Education levels and household income were not associated with likelihood of vaccination. Among the 1,276 lower JE risk travelers, 60 (5%) did not indicate vaccination status. Of the remaining 1,216 travelers, 17 (1.8%, 95% CI: 0.6–3.0%) indicated PS341 that they received the JE vaccine for this trip. Lower risk travelers who received JE vaccine were more likely to have sought advice from a travel medicine clinic (9/17, 53%) than lower risk travelers who did not receive JE vaccine (115/1,199, 10%) (PR 5.6, 95% CI: 2.4–13.2). Education levels and household income were not associated with vaccination. We found

that a quarter of US resident travelers to Asia had an itinerary for which JE vaccine should have been considered but only 11% of these travelers reported having received the vaccine. Of the travelers with higher JE risk itineraries, >80% planned to spend ≥1 month in a JE-endemic country and more than a third reported they would spend ≥6 months in Asia; the remaining higher JE risk travelers

planned to spend at least half of their time in rural areas. These data suggest that US travelers who plan to have prolonged stays or extensive rural exposure in Asia may not be recommended or considered for JE vaccination according to ACIP recommendations. selleckchem However, <2% of travelers with lower risk itineraries received JE vaccine, suggesting that it is not being inappropriately used in shorter term travelers to urban areas with little risk of disease. This survey was performed in 2007, prior to the licensure of the new inactivated Vero cell culture-derived JE vaccine in 2009.[12] Given concerns about rare but serious adverse events associated with the previously available mouse

brain-derived JE vaccine,[1, 2, 13] it will be important to see if JE vaccination increases among higher risk, and possibly lower risk, travelers. However, the new vaccine still requires a two-dose primary series administered 28 days apart and costs more than $160 per dose.[1, 14] Furthermore, the vast majority of travelers in this survey reported that they did not receive JE vaccine because they were not aware of it, were advised not to receive it, or had otherwise determined that they many did not need it for their trip. Vaccine cost, inadequate time prior to travel, and concerns about adverse events were uncommon reasons reported for not being vaccinated. These data suggest that travelers and health care providers still need to be educated about the risks of travel-associated JE and itineraries for which JE vaccine might be indicated. For most travelers to Asia, the risk for JE is very low but varies based on destination, duration, season, and activities.[1, 4] During the 39 years from 1973 to 2011, only 62 cases of travel-associated JE among persons from nonendemic countries were reported in the literature, including 16 (26%) travelers from the United States.