The attack rates of hepatitis A among Dutch travelers to developing regions have declined between 1995 and 2006. This decline correlated with improved hygienic standards at the travel destination.10 Improvements in travelers’ risk perception, risk behavior, and protection may also have contributed, but were not assessed in that study. Our results show that the attitude toward risk-seeking behavior and protection rates have also improved over time, which might have added to the observed decline in hepatitis A attack rates among Dutch travelers. Previous studies also suggested that initiatives to improve travel learn more health

education should target all groups of travelers, including business

travelers, those VFR, and the older adults.7,8 Our questionnaire-based survey specifically focused on the impact of the composite KAP profile of five pre-defined risk groups, eg, the group Selleckchem IBET762 of older adult travelers, the group of solo travelers, the group of business travelers, last-minute travelers, and those VFR, on their relative risk for hepatitis A. When focusing on older adult travelers, our data suggested that—although they traveled more frequently to high-risk destinations—the KAP of older adult travelers had no significant impact on their relative risk for hepatitis A. In fact, the risk profile may even be lower than anticipated Reverse transcriptase as older adult travelers had more intended risk-avoiding

behavior than their younger counterparts to the same risk destination. Although an age above 60 years was recognized as an important determinant for improving risk perception, the knowledge and protection rate of older adult travelers did not differ significantly from younger-aged travelers nor were there significant changes in knowledge and practice of older adult travelers over the years. Recent hepatitis A seroprevalence data from the Netherlands indicated that people born after the Second World War showed lower seroprevalence rates compared to people born before or during this war.11 This decrease is probably causally related to increased hygienic standards hereafter but also indicates an increasing age of the susceptible population. In contrast, the KAP of solo travelers, in particular to high-risk destinations, increased their relative risk of hepatitis A. The risk perception of solo travelers was lower than non-solo travelers, they had more intended risk behavior and their protection rates were lower. However, the increased relative risk of solo travelers may have been reduced, considering solo travelers more frequently visited destinations with a low-to-intermediate risk for hepatitis A.