Hepatitis B: A cross-sectional survey of knowledge, attitudes and practices amongst backpackers in Thailand

Background: In 2013, 200 million tourists visited countries that are endemic for hepatitis B virus (HBV). Backpackers are potentially at greater risk of hepatitis B than other travellers yet exposure to HBV remains under researched in this population. Method: A cross-sectional survey of backpackers visiting two islands in Thailand was performed during early 2015. Participation in activities with high HBV exposure risk was recorded, alongside rates of vaccination and an evaluation of knowledge and attitudes towards the risk of HBV. Results: 1680 questionnaires were completed and analysed; the median participant age was 24 (range: 18-68) and 47.9% were male. 20.8% took part in activities with a high risk of HBV exposure. Over two-thirds of the sample were not protected against HBV. 24% were able to correctly identify HBV transmission methods. 44.1% underestimated the risk of HBV in Thailand. Conclusions: The proportion of backpackers participating in high-risk activities was double the level found in previous studies that have examined the HBV exposure risk amongst travellers to endemic countries. Voluntary risk activities were the largest source of potential exposure to HBV and rates of vaccination are low. Backpackers should be considered for routine vaccination and education on risk behaviours should be included in the pre-travel consultation. (C) 2016 Elsevier Ltd. All rights reserved.