1%) than it did for European (24.0%)1 or US travelers (19%),4 and this may have been due to lack of availability of professional travel health services. Although there have been no studies of the quality of health advice provided by Japanese websites, Horvath et al.8 found that the information provided on commercial travel websites was generally unsatisfactory. Travelers

Doxorubicin in vitro who do not fully understand the health risks they face at their destination are unlikely to comply with any interventions that a health professional may recommend. The high number of travelers in this study (over 50%) who were unaware of, or perceived there to be no health threat of three major travel-associated vaccine-preventable diseases (hepatitis A, hepatitis B, and typhoid fever) is cause for concern. It is interesting that a third of respondents considered there to be a high risk of rabies infection. They may have been influenced by reports of two recent cases of rabies infection in Japanese travelers to the Philippines.9,10

While there is almost a 100% case fatality rate for rabies infection, travelers should be aware that hepatitis A, hepatitis B, and typhoid fever are much more common travel-related diseases,11 and therefore a more balanced view of the need to take precautions to prevent these infections is needed. This study showed serious shortcomings in the perceptions travelers held about being immunized. Only half check details (50.7%) of the respondents considered that vaccinations would be highly protective, compared with 83.4% of European travelers1 and

74% of US travelers,4 and only 13.6% considered them to be safe, compared with 34.7% of European travelers1 and 46% of US travelers.4 One in five Japanese travelers (19.2%) thought that vaccinations were unnecessary, whereas only 4.4% of European travelers thought this to be so.1 find more In fact, few Japanese travelers were vaccinated against three major vaccine-preventable diseases, hepatitis A (5.6%), hepatitis B (4.3%), and typhoid fever (0.3%). The European,1 South African,3 and US4 studies showed that 41.6, 66, and 24%, respectively, had immunity to hepatitis A, and 31.4, 56, and 29% were hepatitis B-immune. In addition, a German study of travelers to tropical and subtropical areas revealed that 59% had received hepatitis A vaccine.12 Very few Japanese travelers nowadays would have natural immunity to hepatitis A. Recently, Mizuno et al.13 showed that 91% of those under 60 years of age who attended for pre-travel advice and who had not been vaccinated against hepatitis A were seronegative. As regards typhoid fever, only 0.3% of our study participants were considered to have immunity, whereas 44.0% of Western travelers in the Asian/Australian study,2 44% in the South African study,3 and 31.7% in the Spanish study14 were considered to be immune. The reportedly low rates of prior vaccination against tetanus, polio, tuberculosis, and diphtheria are also a concern.