Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet

• Type of Material: Article
• Authors: Sara M. Lammert, Massachusetts General Hospital; Sowmya R. Rao, Boston University Medical Center; Emily S. Jentes, Centers for Disease Control and Prevention; Jessica Fairley, Emory University; Stefanie Erskine, Centers for Disease Control and Prevention; Allison T. Walker, Centers for Disease Control and Prevention; Stefan H. Hagmann, Bronx-Lebanon Hospital Center; Mark J. Sotir, Centers for Disease Control and Prevention; Edward T. Ryan, Harvard Medical School; Regina C. LaRocque, Harvard Medical School
• Language: English
• Date: 2016-10-30
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option B - CC-BY
• Publication Version: Final Published Version
• Copyright Statement: © International Society of Travel Medicine, 2016. Published by Oxford University Press.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/jtm/taw075
• Title of Journal or Parent Work: Journal of Travel Medicine
• ISSN: 1195-1982
• Volume: 24
• Issue: 1
• Start Page: 075
• End Page: 075
• Grant/Funding Information: This work was supported by US Centers for Disease Control and Prevention Grants [U19CI000514, U01CK000175].
• Keywords: International travel; vaccine refusal
• Research Categories: Health Sciences, Immunology; Health Sciences, Public Health

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.