The risk of acquiring hepatitis a and b among travelers in selected eastern and southern europe and non-european mediterranean countries : Review and consensus statement on hepatitis a and b vaccination

Large numbers of Europeans travel frequently to destinations both near and far, and there is a growing trend toward shorter but more frequent trips.1 Traditional destinations for European (EU) travelers, such as France, Italy, and Spain, have shown only limited tourism growth in recent years, with these countries experiencing growth of 2.4, 0.6, and 3.3%, respectively, in 2000 to 2001. Many more Europeans now visit non‐EU Mediterranean destinations, for example, Morocco, Egypt, and Turkey (which experienced growth of 17, 49, and 29%, respectively, in 2004), and newly emerging travel destinations in Eastern and Southern Europe, for example, Croatia (which experienced growth of 6% in 2004).2 Importantly, travel to such destinations is not generally perceived as a potential health risk3 in the same way as travel to more “exotic” destinations (eg, Thailand, Mexico). Many Europeans traveling to Turkey or to North Africa, for example, do not consider themselves to be at major risk of infection with the hepatitis A virus (HAV) or hepatitis B virus (HBV).4,5 There is a need to ensure that international vaccination recommendations reflect these changing travel trends and address uncertainties about the risk of HAV and HBV, particularly in newer travel destinations. Furthermore, the development and adoption of standardized HAV vaccination statements is an important public health issue. In January 2005, a panel of EU travel medicine, public health, and epidemiology experts met in Vienna, Austria. The aim of the meeting was to provide a responsible assessment of currently available data regarding HAV and HBV epidemiology and vaccination recommendations for nonimmune travelers visiting specific Eastern and Southern Europe and non‐EU Mediterranean (ESENEM) destinations. Countries considered by the panel were Albania, Baltic States (Estonia, Latvia, Lithuania), Bosnia Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Egypt, Former Yugoslav Republic of Macedonia (FYROM), Greece, Hungary, Israel, Italy, …