[5] Despite this recommendation, screening for HBV in the foreign-born remains inconsistent, and many individuals from HBV-risk this website countries have not been screened and are unaware of their status.[6-9] Asians and Pacific Islanders comprise the largest groups of Americans with chronic HBV infection, with a disproportionately high incidence of HCC.[10, 11] The US National Health and Nutrition Examination Survey (1999–2008) found the highest prevalence

of chronic HBV (1.97%) in the group called “other race or ethnic groups,” most of whom are Asians.[12] Recent studies confirm that a 2% threshold for prevalence of chronic HBV infection, screening, and vaccinating is cost-effective.[3, 13] Many health care providers, however, lack knowledge about identification, screening, and vaccination in these high-risk populations.[14-17] Torin 1 mw In the United States, universal HBV immunization for infants at birth was instituted in 1991. Immunization of risk groups has been advocated for many years, including adults who travel to countries with HBsAg prevalence ≥2%.[4, 18] Although the World Health Organization (WHO) recommended universal HBV vaccination for infants in 1992, many foreign-born individuals living in the United States have not been vaccinated.

We hypothesize that the travel clinic is an underutilized setting for testing and immunization for HBV. Using data collected during a study of the demographics, medical history, and trip characteristics of travelers seen for pre-travel consultation in the Boston area, we describe for travelers born in countries with HBsAg prevalence ≥2% and for those born in

the United States, the proportion tested for HBV, their test results, and characteristics associated with testing, infection, and receiving vaccine. The Boston Area Travel Medicine Network (BATMN) consists of five travel clinics in metropolitan Boston that see approximately 7,500 travelers annually and collaborate on travelers’ health research. De-identified demographic data, trip information, HBV serology results, and vaccination Etofibrate status were collected for all travelers at the pre-travel consultations during the study period (June 12, 2008, for four sites and October 21, 2008, for one site through July 31, 2010). Data were entered into a secure database (CS-Pro, US Census Bureau, Washington, DC). IRB approvals were obtained at all sites and the CDC, including waivers of informed consent. Some sites offered optional data fields for clinicians to indicate why a person with unknown HBV status declined testing in a travel clinic including: (1) unclear if insurance covered test, (2) unaware of HBV or risk factors, (3) previously tested but results unknown, (4) patient declined phlebotomy, or (5) get the test from a primary doctor.