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

Abstract

BackgroundWhile 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.MethodsWe 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.ResultsThe 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.ConclusionsThere 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.

Addressing vaccine-preventable encephalitis in vulnerable populations

“…Involving local stakeholders in the campaign and engaging them to carry the message to populations prove to be powerful strategies to improve vaccine coverage in at-risk groups, such as the homeless [85,118 ▪ ]. To increase awareness of travel-related encephalitis and encourage travelers to make informed decisions, more travel clinics should be set up, manned by healthcare providers who are kept up-to-date on VPDs and vaccine recommendations [114]. Joint efforts to fight misinformation and disinformation are important to address vaccine hesitancy.…”

“…Prevaccination data showing substantial hospitalizations and complications from varicella infection contests the prevailing perception in some European countries that varicella is a low public health priority [113]. Underestimation by the traveler and even healthcare providers of disease risk and severity is also a barrier to vaccination [114]. In another survey, only 11% of travelers at high risk for Japanese encephalitis received at least one dose of the Japanese encephalitis vaccine [115].…”

Vaccination against Tick-Borne Encephalitis (TBE) in Italy: Still a Long Way to Go

“…Although the recommendation to undergo vaccination is particularly strong for people traveling to endemic areas, awareness of the risk of contracting TBE when traveling to such regions is much lower than the perceived risk of contracting hepatitis A or B (about 30 vs. 70%) [83,84]. These findings suggest that the perceived low risk of exposure to TBE among travelers to endemic regions causes these subjects to underestimate the need for pre-travel vaccinations.…”

“…These findings suggest that the perceived low risk of exposure to TBE among travelers to endemic regions causes these subjects to underestimate the need for pre-travel vaccinations. There is therefore a need to increase travelers' awareness of the risk of TBE and its prevention, and travel clinics could play an important role in this process [83,84]. In the context of travel medicine, it is important to emphasize that the rapid immunization schedules, with an interval of 2 weeks between the first two doses, have been seen to elicit high antibody titers 14 days after administration of the second dose (89.3%), and 7 days after administration of the third dose (91.7%) [43].…”

Multinational survey shows low awareness of tick-borne encephalitis and rabies among travellers to endemic regions

“…In this supplement of the Journal of Travel Medicine , we describe travellers’ attitudes to rabies 1 and tick-borne encephalitis (TBE) 2 based on online panel surveys of adults who had travelled to a rabies or TBE endemic country or region in the past 3 years (visit-risk sample: 4678 for rabies and 4375 for TBE). For each disease, a sub-sample of travellers undertaking pre-defined activities that increased the risk of exposure to rabies (850) or TBE (375) received a more detailed questionnaire (activity-risk sub-samples).…”