Vaccinations of International Travellers From Greece to Sub-Saharan Africa

Document Type : Original Article


1 Travel Medicine Office, Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece

2 Regional Department of Public Health of Attica, Athens, Greece


Introduction: The number of travellers from Greece who travel to sub-Saharan Africa has increased during the last decade. Our aim in this research was to study vaccination patterns for travellers travelling to sub-Saharan Africa.
Methods: A cross-sectional study was conducted from January 2011 until December 2014 in all (57) public health departments in Greece. Travellers over 18 years travelling to sub-Saharan Africa participated in this study. A standard form was used in order to collect data about travellers’ demographics, immunization history and travel information.
Results: During the study period, 1768 travellers (median age: 39.2 years) travelling to sub-Saharan Africa participated. Among them, 69.2% of them were male and 95.4% of them had a Greek nationality. Nigeria was their most common destination (15.7%). Among all the travellers, 56.7% stayed in urban areas, 57.9% travelled for less than one month, 58.5% for work, 29% for vacation, and 5.8% for visiting friends and relatives. Furthermore, 79.7%, 30.9%, 19.7%, 16.8%, and 14.1% received the yellow fever, typhoid fever, tetanus-diphtheria, hepatitis A, and meningococcal vaccines, respectively. The purpose of travelling was statistically significantly associated with gender, nationality, and the duration of travel. Tetanus, hepatitis A & B, poliomyelitis, rabies and meningococcal vaccines were more commonly recommended for recreational travel, whereas tetanus, hepatitis A, and poliomyelitis vaccines for short-term travellers and typhoid vaccine for long-term travellers.
Conclusion: It can be concluded that vaccination rrecommendations should be improved for the travellers to sub-Saharan Africa. Individualized and more selective pre-travel recommendations are needed taking in consideration the purpose and duration of travel, the area and place of stay.


  1. World Tourism Organization. Annual report 2014. Accessed November 26, 2016.
  2. Khan K, Arino J, HuW, et al. Spread of a novel influenza A (H1N1) virus via global airline transportation. N Engl J Med. 2009;361:212-214. doi:10.1056/NEJMc0904559.
  3. Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med. 2006;354()2):119–30. doi:10.1056/NEJMoa051331.
  4. Leder K, Torresi J, Libman MD, et al. GeoSentinel Surveillance Network. GeoSentinel surveillance of illness in returned travelers, 2007-2011. Ann Intern Med. 2013;158(6):456-468. doi:10.7326/0003-4819-158-6-201303190-00005.
  5. Boggild AK, Castelli F, Gautret P, et al. Vaccine-preventable diseases in returned international travelers: results from the GeoSentinel Surveillance Network. Vaccine 2010;28(46):7389-7395. doi:10.1016/j.vaccine.2010.09.009.
  6. Maltezou HC, Patrinos S, Veneti L, et al. Hepatitis A and enteric fever in Greece, 2004-2011: a cross-sectional analysis. Travel Med Infect Dis. 2014;12(2):143-148. doi:10.1016/j.tmaid.2013.10.004.
  7. Wilson ME, Weld LH, Boggild A, et al. Fever in returned travelers: results from the GeoSentinel Surveillance Network. Clin Infect Dis. 2007;44:1560-1568. doi:10.1086/518173.
  8. Hatz C, Chen LH. Pre-travel consultation. In: Keystone JS, Freedman DO, Kozarsky PE, Connor BA, Nothdurft HD, eds. Travel Medicine. 3rd ed. Spain: Mosby; 2013:77-101.
  9. Hellenic Centre for Disease Control and Prevention (KEELPNO). Accessed February 16, 2017.
  10. World Health Organization. International Travel and Health 2012. Accessed November 26, 2016.
  11. Centers for Disease Control and Prevention. Accessed February 16, 2017.
  12. National Vaccination Program for Children and Adolescents (in Greek). Accessed November 26, 2016. Published 2011.
  13. Smeti P, Pavli A, Katerelos P, Maltezou HC. Typhoid vaccination for international travelers from Greece visiting developing countries. J Travel Med. 2014;21:99-103. doi:10.1111/jtm.12076.
  14. Pavli A, Katerelos P, Smeti P, Maltezou HC. Meningococcal vaccination for international travelers from Greece visiting developing countries. Travel Med Infect Dis. 2016;14:261-266 .
  15. Hellenic Statistical Authority. Accessed 12 March, 2016.
  16. Hamer DH, Connor BA. Travel health knowledge, attitudes and practices among United States travelers. J Travel Med 2004;11:23-26.
  17. Van Herck K, Van Damme P, Castelli F, et al. Knowledge, attitudes and practices in travel-related infectious diseases: the European airport survey. J Travel Med. 2004;11:3-8.
  18. Wilder-Smith A, Khairullah NS, Song JH, et al. Travel health knowledge, attitudes and practices among Australasian travelers. J Travel Med. 2004;11:9-15.
  19. Pavli A, Spilioti A, Smeti P, et al. Vaccination and malaria prevention among international travelers departing from Athens International Airport to African destinations. J Trop Med. 2014;2014:563030. doi:10.1155/2014/563030.
  20. World Health Organization. Disease Outbreak News. Accessed February 16, 2017.
  21. Gunaratnam P, Tobin S, Seale H, McAnulty JM. Infectious diseases in returned travelers, NSW, 2010-2011. N S W Public Health Bull. 2014;24:171-175.
  22. Hellenic Centre for Disease Control and Prevention (KEELPNO). Accessed March 12, 2016.
  23. Monge-Maillo B, Norman FF, Pérez-Molina JA, et al. Travelers visiting friends and relatives (VFRs) and imported infectious disease: travelers, immigrants or both? a comparative analysis. Travel Med Infect Dis. 2014;12(1):88-94. doi:10.1016/j.tmaid.2013.07.004.
  24. Steinberg EB, Bishop R, Haber P, et al. Typhoid fever in travelers: who should be targeted for prevention? Clin Infect Dis. 2004;39:186-191.
  25. Centers for Disease Control and Prevention. Accessed March 12, 2015.
  26. Larocque RC, Rao SR, Lee J, et al. Global TravEpiNet: a national consortium of clinics providing care to international travelers - analysis of demographic characteristics, travel destinations, and pre-travel healthcare of high-risk US international travelers, 2009-2011. Clin Infect Dis. 2012;54(4):455-462. doi:10.1093/cid/cir839.
  27. Steffen R. Changing travel-related global epidemiology of hepatitis A. Am J Med. 2005;118(suppl 10A):S46-S49.
  28. Mutsch M, Spicher VM, Gut C, Steffen R. Hepatitis A virus infections in travelers, 1988–2004. Clin Infect Dis. 2006;42:490–497.
  29. Leggat PA, Zwar NA, Hudson BJ. Travel Health Advisory Group, Australia. Hepatitis B risks and immunisation coverage amongst Australians traveling to Southeast Asia and East Asia. Travel Med Infect Dis. 2009;7(6):344-349. doi:10.1016/j.tmaid.2009.03.008.
  30. Zuckerman JN, Hoet B. Hepatitis B immunisation in travelers: poor risk perception and inadequate protection. Travel Med Infect Dis. 2008;6(5):315-320. doi:10.1016/j.tmaid.2008.05.001.
  31. World Health Organization. International Travel and Health, Accessed Accessed March 12, 2016.
  32. Goodman AL, Masuet-Aumatell C, Halbert J, Zuckerman JN. Awareness of meningococcal disease among travelers from the United Kingdom to the meningitis belt in Africa. Am J Trop Med Hyg. 2014;91(2):281-286. doi:10.4269/ajtmh.13-0763.
  33. Pavli A, Saroglou G, Hadjianastasiou S, et al. Knowledge and practices about rabies among travel medicine consultants in Greece. Travel Med Infect Dis. 2011;9(1):32-36. doi:10.1016/j.tmaid.2010.11.004.
  34. Altmann M, Parola P, Delmont J, et al. Knowledge, attitudes, and practices of French travelers from Marseille regarding rabies risk and prevention. J Travel Med. 2009;16(2):107-111. doi:10.1111/j.1708-8305.2008.00283.x.
  35. Gautret P, Parola P. Rabies vaccination for international travelers. Vaccine. 2012;30:126-133. doi:10.1016/j.vaccine.2011.11.007.