Determinants of Compliance of Travelers with Vaccination and Malaria Prophylaxis at a Travel Clinic

BACKGROUND: Pre-travel medical consultation is essential to reduce health impairment during travel. Yellow fever vaccination (YFV) is mandatory to enter some endemic countries. In this study, we evaluated the factors that affect compliance with appropriate prevention of infectious diseases in travelers who visited clinic for YFV. METHODS: For this retrospective study, chart reviews for 658 patients who visited a travel clinic for YFV before travel were conducted. The period of this study was from January 2016 to September 2018. The associations between appropriate vaccination and factors such as travel duration, destination, time of visiting clinic before departure, and purpose of travel were analyzed. RESULTS: Among 658 patients who got YFV during the study period, 344 patients (52.3%) received additional vaccination or malaria prophylaxis following a physician's recommendation. Travelers who visited the clinic more than 21 days before departure were more compliant than those who visited 14 days or fewer before departure (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.23–2.93; P = 0.004). Travelers visiting Africa were more compliant than were those traveling to South and Central America (OR, 1.97; 95% CI, 1.34–2.90; P = 0.001). Travelers in age groups of 40-49 years and over 70 years were less compliant than the 18–29 years old population (OR, 0.51; 95% CI, 0.28–0.93; P = 0.027 and OR, 0.19; 95% CI, 0.04–0.84; P = 0.03, respectively). Also, those who traveled for tour or to visit friends or relatives were more compliant than those who departed for business (OR, 0.77; 95% CI, 1.03–3.56; P = 0.04). CONCLUSION: For appropriate vaccination, pre-travel consultation at least 3 weeks before departure is crucial. Travelers should be aware of required vaccination and malaria prophylaxis before visiting South and Central America and Asia. Plans to enhance compliance of the elderly and business travelers should be contrived.