesia or Thailand. Passengers departing from Perth International Airport were invited to participate in a self-administered survey. The survey determined PTHA seeking behaviour, knowledge of specific disease risks, and expected disease-prevention behaviours abroad. Multivariate regression modelling was used to assess demographic and travel-related factors associated with seeking PTHA. Responses from 1334 travellers were analysed. The proportion correctly identifying specific overseas disease risks ranged from 27% to 98%. High levels of planned disease-preventive behaviours were reported; however only 32% of respondents sought PTHA for their trip, most commonly from friends/family (15%) or a GP (14%). Many travellers (87%) made online travel purchases, but few (8%) used the Internet to source PTHA. WA travellers to Bali and Thailand were unlikely to seek PTHA and knowledge varied regarding infectious disease risks associated with travel. High rates of internet use when planning travel may provide an opportunity for destination-specific health promotion messaging and should be explored.

Travelers' health problems and behavior: prospective study with post-travel follow-up

Background

The annual number of international tourist arrivals has recently exceeded one billion, yet surprisingly few studies have characterized travelers’ behavior, illness, and risk factors in a prospective setting. Particularly scarce are surveys of data spanning travel, return, and follow-up of the same cohort.

This study examines behavior and illness among travelers while abroad, after return home, and at follow-up. Patterns of behavior connected to type of travel and illness are characterized so as to identify risk factors and provide background data for pre-travel advice.

Methods

Volunteers to this prospective cohort study were recruited at visits to a travel clinic prior to departure. Data on the subjects’ health and behavior were collected by questionnaires before and after journeys and over a three-week follow-up. In addition, the subjects were asked to fill in health diaries while traveling.

Results

The final study population consisted of 460 subjects, 79 % of whom reported illness during travel or on arrival: 69 % had travelers’ diarrhea (TD), 17 % skin problems, 17 % fever, 12 % vomiting, 8 % respiratory tract infection, 4 % urinary tract infection, 2 % ear infection, 4 % gastrointestinal complaints other than TD or vomiting, and 4 % other symptoms. Of all subjects, 10 % consulted a doctor and 0.7 % were hospitalized; 18 % took antimicrobials, with TD as the most common indication (64 %). Ongoing symptoms were reported by 25 % of all travelers upon return home.

During the three-week follow-up (return rate 51 %), 32 % of respondents developed new-onset symptoms, 20 % visited a doctor and 1.7 % were hospitalized.

Factors predisposing to health problems were identified by multivariable analysis: certain regions (Southern Asia, South-Eastern Asia, and Eastern Africa), female gender, young age, and long travel duration.

Conclusions

Despite proper preventive measures like vaccinations, malaria prophylaxis, and travel advice, the majority of our subjects fell ill during or after travel. As the symptoms mostly remained mild, health care services were seldom needed. Typical traveler profiles were identified, thereby providing a tool for pre-travel advice. The finding that one third reported new-onset illness during follow-up attests to the importance of advising clients on potential post-travel health problems already during pre-travel visits.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1682-0) contains supplementary material, which is available to authorized users.

Methodologies for measuring travelers' risk perception of infectious diseases: A systematic review

Numerous studies in the past have stressed the importance of travelers' psychology and perception in the implementation of preventive measures. The aim of this systematic review was to identify the methodologies used in studies reporting on travelers' risk perception of infectious diseases. A systematic search for relevant literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There were 39 studies identified. In 35 of 39 studies, the methodology used was that of a knowledge, attitude and practice (KAP) survey based on questionnaires. One study used a combination of questionnaires and a visual psychometric measuring instrument called the 'pictorial representation of illness and self-measurement" or PRISM. One study used a self-representation model (SRM) method. Two studies measured psychosocial factors. Valuable information was obtained from KAP surveys showing an overall lack of knowledge among travelers about the most frequent travel-associated infections and associated preventive measures. This methodological approach however, is mainly descriptive, addressing knowledge, attitudes, and practices separately and lacking an examination of the interrelationships between these three components. Another limitation of the KAP method is underestimating psychosocial variables that have proved influential in health related behaviors, including perceived benefits and costs of preventive measures, perceived social pressure, perceived personal control, unrealistic optimism and risk propensity. Future risk perception studies in travel medicine should consider psychosocial variables with inferential and multivariate statistical analyses. The use of implicit measurements of attitudes could also provide new insights in the field of travelers' risk perception of travel-associated infectious diseases.

Travel Pattern and Prescription Analysis at a Single Travel Clinic Specialized for Yellow Fever Vaccination in South Korea

BACKGROUND

Travel-related risks for infectious diseases vary depending on travel patterns such as purpose, destination, and duration. In this study, we describe the patterns of travel and prescription of vaccines as well as malaria prophylaxis medication (MPM) at a travel clinic in South Korea to identify the gaps to fill for the optimization of pre-travel consultation.

MATERIALS AND METHODS

A cohort of travel clinic visitors in 2011 was constructed and early one-third of the visitors of each month were reviewed. During the study period, 10,009 visited the travel clinic and a retrospective chart review was performed for 3,332 cases for analysis of travel patterns and prescriptions.

RESULTS

People receiving yellow fever vaccine (YFV) (n = 2,933) were traveling more frequently for business and tourism and less frequently for providing non-medical service or research/education compared to the 399 people who did not receive the YFV. Overall, most people were traveling to Eastern Africa, South America, and Western Africa, while South-Eastern Asia was the most common destination for the non-YFV group. Besides YFV, the typhoid vaccine was the most commonly prescribed (54.2%), while hepatitis A presented the highest coverage (74.7%) considering the natural immunity, prior and current vaccination history. Additionally, 402 (82.5%) individuals received a prescription for MPM among the 487 individuals travelling to areas with high-risk of malaria infection. Age over 55 was independently associated with receiving MPM prescription, while purpose of providing service and travel duration over 10 days were associated with no MPM prescription, despite travelling to high-risk areas.

CONCLUSION

Eastern Africa and South America were common travel destinations among the visitors to a travel clinic for YFV, and most of them were travelling for tourism and business. For the individuals who are traveling to areas with high-risk for malaria, more proactive approach might be required in case of younger age travelers, longer duration, and travel purpose of providing service to minimize the risk of malaria infection.

HAV & HBV vaccination among travellers participating in the National Health and Wellness Survey in five European countries

BACKGROUND

A main cause of hepatitis A and B infections in European countries is travel to endemic countries. Most research on hepatitis vaccination among travellers from Europe has been conducted in airports or travel clinics, samples which potentially overrepresented frequent travellers.

METHODS

2102 respondents across France, Germany, Italy, Spain, and UK completed an internet-based questionnaire. Vaccination status, travel to endemic countries, and other characteristics were compared across frequent, occasional, and non-travellers. Logistic regressions tested association between vaccination and travel adjusting for potential confounders.

RESULTS

Most respondents were occasional travellers (61%) and 24% were frequent travellers. Frequent travellers had 2.3-2.4 times the odds of being vaccinated relative to non-travellers, and odds of vaccination were 2.5-3.1 times higher among travellers to endemic areas relative to others (all p < .05). Frequent travellers were more aware of their vaccination status (HAV: 80% vs. 72%; HBV: 82% vs. 74%), though many who were vaccinated could not identify the number of injections to complete the series (47% vs. 29%) (all p < .05).

CONCLUSION

Travel frequency and destination endemicity are associated with increased hepatitis A and B vaccination. The number of unvaccinated travellers and the lack of recall for the dosing schedule suggest the need to improve travellers' awareness and adherence to recommendations.

Knowledge, attitudes, and practices regarding travel health among Muscat International Airport travelers in Oman: Identifying the gaps and addressing the challenges

Although the majority of travel-associated communicable diseases can be prevented, the public health burden of these diseases remains significant. Relatively little is known about how travelers know and perceive the health risks associated with travel and how they utilize preventive measures before and while traveling abroad. This study was conducted to determine the level of the knowledge, attitudes, and practices (KAP) of Muscat International Airport travelers about travel health in order to assess the knowledge gap and the need for travel health services in Oman. A cross-sectional study was conducted over a period of 1 week using a self-administered questionnaire. The overall level of knowledge about vaccine-preventable diseases, food safety, and preventive measures against insect bites of the participants was inadequate. The practice concerning preventive travel health measures, such as the use of specific immunizations and antimalarial prophylaxis, was very limited, and influenced by some personal and travel-related factors. The inadequate level of travelers’ knowledge and poor utilization of travel medicine services highlights the need for the provisions of specialized travel medicine services at the national level and to develop educational materials promoting the importance of pre-travel health advice.

Pre-travel advice seeking from GPs by travellers with chronic illness seen at a travel clinic

PURPOSE

Travellers are ageing and frequently report chronic illness. Pre-travel health advice is crucial, particularly in this subgroup, and general practitioners (GPs) are first in line for treatment adjustment before departure. Our aim is to evaluate pre-travel health advice seeking from GPs by travellers with chronic illness seen at a travel clinic.

METHODS

A cross-sectional observational survey using a questionnaire was conducted between August 2013 and July 2014 in travellers attending the travel medicine clinic of a tertiary university hospital in France.

RESULTS

During the study, 2019 travellers were included. Mean age was 39.4 years (±18.8). Three hundred and ninety-one (19.4%) travellers reported a history of a chronic illness. Arterial hypertension and diabetes mellitus were the most frequently reported illnesses, affecting, respectively, 168 (8.3%) travellers and 102 (5.1%). Hajj pilgrims were more likely to report a history of chronic illness than other travellers. Only 810 (40.1%) travellers sought pre-travel advice from their GP. Six hundred and fifty-two (40.1%) healthy travellers and 158 (40.5%) travellers reporting chronic illness sought pre-travel advice from their GP (P = 0.96).

CONCLUSION

Travellers with a history of chronic illness do not seek pre-travel health advice from their GP more frequently than healthy travellers. Travel health specialists are generally not the best practitioners to manage the care of underlying medical conditions presenting risks during travel. However, GPs offer continuity and disease management expertise to improve the specificity of pre-travel planning. Thus, ongoing collaboration between the traveller, GP and travel health specialist is likely to yield the best outcomes.

Provision of travel medicine advice through community pharmacies: assessment of knowledge, attitudes and practices of pharmacists in Malaysia

OBJECTIVES

The risk for travel-related illnesses has increased with significant growth in international travel, but very few travellers seek travel advice. Community pharmacists can play a vital role in the provision of travel medicine advice due to their accessibility. This study aimed to assess travel medicine knowledge, attitudes and practices (KAP) among community pharmacists in Kuala Lumpur, Malaysia.

METHODS

A self-administered KAP questionnaire was distributed to a convenience sample of pharmacists in Kuala Lumpur identified from the list of licensed community pharmacists in Malaysia year 2014.

KEY FINDINGS

Questionnaires were returned by 111 pharmacists of 143 distributed (response rate, 78%). Most of the respondents (82%) were not trained in travel medicine. Overall, mean knowledge score was 4.4 ( ± 1.7), indicating a moderate level of knowledge on a variety of travel-related health issues. Community pharmacists who graduated from foreign universities possessed significantly higher knowledge scores than did those who graduated locally (P < 0.05). The majority had a positive attitude towards travel medicine. A vast majority provided travel medicine advice mainly to adults who travel as tourists, and the primary travel advice given was on traveller's diarrhoea.

CONCLUSION

There are gaps in the knowledge and practice of travel medicine among Malaysian pharmacists. Positive attitudes of pharmacists towards travel medicine and appropriate interventions, such as incorporation of travel medicine in local pharmacy curricula, continuous pharmacy education or certified training may improve the quality of travel advice given and allow pharmacists to be recognised as a credible source of information on travel medicine.

Travellers' profile, travel patterns and vaccine practices--a 10-year prospective study in a Swiss Travel Clinic

BACKGROUND

The travel clinic in Lausanne serves a catchment area of 700 000 of inhabitants and provides pre- and post-travel consultations. This study describes the profile of attendees before departure, their travel patterns and the travel clinic practices in terms of vaccination over time.

METHODS

We included all pre-travel first consultation data recorded between November 2002 and December 2012 by a custom-made program DIAMM/G. We analysed client profiles, travel characteristics and vaccinations prescribed over time.

RESULTS

Sixty-five thousand and forty-six client-trips were recorded. Fifty-one percent clients were female. Mean age was 32 years. In total, 0.1% were aged <1 year and 0.2% ≥80 years. Forty-six percent of travellers had pre-existing medical conditions. Forty-six percent were travelling to Africa, 35% to Asia, 20% to Latin America and 1% (each) to Oceania and Europe; 19% visited more than one country. India was the most common destination (9.6% of travellers) followed by Thailand (8.6%) and Kenya (6.4%). Seventy-three percent of travellers were planning to travel for ≤ 4 weeks. The main reasons for travel were tourism (75%) and visiting friends and relatives (18%). Sixteen percent were backpackers. Pre-travel advice were sought a median of 29 days before departure. Ninety-nine percent received vaccine(s). The most frequently administered vaccines were hepatitis A (53%), tetanus-diphtheria (46%), yellow fever (39%), poliomyelitis (38%) and typhoid fever (30%).

CONCLUSIONS

The profile of travel clinic attendees was younger than the general Swiss population. A significant proportion of travellers received vaccinations that are recommended in the routine national programme. These findings highlight the important role of travel clinics to (i) take care of an age group that has little contact with general practitioners and (ii) update vaccination status. The most commonly prescribed travel-related vaccines were for hepatitis A and yellow fever. The question remains to know whether clients do attend travel clinics because of compulsory vaccinations or because of real travel health concern or both.

General Practitioners' Perception of Risk for Travelers Visiting Friends and Relatives

BACKGROUND

General practitioners (GPs) are an important source of pre-travel health advice for travelers; however, only a few studies have investigated primary healthcare provider-related barriers to the provision of pre-travel health advice, particularly to travelers visiting friends and relatives (VFR). We aimed to investigate Australian GPs' knowledge, attitudes, and practices with regard to VFR travelers.

METHODS

A postal survey was sent to randomly sampled GPs in Sydney, Australia, in 2012. The questionnaire investigated GPs' perception of risk and barriers to the provision of advice to VFR travelers.

RESULTS

Of 563 GPs, 431 (76.6%) spoke a language other than English (LOTE) with 361 (64.1%) consulting in a LOTE. Overall, 222 (39.4%) GPs considered VFR travelers to be at higher risk than holiday travelers, with GPs consulting in English only [adjusted odds ratio (aOR) 1.65, 95% confidence interval (CI) 1.11-2.44, p = 0.01] and GPs considering long-term migrants as VFR travelers (aOR 1.86 95% CI 1.07-3.23, p = 0.03) remaining significant on multivariate analysis.

CONCLUSIONS

Multilingual GPs are a valuable resource to reducing language and cultural barriers to healthcare. Targeted education of this subgroup of GPs may assist in promoting pre-travel health assessments for VFR travelers. Awareness of the need for opportunistic targeting of migrants for pre-travel consultation through routine identification of future travel is needed.

The Knowledge and Uptake of Travel Vaccine Among Medical Doctors in a Tertiary Health Institution in Plateau State, North Central Nigeria

Background:

Travelers play a significant role in the spread of infectious diseases across international borders, through their travel patterns and behaviors. Travel maybe the only risk factor for infectious diseases that are well controlled in the travelers’ country of residence, particularly vaccine-preventable diseases. The role of vaccination among travelers is an essential component of the control of travel-associated infectious diseases. This study was conducted to assess the knowledge and uptake of travel vaccine among medical doctors in Jos University Teaching Hospital (JUTH).

Materials and Methods:

This was a descriptive cross-sectional study conducted in 2013 using quantitative method of data collection among 189 medical doctors. Epi Info™ statistical software package version 3.5.4 was used for data analysis and a P ≤ 0.05 was considered statistically significant.

Result:

The mean age of the respondents was 33.8 ± 4.5 years, majority of the respondents (96.3%) were aware of travel vaccines with 45 (71.4%) of the 63 respondents who had embarked on international travel prior to the study had taken travel vaccine in their last travel. Knowledge of travel vaccination was found to have statistically significant relationship with uptake of travel vaccine (P = 0.013).

Conclusion:

This study has revealed the need to improve the knowledge and uptake of travel vaccine among medical doctors.

Chinese travellers visiting friends and relatives--A review of infectious risks

BACKGROUND

Travellers are potential vectors in the transmission of infectious diseases across international borders. Travellers visiting friends and relatives (VFR) have a particularly high risk of acquiring certain infections during travel. Chinese VFR travellers account for a substantial proportion of all travel in Western countries with high migrant populations.

METHODS

A literature review was undertaken regarding major infectious disease risks for VFR travellers visiting China. This included an examination of the previous pandemics arising in China, the likelihood of future outbreaks in China from H5N1 and H7N9 avian influenza viruses, the potential role of travellers in disease transmission, and the special risks for VFR travellers.

RESULTS

China has been the origin of several influenza pandemics in past few decades, and the origin of several emerging infectious diseases with pandemic potential, including SARS. Travel to and from China has the potential for global spread of emergent infectious diseases, as seen in the SARS outbreak in 2003. For VFR travellers, the risk of other infectious diseases may also be greater in China compared to their countries of migration, including hepatitis A and B, dengue fever, typhoid, and other diseases.

CONCLUSIONS

VFR travel to China may be associated with increased risk of acquiring a range of infectious diseases, and also poses a potential risk for importation of future pandemics to other countries. Chinese VFR travellers need to be cognisant of these risks and health professionals should consider educational interventions to minimise these risks.

Are French general practitioners consulted before travel to developing countries? A cross-sectional study conducted in a French airport

BACKGROUND

General practitioners (GPs) could play a central role in preventing travel-related health issues. The aim of this study was to assess, in travellers departing to developing countries from a French airport, the proportion of individuals having sought GP counseling before departure and to identify determinants for having consulted a GP.

METHODS

Cross-sectional study conducted between November 2012 and July 2013, in all adults living in France. Sociodemographic, health characteristics, type of travel and resources consulted before departure were collected. A descriptive analysis was performed. Determinants for having consulted a GP before departure were investigated using a logistic regression analysis.

RESULTS

Of the 360 travellers included, 230 (64%) sought health counseling before departure. GPs were the main source of information for 134 (58%) travellers having sought health information and the only one for 49 (21%). Almost half of the travellers (48%) departing to sub-Saharan countries did not seek health counseling from a medical doctor (GP, non-GP specialist, specialist consulted in an international vaccination center or occupational physician). Individuals significantly more likely to travel without having consulted a GP were young and male, held foreign nationality, had travelled more than five times before, rarely consulted their GP and were travelling to a non-malarious area.

CONCLUSION

GPs were the main but not the only source of information and counseling before traveling to a developing country. This study helps identify the characteristics of individuals likely to travel without having consulted a GP before departure.

Impact of advice given to travelers concerning the main infectious risks associated with traveling in the tropics

INTRODUCTION

The prevention of sanitary risks related to traveling in the tropics implies delivering a large amount of information to travelers. The objective of our study was to assess the knowledge acquired by travelers during a pre-travel consultation.

METHODS

A before and after study was conducted among 202 travelers having consulted at the Tours international vaccine center. We used self-administrated questionnaires (score out of 100 marks) concerning diet, hygiene, anti-vectorial prevention (AVP), and sexual-transmitted infections (STI). The scores obtained before and after consultation were compared globally and for each topic.

RESULTS

The travelers' global knowledge had improved after consultation (66.1 vs. 75.5%; P < 0.0001) as well as for each topic. The most important improvement concerned hygiene (+12.5%; P < 0.0001) and the lowest concerned STI (+5.8%; P < 0.0001). The multivariate analysis revealed that not having searched for information before consulting was the main factor associated with global knowledge improvement (P < 0.0001) (unplanned professional traveling compared to humanitarian mission prepared ahead of departure time). The recommendations for diet were less well acquired in travelers > 50 years of age than in those < 30 years of age (P < 0.002).

CONCLUSION

A specialized pre-travel consultation improves the travelers' knowledge for the main prevention measures but does not allow them to acquire all required knowledge. Taking into account the travelers' initial knowledge and their ability to learn could improve the impact of the pre-travel consultation.

Australian Hajj pilgrims' infection control beliefs and practices: Insight with implications for public health approaches

BACKGROUND

Hajj is one of the largest annual mass gatherings around the world. Although the Saudi Arabian health authority recommends vaccination and other infection control measures, studies identified variable uptake of these measures among pilgrims, and the reasons behind this variability remain unclear. This qualitative study aimed to addresses this knowledge gap.

METHODS

In-depth interviews were conducted with pilgrims over 18 years of age.

RESULTS

A total of 10 participants took part in the study. There was low perception of the potential severity of respiratory conditions and the need for influenza vaccination during Hajj. Different attitudes were found by age group with elderly participants believing that they were under Allah's protection, and were fatalistic about the risk of illness. While younger participants described the impact infections would have on their worship. Facemask use was infrequent with discomfort; difficulty in breathing and a feeling of isolation were commonly cited barriers to use of facemasks. Participants accepted and trusted preventative health advice from travel agents and friends who had previously undertaken the Hajj more so than primary care practitioners.

CONCLUSIONS

This study extended our understanding of how health beliefs influence uptake of preventive measures during the Hajj, and the gaps in the provision of Hajj-specific health information to pilgrims.