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Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet.
J Travel Med. 2016 Jul; 24(1)JT

Abstract

BACKGROUND

International travellers are at risk of travel-related, vaccine-preventable diseases. More data are needed on the proportion of travellers who refuse vaccines during a pre-travel health consultation and their reasons for refusing vaccines.

METHODS

We analyzed data on travellers seen for a pre-travel health consultation from July 2012 through June 2014 in the Global TravEpiNet (GTEN) consortium. Providers were required to indicate one of three reasons for a traveller refusing a recommended vaccine: (1) cost concerns, (2) safety concerns or (3) not concerned with the illness. We calculated refusal rates among travellers eligible for each vaccine based on CDC recommendations current at the time of travel. We used multivariable logistic regression models to examine the effect of individual variables on the likelihood of accepting all recommended vaccines.

RESULTS

Of 24 478 travellers, 23 768 (97%) were eligible for at least one vaccine. Travellers were most frequently eligible for typhoid (N = 20 092), hepatitis A (N = 12 990) and influenza vaccines (N = 10 539). Of 23 768 eligible travellers, 6573 (25%) refused one or more recommended vaccine(s). Of those eligible, more than one-third refused the following vaccines: meningococcal: 2232 (44%) of 5029; rabies: 1155 (44%) of 2650; Japanese encephalitis: 761 (41%) of 1846; and influenza: 3527 (33%) of 10 539. The most common reason for declining vaccines was that the traveller was not concerned about the illness. In multivariable analysis, travellers visiting friends and relatives (VFR) in low or medium human development countries were less likely to accept all recommended vaccines, compared with non-VFR travellers (OR = 0.74 (0.59-0.95)).

CONCLUSIONS

Travellers who sought pre-travel health care refused recommended vaccines at varying rates. A lack of concern about the associated illness was the most commonly cited reason for all refused vaccines. Our data suggest more effective education about disease risk is needed for international travellers, even those who seek pre-travel advice.

Authors+Show Affiliations

Travelers' Advice and Immunization Center, Massachusetts General Hospital, Boston, MA, USA.Department of Surgery, Boston University Medical Center, Boston, MA, USA.Division of Global Migration and Quarantine, Travelers' Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA.Division of Global Migration and Quarantine, Travelers' Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.Division of Global Migration and Quarantine, Travelers' Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.Division of Pediatric Infectious Diseases, Bronx-Lebanon Hospital Center, Bronx, NY.Division of Global Migration and Quarantine, Travelers' Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.Travelers' Advice and Immunization Center, Massachusetts General Hospital, Boston, MA, USA. Harvard Medical School, Boston, MA.Travelers' Advice and Immunization Center, Massachusetts General Hospital, Boston, MA, USA rclarocque@partners.org. Harvard Medical School, Boston, MA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27799502

Citation

Lammert, Sara M., et al. "Refusal of Recommended Travel-related Vaccines Among U.S. International Travellers in Global TravEpiNet." Journal of Travel Medicine, vol. 24, no. 1, 2016.
Lammert SM, Rao SR, Jentes ES, et al. Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet. J Travel Med. 2016;24(1).
Lammert, S. M., Rao, S. R., Jentes, E. S., Fairley, J. K., Erskine, S., Walker, A. T., Hagmann, S. H., Sotir, M. J., Ryan, E. T., & LaRocque, R. C. (2016). Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet. Journal of Travel Medicine, 24(1).
Lammert SM, et al. Refusal of Recommended Travel-related Vaccines Among U.S. International Travellers in Global TravEpiNet. J Travel Med. 2016;24(1) PubMed PMID: 27799502.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet. AU - Lammert,Sara M, AU - Rao,Sowmya R, AU - Jentes,Emily S, AU - Fairley,Jessica K, AU - Erskine,Stefanie, AU - Walker,Allison T, AU - Hagmann,Stefan H, AU - Sotir,Mark J, AU - Ryan,Edward T, AU - LaRocque,Regina C, Y1 - 2016/10/30/ PY - 2016/10/04/accepted PY - 2016/11/2/pubmed PY - 2017/6/8/medline PY - 2016/11/2/entrez KW - International travel KW - vaccine refusal JF - Journal of travel medicine JO - J Travel Med VL - 24 IS - 1 N2 - BACKGROUND: International travellers are at risk of travel-related, vaccine-preventable diseases. More data are needed on the proportion of travellers who refuse vaccines during a pre-travel health consultation and their reasons for refusing vaccines. METHODS: We analyzed data on travellers seen for a pre-travel health consultation from July 2012 through June 2014 in the Global TravEpiNet (GTEN) consortium. Providers were required to indicate one of three reasons for a traveller refusing a recommended vaccine: (1) cost concerns, (2) safety concerns or (3) not concerned with the illness. We calculated refusal rates among travellers eligible for each vaccine based on CDC recommendations current at the time of travel. We used multivariable logistic regression models to examine the effect of individual variables on the likelihood of accepting all recommended vaccines. RESULTS: Of 24 478 travellers, 23 768 (97%) were eligible for at least one vaccine. Travellers were most frequently eligible for typhoid (N = 20 092), hepatitis A (N = 12 990) and influenza vaccines (N = 10 539). Of 23 768 eligible travellers, 6573 (25%) refused one or more recommended vaccine(s). Of those eligible, more than one-third refused the following vaccines: meningococcal: 2232 (44%) of 5029; rabies: 1155 (44%) of 2650; Japanese encephalitis: 761 (41%) of 1846; and influenza: 3527 (33%) of 10 539. The most common reason for declining vaccines was that the traveller was not concerned about the illness. In multivariable analysis, travellers visiting friends and relatives (VFR) in low or medium human development countries were less likely to accept all recommended vaccines, compared with non-VFR travellers (OR = 0.74 (0.59-0.95)). CONCLUSIONS: Travellers who sought pre-travel health care refused recommended vaccines at varying rates. A lack of concern about the associated illness was the most commonly cited reason for all refused vaccines. Our data suggest more effective education about disease risk is needed for international travellers, even those who seek pre-travel advice. SN - 1708-8305 UR - https://www.unboundmedicine.com/medline/citation/27799502/Refusal_of_recommended_travel_related_vaccines_among_U_S__international_travellers_in_Global_TravEpiNet_ L2 - https://academic.oup.com/jtm/article-lookup/doi/10.1093/jtm/taw075 DB - PRIME DP - Unbound Medicine ER -